Radiotherapy and Oncology最新文献

{"title":"Probabilistic evaluation guided IMPT planning with realistic setup and range uncertainties improves the trade-off between OAR sparing and target coverage in neuro-oncological patients","authors":"Jenneke I. de Jong ,&nbsp;Steven J.M. Habraken ,&nbsp;Jesús Rojo-Santiago ,&nbsp;Danny Lathouwers ,&nbsp;Zoltán Perkó ,&nbsp;Sebastiaan Breedveld ,&nbsp;Mischa S. Hoogeman","doi":"10.1016/j.radonc.2025.111171","DOIUrl":"10.1016/j.radonc.2025.111171","url":null,"abstract":"<div><h3>Objective</h3><div>Scenario-based evaluation in proton therapy often relies on a small number of error scenarios, leading to limited insight into the DVH values under uncertainty and suboptimal trade-offs. In this study, we investigated if re-optimization based on probabilistic evaluation improves the trade-off between OAR sparing and target coverage in neuro-oncological patients.</div></div><div><h3>Materials and methods</h3><div>22 neuro-oncological patients were included. 18 met their original target goals (group A), while in 4, target coverage was compromised to spare OARs (group B).</div><div>The probabilistic goal for the CTV was calibrated to be consistent with PTV-based photon plans, resulting in D_99.8%,CTV = 0.95D_pres with a 90 % confidence level. The probabilistic OAR constraints were set to meet the clinical constraints with a 95 % confidence level.</div><div>For both groups, the clinical plans were re-optimized, keeping the clinical objectives and constraints, but reducing robustness for the CTV objective (group A) to meet the probabilistic goal, or for the dose-limiting OAR objectives (group B) without exceeding the constraints.</div><div>For the original and re-optimized plans, polynomial chaos expansion was applied to simulate 10,000 fractionated treatments, deriving probability distributions for relevant DVH parameters.</div></div><div><h3>Results</h3><div>For group A, re-optimization resulted in a population median decrease of 8.2 (range: 0.4–20.8) Gy RBE in the total OAR-related clinical goal values.</div><div>For group B, re-optimization resulted in a population median increase of 2.7 (range: 1.3–6.8) Gy RBE in the D_99.8%,CTV. The population median V_95%,CTV improved from 97.4 % to 99.1 %.</div></div><div><h3>Conclusion</h3><div>We demonstrated that probabilistic evaluation guided IMPT planning enables either OAR sparing or target coverage enhancement.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111171"},"PeriodicalIF":5.3,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192522","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 predictive model based on the dosimetric parameters of the parotid stem cell region to assess the recovery of radiation-induced xerostomia in long-term survivors of nasopharyngeal carcinoma after radical radiotherapy","authors":"Mai Zhang ,&nbsp;Jie Gong ,&nbsp;Yong Zhu ,&nbsp;Zhi-Hua Yang ,&nbsp;Yong-Chun Zhou ,&nbsp;Jing Hu ,&nbsp;Hui Guo ,&nbsp;Hai-Liang Li ,&nbsp;Quan Shi ,&nbsp;Zhong-Fei Wang ,&nbsp;Chang-Hao Liu ,&nbsp;Ning Su ,&nbsp;Li-Na Zhao ,&nbsp;Mei Shi ,&nbsp;Jian Zang","doi":"10.1016/j.radonc.2025.111163","DOIUrl":"10.1016/j.radonc.2025.111163","url":null,"abstract":"<div><h3>Background</h3><div>For nasopharyngeal carcinoma (NPC) patients with bilateral parotids near high − dose areas, more research is needed on how radiation to the parotid stem cell region (SCR) impacts xerostomia. This multicenter study aims to explore SCR radiation dosimetric parameters and clinical factors that influence recovery from radiation-induced xerostomia in long-term survivors.</div></div><div><h3>Methods</h3><div>We analyzed 648 NPC patients from four Chinese centers who underwent radical radiotherapy. Recovery was assessed via patient-reported (PRO) and physician-assessed (PAO) outcomes. The Cox proportional hazards model identified key clinical and dosimetric factors for recovery, aiming to develop an integrated prediction model. Prognostic performance was evaluated with time-dependent area under the receiver operating characteristic curve (AUC), and Cumulative incidence curve estimated recovery across different risk groups.</div></div><div><h3>Results</h3><div>Patients were randomly allocated to training and validation sets at 7:3. Multivariate COX analysis identified age (<em>p</em>=0.000), induction chemotherapy (<em>p</em>=0.003), SCR Dmean (<em>p</em>=0.047), and SCR V20 (<em>p</em>=0.000) as key predictors for xerostomia recovery. A nomogram model using these factors outperformed individual ones in predicting xerostomia recovery for PRO recovery, 3-year/5-year AUC was 0.77/0.806 (training) and 0.773/0.81 (validation); for PAO recovery, it was 0.756/0.786 (training) and 0.748/0.786 (validation). Based on the median score derived from the model, the entire cohort was stratified into high-risk and low-risk groups. Notably, the low-risk group demonstrated a significantly higher recovery rate in both the training set and validation set (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>A model combining SCR dosimetry and clinical factors effectively predicts xerostomia recovery.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111163"},"PeriodicalIF":5.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186566","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":"Failure pattern and salvage in head and neck cancer of unknown primary: A national study by DAHANCA","authors":"Signe Bergliot Nielsen ,&nbsp;Morten Horsholt Kristensen ,&nbsp;Anne Ivalu Sander Holm ,&nbsp;Ruta Zukauskaite ,&nbsp;Christian Rønn Hansen ,&nbsp;Christina Caroline Plaschke ,&nbsp;Anita Birgitte Gothelf ,&nbsp;Bob Smulders ,&nbsp;Eva Samsøe Hinsby ,&nbsp;Martin Skovmos Nielsen ,&nbsp;Patrik Sibolt ,&nbsp;Nina Munk Lyhne ,&nbsp;Maria Andersen ,&nbsp;Mohammad Farhadi ,&nbsp;Hanne Primdahl ,&nbsp;Christian Maare ,&nbsp;Jørgen Johansen ,&nbsp;Christian Godballe ,&nbsp;Thomas Kjærgaard ,&nbsp;Jens Overgaard","doi":"10.1016/j.radonc.2025.111162","DOIUrl":"10.1016/j.radonc.2025.111162","url":null,"abstract":"<div><h3>Background</h3><div>Failure patterns in patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) depend on disease etiology and treatment type and extent. Treatment strategies may include radiotherapy to address any potential mucosal tumor sites, or alternatively, the omission of mucosal irradiation to permit targeted intervention should a primary tumor subsequently emerge. The Danish 2013 guidelines employed both strategies based on N-classification and Epstein-Barr Virus status, but not Human Papilloma Virus (HPV) status. The present study aimed to analyze failure patterns in a complete, nationwide Danish cohort of patients with HNSCCUP, with a focus on HPV status, treatment targets, and salvage outcomes.</div></div><div><h3>Materials &amp; Methods</h3><div>All HNSCCUP patients treated in the period 2014 to 2020, were identified in the DAHANCA database. An image-based pattern of failure analysis was conducted to evaluate the extent of primary treatment coverage at sites of recurrence.</div></div><div><h3>Results</h3><div>In a consecutive cohort of 254 HNSCCUP patients, 43 % had HPV-associated disease (p16 positivity). Treatment modalities included definitive neck dissection (dND) (n = 60) and treatment regiments involving intensity modulated radiotherapy (IMRT, n = 194); either postoperative or primary IMRT with or without adjuvant chemotherapy. 71 patients (28 %) experienced failure within 5 years. Anatomical localization of emerging primaries depended on HPV status and primary treatment modality. Higher rates of emerging primaries were seen in the dND group (35 %) compared to the IMRT group (6 %), with salvage treatment resulting in cure rates of 78 % and 27 %, respectively. Most regional failures in the IMRT group originated within elective clinical target volumes (89 %). No significant difference in loco-regional failure was observed when comparing the dND group with the IMRT group, when including salvage effects.</div></div><div><h3>Conclusion</h3><div>The study findings support a personalized treatment strategy guided by HPV status and highlight the importance of including salvage outcomes in treatment efficacy analyses.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111162"},"PeriodicalIF":5.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186598","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":"National indication protocol for proton radiotherapy in esophageal cancer patients in the Netherlands.","authors":"Christina T Muijs, Yvonne L B Klaver, Joost Nuyttens, Irene M Lips, Karin Muller, Gati Mulder- Ebrahimi, Frank J W M Dankers, Rob Verhoeven, Ewoud Schuit, Maaike Berbee","doi":"10.1016/j.radonc.2025.111164","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111164","url":null,"abstract":"<p><strong>Background: </strong>Chemoradiotherapy (CRT) plays a key role in treating esophageal cancer (EC) but is associated with significant toxicity. Proton radiotherapy (PRT) may reduce this risk by limiting radiation dose to organs at risk. In the Netherlands, PRT is reimbursed only when eligibility criteria defined in a National Indication Protocol for Proton Therapy (NIPP) are met. This study describes the development and implementation of such a protocol for EC based on model-based selection.</p><p><strong>Materials and methods: </strong>A national multidisciplinary working group was formed aiming to develop the NIPP protocol through literature review, evaluation of prediction models, external model validation, and stakeholder engagement.</p><p><strong>Results: </strong>Cardiac events and overall survival were identified as the most clinically relevant endpoints. As no existing models met the quality criteria for model-based selection, a validated 2-year mortality prediction model originally developed for lung cancer was externally validated in EC patients treated with definitive (dCRT) or neoadjuvant (nCRT) CRT. The model performed well after updates to the intercept (both cohorts) and slope (nCRT). Model-based selection was defined as a ≥ 5 % predicted absolute reduction in 2-year mortality with PRT versus photon radiotherapy, using Mean Heart Dose (MHD) and Gross Tumor Volume (GTV) as predictors. Additional selection criteria included WHO performance status 0-2 and exclusion of cT4, cN3, or cM1 status. The NIPP was approved by the Dutch Society of Radiation Oncology in June 2021 and by the Dutch Health Care Institute in October 2021. National implementation and prospective outcome evaluation are ongoing via the ProTRAIT registry.</p><p><strong>Conclusion: </strong>A national indication protocol enabling model-based selection for PRT in EC was successfully implemented in the Netherlands. The NIPP describes eligibility criteria for proton therapy reimbursement and enables reimbursement for individual patients who are expected to benefit from PRT.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111164"},"PeriodicalIF":5.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177912","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":"Efficacy of metastatic lesion radiotherapy in de novo metastatic nasopharyngeal carcinoma patients receiving local regional radiotherapy and chemo-immunotherapy: a multicenter retrospective study","authors":"Shui-Qing He ,&nbsp;Shu-Hui Lv ,&nbsp;Si-Qing Wen ,&nbsp;Lin-Wang ,&nbsp;Ya-Hui Yu ,&nbsp;Guo-Yi Zhang ,&nbsp;Ding-Sheng Peng ,&nbsp;Wei-Xin Bei ,&nbsp;Chun-Lan Chen ,&nbsp;Ze-Yu Zhao ,&nbsp;Ying Huang ,&nbsp;Yan-Qun Xiang ,&nbsp;Guo-Ying Liu","doi":"10.1016/j.radonc.2025.111160","DOIUrl":"10.1016/j.radonc.2025.111160","url":null,"abstract":"<div><h3>Background and purpose</h3><div>De novo metastatic nasopharyngeal carcinoma (dmNPC) exhibits heterogeneous survival outcomes. While combining chemo-immunotherapy with locoregional radiotherapy (LRRT) improves outcomes, the role of metastatic lesion radiotherapy (MLRT) remains controversial, especially in the context of immunotherapy. This study aims to evaluate MLRT’s efficacy in dmNPC patients receiving chemo-immunotherapy and LRRT and establish a prognostic model for identifying MLRT beneficiaries.</div></div><div><h3>Materials and methods</h3><div>The study comprised of 347 dmNPC patients from four different centers. All patients received ≥2 cycles of first-line chemo-immunotherapy and LRRT. MLRT was administered to 77 patients. Prognostic factors were analyzed using Cox regression. A recursive partitioning analysis (RPA) model was employed to construct a prognostic model for risk stratification. Progression-free survival (PFS) differences between MLRT and non-MLRT groups were compared across risk strata.</div></div><div><h3>Results</h3><div>MLRT recipients demonstrated superior median PFS (not reached vs. 34.87 months, p = 0.006). The RPA model classified patients into three risk groups based on the number of metastatic lesions, liver metastasis, and post-treatment Epstein-Barr Virus (EBV) DNA. The 3-year PFS rates for the low-, medium-, and high-risk groups were 71.4 %, 39.2 %, and 12.3 %. MLRT significantly improved 3-year PFS in low-risk patients (82.8 % vs. 69.1 %, p = 0.031), but not in medium or high-risk groups. Independent adverse prognostic factors included detectable post-treatment EBV DNA (HR = 3.36), liver metastasis (HR = 1.5), and &gt;5 metastatic lesions (HR = 1.52).</div></div><div><h3>Conclusion</h3><div>MLRT benefits dmNPC patients with low-risk features (limited metastases, undetectable EBV DNA). Risk stratification using metastatic burden and EBV DNA status may guide personalized MLRT decisions in the immunotherapy era.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111160"},"PeriodicalIF":5.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150614","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 between prostate radiotherapy and survival among patients with metastatic prostate cancer by extent of disease burden","authors":"Peter S. Palencia ,&nbsp;Shayan Smani ,&nbsp;Xiwen Zhao ,&nbsp;Keervani Kandala ,&nbsp;Nethusan Sivanesan ,&nbsp;Jaime A. Cavallo ,&nbsp;Navid Roessler ,&nbsp;Sanjay Aneja ,&nbsp;Yi An ,&nbsp;Marcin Miszczyk ,&nbsp;Michael S. Leapman","doi":"10.1016/j.radonc.2025.111158","DOIUrl":"10.1016/j.radonc.2025.111158","url":null,"abstract":"<div><h3>Background and objective</h3><div>Prostate radiotherapy (RT) is increasingly used in the treatment of hormone-sensitive metastatic prostate cancer (PCa) based on evidence of benefit in subsets with low disease volume. However, survival outcomes of patients with metastatic PCa receiving prostate RT across contemporary distributions of stage are less well understood.</div></div><div><h3>Methods</h3><div>Within the National Cancer Database (2004–2020), we identified individuals with de-novo metastatic PCa treated with hormonal therapy (HT) with or without prostate RT. Kaplan-Meier curves and multivariable proportional hazard regression models were used to compare overall survival (OS) across nodal (M1a), bone (M1b), and visceral (M1c) disease, using propensity score matched (PSM) samples.</div></div><div><h3>Results</h3><div>We identified 48,121 eligible patients, including 42,437 (88.2 %) patients receiving only HT and 5,684 (11.8 %) patients receiving HT + RT. In PSM-adjusted hazard regression models, RT was associated with improved OS (HR: 0.62; 95 % CI: 0.58–0.66; p &lt; 0.001). The association differed by metastatic substage; the risk of death was reduced in patients with M1a (HR: 0.48; 95 % CI: 0.39–0.58; p &lt; 0.001) and M1b disease (HR: 0.60; 95 % CI: 0.56–0.65; p &lt; 0.001). No significant OS benefit was observed in M1c disease (HR: 0.91; 95 % CI: 0.74–1.13; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Prostate RT with HT was associated with improved survival in this observational study of patients with metastatic PCa. However, these associations differed by metastatic substage, with greater benefit in M1a, and no apparent benefit in M1c disease.<!--> <!-->In the era of molecular imaging, further refinement of patient selection for prostate RT may optimize treatment benefit.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111158"},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131833","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 quality assurance of the prospective randomised EORTC-1219/DAHANCA-29 trial: an individual case review analysis.","authors":"Najlaa Alyamani, André Abrunhosa-Branquinho, Coreen Corning, Marjan Sharabiani, Pierre Castadot, Jordi Giralt, Joanna Kazmierska, Warren Grant, Melissa Christiaens, Milan Tomsej, Raquel Bar-Deroma, Angelo F Monti, Jean-Jacques Stelmes, Enrico Clementel, Catherine Fortpied, Sandra Collette, Coen W Hurkmans, Vincent Grégoire, Jens Overgaard, D-C Weber, Nicolaus Andratschke","doi":"10.1016/j.radonc.2025.111141","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111141","url":null,"abstract":"<p><strong>Background: </strong>The EORTC-1219/DAHANCA-29 trial investigated whether adding nimorazole to accelerated radiotherapy (RT) and chemotherapy improves locoregional control of locally advanced head and neck cancer. As part of the trial's RT quality assurance (RTQA) program, individual case review (ICR) of RT plans was performed to assess protocol compliance and treatment planning quality MATERIALS AND METHODS: Nineteen centers submitted RT plans for central review. The trial mandated prospective ICR (p-ICR) for the first five patients per institution, with subsequent plans reviewed retrospectively or as optional p-ICR. Plans were reviewed by radiation oncologists and medical physicists. Plans deemed unacceptable in p-ICR were resubmitted for review, whereas retrospective ICR (r-ICR) cases were reviewed once. Plans were categorized as \"Acceptable as per protocol,\" \"Acceptable variation,\" or \"Unacceptable variation.\".</p><p><strong>Results: </strong>RT plans for all 194 randomized patients were reviewed, with 174p-ICRs and 44 r-ICRs. The delineation acceptability rate for p-ICR improved from 69% at the first submission to 93% at final review. p-ICR had an 18% higher acceptance rate (90%) compared to r-ICR (73%). Dose and plan acceptability remained high (97%) at both first and final submission, with minimal differences between p-ICR and r-ICR.</p><p><strong>Conclusion: </strong>P-ICR significantly improved CTV delineation quality, ensuring higher protocol compliance and treatment planning accuracy. p-ICRs are recommended for complex treatments, tailored to the performance of individual sites.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111141"},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131814","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":"Towards reliable feature interpretation in machine learning-based acute diarrhoea toxicity assessment.","authors":"Souichi Oka, Yoshiki Takahashi, Yoshiyasu Takefuji","doi":"10.1016/j.radonc.2025.111140","DOIUrl":"10.1016/j.radonc.2025.111140","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111140"},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The climate and health impact of U.S. radiation therapy: estimating greenhouse gas emissions, DALYs, and potential of hypofractionation.","authors":"Katie E Lichter, Alyssa Asaro, Muhammad Mustafa Qureshi, Minh Tam Truong, Akash Parekh, Alon Witztum, Chirjiv Anand, Genevieve S Silva, Trevor Royce, Nicholas G Zaorsky, Surbhi Grover, May Abdel-Wahab, Cassandra Thiel, Matthew J Eckelman, Nicolas Prionas, Sue S Yom, Osama Mohamad","doi":"10.1016/j.radonc.2025.111161","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111161","url":null,"abstract":"<p><strong>Background/purpose: </strong>Climate change is a global crisis, with the healthcare sector contributing 8.5-10% of greenhouse gas (GHG) emissions in the United States (U.S.). Radiation oncology, particularly through patient transportation for external beam radiation therapy (EBRT), is known to contribute to these emissions. In this study, we aim to quantify the annual GHG emissions in carbon dioxide equivalents (CO₂e) from EBRT in the U.S., estimate their down-stream impact on human health in terms of disability-adjusted life-years (DALYs) lost, and evaluate the potential reduction in emissions through increased adoption of hypofractionation, using early-stage breast cancer as a model.</p><p><strong>Materials/methods: </strong>This is a retrospective analysis using life cycle assessment (LCA) methodologies, integrating real-world data on patient transportation and energy use, and simulations of alternative fractionation schedules following previously established breast treatment guidelines. The study included 556,426 patients who received EBRT for nine cancer types (breast, central nervous system, gastrointestinal, genitourinary, gynecological, head and neck, musculoskeletal, skin, and thoracic), as recorded in the National Cancer Database (NCDB) in 2019 and 2020. Of these, 49,909 patients with early-stage breast cancer (stages I-II, node-negative) were modeled for hypofractionation scenarios.</p><p><strong>Results: </strong>In 2019 and 2020, EBRT treatments in the U.S. resulted in 3.3 and 2.7 million metric tonnes of CO₂e, respectively. Corresponding DALYs lost were 1,040 in 2019 and 863 in 2020. Simulations showed that increasing use of hypofractionation for eligible breast cancer treatments could reduce GHG emissions by up to 64%.</p><p><strong>Conclusions: </strong>Establishing baseline U.S. GHG emissions from EBRT offers a foundation for identifying opportunities to mitigate emissions. Investigating clinical practices from an environmental perspective can yield dual benefits: improved quality of care and significant emissions reductions.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111161"},"PeriodicalIF":5.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125883","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":"Evaluation of the association between sex-linked genes and treatment response in lung cancer","authors":"A Kinsella ,&nbsp;A Prina-Mello ,&nbsp;L Marignol","doi":"10.1016/j.radonc.2025.111159","DOIUrl":"10.1016/j.radonc.2025.111159","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The impact of biological sex on treatment response and prognosis in lung cancer remains poorly understood. This study investigates the relationship between sex-linked genes, DNA repair, senescence, and survival in male and female patients with lung cancer.</div></div><div><h3>Materials and Methods</h3><div>Whole-genome mRNA expression data from The Cancer Genome Atlas (TCGA) PanCancer Atlas for lung adenocarcinoma (LUAD) were analyzed (N = 275 female, N = 239 male). Curated lists of 874 X-linked, 57 Y-linked, and 314 DNA damage response (DDR) genes were obtained from UniProt and HUGO. Additionally, 279 senescence genes were sourced from <span><span>Senescence.info</span><svg><path></path></svg></span>. Overall survival (OS) was assessed using Kaplan-Meier analysis. Correlation analyses between sex-linked and DDR/senescence genes used Spearman’s rank correlation. Based on their strong association with DDR genes and OS in patient tumours, two top-ranked X-linked genes, <em>CENPI</em> and <em>ERCC6L</em>, were further evaluated <em>in vitro</em> in male (A549) and female (H1975) lung adenocarcinoma cells after radiation or fisetin treatment.</div></div><div><h3>Results</h3><div>Of 44 Y-linked genes evaluated, 11 were differentially expressed; <em>PRKY</em> was significantly associated with OS. In tumours, 287 (male) and 314 (female) X-linked genes were altered, with strong correlations to DDR genes. Low <em>ERCC6L</em> expression was linked to increased OS in males treated with radiation (p = 0.036, HR = 3.1). Radiation and fisetin treatment modified <em>CENPI</em> and <em>ERCC6L</em> expression in a sex-specific manner.</div></div><div><h3>Conclusion</h3><div>Sex-linked gene expression in lung tumours influences DDR and senescence pathways, correlating with survival outcomes. These findings highlight the importance of sex-specific analysis in lung cancer research and treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111159"},"PeriodicalIF":5.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125943","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}