Radiotherapy and Oncology最新文献

{"title":"The role of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer at different risks of brain metastasis: A multicenter retrospective study","authors":"Xingyue Li ,&nbsp;Shuangqing Lu ,&nbsp;Jingli Lv ,&nbsp;Song Guan ,&nbsp;Meng Yan ,&nbsp;Hui Zhu ,&nbsp;Jianzhong Cao ,&nbsp;Lujun Zhao","doi":"10.1016/j.radonc.2025.110897","DOIUrl":"10.1016/j.radonc.2025.110897","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To evaluate the value of prophylactic cranial irradiation (PCI) in patients with limited-stage small cell lung cancer (LS-SCLC) at different risks of brain metastasis (BM).</div></div><div><h3>Materials and methods</h3><div>A retrospective study included 498 LS-SCLC patients from three centers who achieved complete or partial response (CR/PR) after radical chemoradiotherapy. A nomogram was developed using significant factors associated with BM, identified through univariate and multivariate analyses. Patients were stratified into high- and low-risk groups based on risk scores. The incidence of BM was compared between patients with and without PCI in different risk-stratified populations using the log-rank test.</div></div><div><h3>Results</h3><div>The nomogram included age, start of treatment to the end of radiotherapy (SER), hemoglobin, prognostic nutritional index (PNI), ProGRP, and NSE. The area under the receiver operating characteristics (AUC) of the nomogram for predicting the 2-year probability of intracranial progression-free survival (IPFS) were 0.738, 0.811, and 0.726 in the training, internal validation, and external validation cohorts, respectively. In the low-risk group, no significant differences were observed in BM incidence (<em>p</em> = 0.220), OS (<em>p</em> = 0.679), or PFS (<em>p</em> = 0.616) between PCI and non-PCI groups. In the high-risk group, PCI significantly reduced BM incidence (<em>p</em> &lt; 0.0001) and improved PFS (<em>p</em> = 0.032), while no significant differences were found in OS (<em>p</em> = 0.778). Propensity score-matching analysis showed similar results.</div></div><div><h3>Conclusion</h3><div>PCI did not improve OS in patients regardless of high or low risk of BM. However, PCI did significantly reduce the incidence of BM and prolong PFS in patients at a high risk of BM.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110897"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873991","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":"Prognostic gene expression signatures for HPV-negative head and neck squamous cell carcinoma","authors":"Stefano Cavalieri ,&nbsp;Ruud H. Brakenhoff ,&nbsp;C. René Leemans ,&nbsp;Frank J.P. Hoebers ,&nbsp;Tito Poli ,&nbsp;Kathrin Scheckenbach ,&nbsp;Nicola Alessandro Iacovelli ,&nbsp;Marzia Franceschini ,&nbsp;Ester Orlandi ,&nbsp;Lisa Licitra ,&nbsp;Loris De Cecco","doi":"10.1016/j.radonc.2025.110900","DOIUrl":"10.1016/j.radonc.2025.110900","url":null,"abstract":"<div><h3>Background</h3><div>Head and neck squamous cell carcinoma (HNSCC) is a leading cause of cancer-related deaths worldwide, with HPV-negative cases being particularly aggressive. These cases often show poor prognosis and low responsiveness to radiotherapy. Improved prognostic tools and treatment strategies are needed to enhance outcomes.</div></div><div><h3>Aim</h3><div>To evaluate the prognostic value of various gene expression signatures in predicting survival outcomes in HPV-negative HNSCC patients receiving radiotherapy and to compare their accuracy against the current TNM staging system.</div></div><div><h3>Methods</h3><div>This observational cohort study used data from the European BD2Decide project, systematically analyzing gene expression in loco-regionally advanced, non-metastatic HPV-negative HNSCC patients (stage III-IVa/b) treated with curative radiotherapy (post-operative or definitive) between 2008 and 2017. The primary outcome was overall survival (OS), with secondary outcomes including disease-free survival (DFS), distant metastasis-free survival (DMFS), and loco-regional recurrence-free survival (LRRFS). The prognostic performance of selected gene expression signatures was evaluated using receiver operating characteristic (ROC) curves and hazard ratios (HR) from Cox models.</div></div><div><h3>Results</h3><div>The study included 783 patients, with a median age of 63 years, mostly male (68 %), with significant tobacco (84 %) and alcohol (69 %) exposure. The 172-gene signature (172GS) showed the highest prognostic accuracy, outperforming the TNM system in predicting OS, DFS, DMFS, and LRRFS. Multivariable analysis confirmed its independent prognostic value.</div></div><div><h3>Conclusions</h3><div>The 172GS gene signature offers superior prognostic information compared to TNM staging, supporting its potential use for better risk stratification and personalized treatment planning in HPV-negative HNSCC. Future trials should consider tumor biology and gene signatures for better patient selection.</div><div><em>Trial Registration:</em> NCT02832102.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110900"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870343","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":"Aims+Scope/Editorial Board/ Publication information","authors":"","doi":"10.1016/S0167-8140(25)00151-3","DOIUrl":"10.1016/S0167-8140(25)00151-3","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110856"},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835237","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":"Safety and quality of life of PSMA-PET- and MRI-based focal dose escalated radiotherapy for intermediate- and high-risk prostate cancer: Primary endpoint analysis of the bi-centric phase II HypoFocal trial (ARO2020-01)","authors":"Simon K.B. Spohn ,&nbsp;Constantinos Zamboglou ,&nbsp;Sophia L. Bürkle ,&nbsp;Martin T. Freitag ,&nbsp;Joachim Brumberg ,&nbsp;Hannes Engel ,&nbsp;Mark Gainey ,&nbsp;Marius Kamps ,&nbsp;Paolina Toncheva ,&nbsp;Tanja Sprave ,&nbsp;Simon Kirste ,&nbsp;August Sigle ,&nbsp;Cordula Jilg ,&nbsp;Christian Gratzke ,&nbsp;Sonja Adebahr ,&nbsp;Michael Mix ,&nbsp;Fabian Bamberg ,&nbsp;Sebastian Zschaeck ,&nbsp;Pirus Ghadjar ,&nbsp;Dimos Baltas ,&nbsp;Anca L. Grosu","doi":"10.1016/j.radonc.2025.110883","DOIUrl":"10.1016/j.radonc.2025.110883","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>To present the primary endpoint results, toxicities and quality of life (QoL) after two-year follow-up (FU) of the HypoFocal Phase II trial.</div></div><div><h3>Material and Methods</h3><div>Intermediate- and high-risk prostate cancer (PCa) patients were treated with moderately hypofractionated radiotherapy (MHRT) of 60 Gy in 20 fractions and a focal-boost of up to 75 Gy in Arm A, or high-dose-rate-brachytherapy (HDR-BT) of 15 Gy to the whole-gland with a boost of up to 19 Gy, followed by external beam RT (EBRT) of 44 Gy in 20 fractions in Arm B. Boost was based on combined information by multiparametric-magentic-resonance-tomography (mpMRI) and positron-emission-tomography targeting prostate-specific-membrane-antigen (PSMA-PET). Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed according to CTCAEv5.0. QoL was assessed with validated questionnaires (IPSS, QLQ-PR25 and QLQ-PR30).</div></div><div><h3>Results</h3><div>Twenty-five patients were treated with MHRT and 30 patients with HDR-BT + EBRT. At two-year-FU, the rate of grade 2 + GU and GI toxicity was 24 % and 8 % in Arm A and 10 % and 0 % in Arm B, respectively. Two grade 3 GI toxicities were reported in Arm A, which can be attributed to multifactorial genesis and interventions. QoL was good with significant and minimally-important-differences only in bowel symptoms in Arm A and sexual functioning in Arm B. One patient in each arm relapsed. Limitations are the relatively small sample size.</div></div><div><h3>Conclusion</h3><div>This is the first trial do demonstrate safety and feasibility of focal dose-escalation based on mpMRI and PSMA-PET in MHRT and HDR-BT + EBRT in intermediate- and high-risk PCa. Particularly, HDR-BT offers good toxicity and QoL profiles. Radiation proctitis demands careful management.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110883"},"PeriodicalIF":4.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870346","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":"Ex vivo brain MRI to assess conventional and FLASH brain irradiation effects","authors":"Jeannette Jansen ,&nbsp;Adam Kimbler ,&nbsp;Olivia Drayson ,&nbsp;Bernard Lanz ,&nbsp;Jessie Mosso ,&nbsp;Veljko Grilj ,&nbsp;Benoit Petit ,&nbsp;Javier Franco-Perez ,&nbsp;Aaron Simon ,&nbsp;Charles L. Limoli ,&nbsp;Marie-Catherine Vozenin ,&nbsp;Craig Stark ,&nbsp;Paola Ballesteros-Zebadua","doi":"10.1016/j.radonc.2025.110894","DOIUrl":"10.1016/j.radonc.2025.110894","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The FLASH effect expands the therapeutic ratio of tumor control to normal tissue toxicity observed after delivery of ultra-high (&gt;100 Gy/s FLASH-RT) vs. conventional dose rate radiation (CONV-RT). In this first exploratory study, we assessed whether ex vivo Magnetic Resonance Imaging (MRI) could reveal long-term differences after FLASH-RT and CONV-RT whole-brain irradiation.</div></div><div><h3>Materials and methods</h3><div>Female C57BL/6 mice were divided into three groups: control (non-irradiated), conventional (CONV-RT 0.1 Gy/s), and ultra-high dose rates (FLASH-RT 1 pulse, 5.5 x 10^6 Gy/s), and received 10 Gy of whole-brain irradiation in a single fraction at 10 weeks of age. Mice were evaluated by Novel Object Recognition cognitive testing at 10 months post-irradiation and were sampled at 13 months post-irradiation. Ex vivo brains were imaged with a 14.1 Tesla/26 cm magnet with a multimodal MRI protocol, including T2-weighted TurboRare (T2W) and diffusion-weighted imaging (DWI) sequences.</div></div><div><h3>Results</h3><div>In accordance with previous results, cognitive tests indicated that animals receiving CONV-RT exhibited a decline in cognitive function, while FLASH-RT performed similarly to the controls. Ex vivo MRI showed decreased hippocampal mean intensity in the CONV-RT mice compared to controls, but not in the FLASH-RT group. Comparing CONV-RT to control, we found significant changes in multiple whole-brain diffusion metrics, including the mean Apparent Diffusion Coefficient (ADC) and Mean Apparent Propagator (MAP) metrics. By contrast, no significant diffusion changes were found between the FLASH-RT and control groups. In an exploratory analysis, compared to controls, regional diffusion metrics were primarily altered in the basal forebrain and the insular cortex after conventional radiation therapy (CONV-RT), and to a lesser extent after flash radiation therapy (FLASH-RT).</div></div><div><h3>Conclusion</h3><div>This study presents initial evidence that ex vivo MRI uncovered changes in the brain after CONV-RT but not after FLASH-RT. The study indicates the potential use of ex vivo MRI to analyze the brain radiation responses at different dose rates.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110894"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873998","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 multiscale radiation biophysical stochastic model describing the cell survival response at ultra-high dose rate under different oxygenations and radiation qualities","authors":"Marco Battestini ,&nbsp;Marta Missiaggia ,&nbsp;Sara Bolzoni ,&nbsp;Francesco G. Cordoni ,&nbsp;Emanuele Scifoni","doi":"10.1016/j.radonc.2025.110895","DOIUrl":"10.1016/j.radonc.2025.110895","url":null,"abstract":"<div><h3>Background and purpose</h3><div>While the advantages of ultra-high dose-rate (UHDR) irradiation have been well highlighted experimentally, the biological mechanism underlying the FLASH effect is still unclear and highly debated. The aim of this work is to reproduce the main <em>in-vitro</em> UHDR experiments and to try to explain the different <em>in-vivo</em> response between healthy tissues and tumors, developing a fully consistent radiation biophysical model for UHDR regime.</div></div><div><h3>Materials and methods</h3><div>We developed the <em>MultiScale Generalized Stochastic Microdosimetric Model</em> (MS-GSM²), a multi-stage extension of the GSM², which is a probabilistic model describing the time evolution of the lesions in an irradiated cell nucleus. We coupled the slow DNA damage evolution with the fast chemical reaction kinetics, including the impact of the redox environment.</div></div><div><h3>Results</h3><div>The MS-GSM² can investigate the combined effects of chemical species, DNA damage formation and time evolution. We demonstrate that the MS-GSM² predictions are coherent with the <em>in-vitro</em> UHDR experimental results across various oxygenation levels, and radiation qualities. We analyze the role of the chemical environmental conditions of the irradiated medium, i.e. oxygenation, and scavengers concentration, discussing possible factors that can attenuate or level out the dose rate dependence of the cell survival, to understand the differential effect that occurs <em>in-vivo</em> between normal tissue and tumor.</div></div><div><h3>Conclusion</h3><div>The MS-GSM² can accurately describe multiple aspects of the FLASH effect and be consistent with the main evidence from the <em>in-vitro</em> experiments with different types of radiation and oxygenations. Our model proposes a consistent explanation for the differential outcomes observed in normal tissues and tumors, <em>in-vivo</em> and <em>in-vitro</em>.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110895"},"PeriodicalIF":4.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143847450","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":"Radiation oncology patients’ perceptions of artificial intelligence and machine learning in cancer care: A multi-centre cross-sectional study","authors":"Joseph Chan ,&nbsp;Lisa Parker ,&nbsp;Stacy Carter ,&nbsp;Brooke Nickel ,&nbsp;Susan Carroll","doi":"10.1016/j.radonc.2025.110891","DOIUrl":"10.1016/j.radonc.2025.110891","url":null,"abstract":"<div><h3>Aim</h3><div>The use of artificial intelligence (AI) and machine learning (ML) is increasingly widespread in radiation oncology. However, patient engagement to date has been poor. Respect for persons in the healthcare setting and the principle of informed consent requires recognition of patient perspectives. The aim of this study was to provide a baseline understanding of patient views about the use of AI/ML in the specific context of radiotherapy to contribute towards future governance of the technology.</div></div><div><h3>Methods</h3><div>We developed a new questionnaire regarding AI/ML use in radiotherapy. Radiation oncology patients were surveyed from June to October 2024 at two public hospitals in Australia. Questions were on a five-point Likert scale and grouped into six topics. A free text item allowed participants to comment further.</div></div><div><h3>Results</h3><div>We analysed 474 completed questionnaires (474/811, 58 % completion rate). Most participants supported using AI/ML to help physicians with radiation oncology specific tasks (Median Score (MS) 4.3) and held positive views on the general benefits of AI/ML (MS 4.0). Patients also strongly expressed a preference to be aware and informed (MS 2.2). Significant uncertainty remained about whether AI/ML use would enable retention of the human touch and equity in care (MS 3.1).</div></div><div><h3>Conclusion</h3><div>This is the largest questionnaire study to date of radiation oncology patients’ perceptions of AI/ML, establishing a clear baseline. These results can inform future governance around AI/ML in radiotherapy. Actionable steps include informing patients of AI/ML use in their care and engaging physicians during development and regulation of the technology.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110891"},"PeriodicalIF":4.9,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895023","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":"Externally validated digital decision support tool for time-to-osteoradionecrosis risk-stratification using right-censored multi-institutional observational cohorts","authors":"Laia Humbert-Vidan ,&nbsp;Serageldin Kamel ,&nbsp;Andrew Wentzel ,&nbsp;Zaphanlene Kaffey ,&nbsp;Moamen Abdelaal ,&nbsp;Kyle B. Spier ,&nbsp;Natalie A. West ,&nbsp;G.Elisabeta Marai ,&nbsp;Guadalupe Canahuate ,&nbsp;Xinhua Zhang ,&nbsp;Melissa M. Chen ,&nbsp;Kareem A. Wahid ,&nbsp;Jillian Rigert ,&nbsp;Seyedmohammadhossein Hosseinian ,&nbsp;Andrew J. Schaefer ,&nbsp;Kristy K. Brock ,&nbsp;Mark Chambers ,&nbsp;Adegbenga O. Otun ,&nbsp;Ruth Aponte-Wesson ,&nbsp;Vinod Patel ,&nbsp;Stephen Y. Lai","doi":"10.1016/j.radonc.2025.110890","DOIUrl":"10.1016/j.radonc.2025.110890","url":null,"abstract":"<div><h3>Background</h3><div>Existing studies on osteoradionecrosis of the jaw (ORNJ) have primarily used cross-sectional data, assessing risk factors at a single time point. Determining the time-to-event profile of ORNJ has important implications to monitor oral health in head and neck cancer (HNC) long-term survivors.</div></div><div><h3>Methods</h3><div>Data were retrospectively obtained for a clinical observational cohort of 1129 patients (198 ORNJ cases) with HNC treated with radiotherapy (RT) at The University of Texas MD Anderson Cancer Center. A Weibull Accelerated Failure Time model was trained on previously identified dosimetric, clinical and demographic predictors. External validation was performed using an independent cohort of 265 patients (92 ORNJ cases) treated at Guy’s and St. Thomas’ Hospitals. To facilitate clinical implementation of the model, an online graphical user interface (GUI) was developed, including formal stakeholder usability testing.</div></div><div><h3>Results</h3><div>Our model identified that gender (males), pre-RT dental extractions and D25% were associated with a 38 %, 27 % and 12 % faster onset of ORNJ, respectively, with adjusted time ratios of 0.62 (p = 0.11), 0.73 (p = 0.13) and 0.88 (p &lt; 0.005). The model demonstrated strong internal calibration (integrated Brier score of 0.133, D-calibration p-value 0.998) and optimal discrimination at 72 months (Harrell’s C-index of 0.72).</div></div><div><h3>Conclusion</h3><div>This study is the first to demonstrate a direct relationship between radiation dose and the time to ORNJ onset, providing a novel characterization of the impact of delivered dose and patient-related factors not only on the probability of a late effect (ORNJ), but the conditional risk during survivorship.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110890"},"PeriodicalIF":4.9,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844876","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 the Common Terminology Criteria for Adverse Events (CTCAE) evolution on toxicity scoring in gynaecological radiotherapy","authors":"Sofia Spampinato ,&nbsp;Kari Tanderup ,&nbsp;Amelia Barcellini ,&nbsp;Ewa Burchardt ,&nbsp;Gemma Eminowicz ,&nbsp;Barbara Šegedin ,&nbsp;Magdalena Stankiewicz ,&nbsp;Margit Valgma ,&nbsp;Kathrin Kirchheiner","doi":"10.1016/j.radonc.2025.110881","DOIUrl":"10.1016/j.radonc.2025.110881","url":null,"abstract":"<div><h3>Purpose</h3><div>The Common Terminology Criteria for Adverse Events (CTCAE) is the established toxicity scoring system that assigns severity grades (G1 = mild to G5 = death) to Adverse Events (AEs). Compared to CTCAE v3.0 (2006), updated versions introduced changes in severity grade definitions. This study evaluated changes between v3.0 and v5.0 (2017) for AEs in gynaecological radiotherapy.</div></div><div><h3>Material and methods</h3><div>After selecting AEs relevant for gynaecological radiotherapy in v3.0, changes in severity grades were identified using CTCAE v3.0-to-v5.0 mapping tables. Six radiation oncologists (ROs) evaluated severity grade definitions for changes in: clinical interpretation, subjective (patient-reported symptoms) and objective (details on medication/intervention) information, and expected severe (≥G3) events. Agreement was based on at least five (≥5)ROs.</div></div><div><h3>Results</h3><div>Gastrointestinal, urinary, reproductive, general and injury/musculoskeletal AEs were selected (n = 118). G4 definitions in v5.0 were removed in 22 % of AEs. ≥5ROs agreed on changes affecting clinical interpretation especially for G2 (31 %) and G3 (30 %). For subjective information, 18 % of G2 and 15 % of G3 were judged relying more on patient-reported symptoms. Less objective information was found in 51 % of G3 definitions. Variability in agreement was observed especially for subjective information in G3 and expected ≥G3 events.</div></div><div><h3>Conclusion</h3><div>This analysis revealed that severity grade definitions in v3.0 and v5.0 for AEs in gynaecological radiotherapy present changes with potential impact on scoring in clinical studies. Notably, 22 % of AEs in v5.0 no longer have G4 defined, and G3 definitions often include fewer details on medication/intervention. Variability in ROs’ interpretations is frequently observed, highlighting the need for education to standardise toxicity scoring.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110881"},"PeriodicalIF":4.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844740","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":"Thoracic radiotherapy schedules in limited-stage small cell lung cancer: A systematic review and network meta-analysis","authors":"Xiao Zhong ,&nbsp;Yingnan Liu ,&nbsp;Yuhan Ji ,&nbsp;Linlin Wang","doi":"10.1016/j.radonc.2025.110888","DOIUrl":"10.1016/j.radonc.2025.110888","url":null,"abstract":"<div><h3>Background</h3><div>Currently, the accepted standard management of limited-stage small cell lung cancer (LS-SCLC) is concurrent chemoradiotherapy; however, the thoracic radiotherapy regimen remains controversial. Therefore, this <em>meta</em>-analysis aims to compare efficacy and safety of different thoracic radiotherapy regimens.</div></div><div><h3>Methods</h3><div>Relevant randomized controlled trials (RCTs) were sourced in PubMed, Cochrane Library, Web of Science, and EMBASE to assess antitumor effects (overall survival, OS; progression-free survival, PFS; overall response rate, ORR) and toxicity (adverse effects, AEs).</div></div><div><h3>Results</h3><div>Of the 2225 screened articles, 8 RCTs (involving 2363 patients) were included. The control arm was defined as 45 Gy/30f BID. The experimental arms were categorized into three groups: high-dose hyper-fractionation (hHyper-RT: 54 Gy/30f BID, 60 Gy/40f BID), hypo-fractionation (Hypo-RT: 42 Gy/15f QD, 65 Gy/26f QD), and conventional fractionation (Conv-RT: 45 Gy/25f QD, 66 Gy/33f QD, 70 Gy/35f QD). Compared with 45 Gy/30f BID, hHyper-RT (54 Gy/30f BID and 60 Gy/40f BID) showed improved OS (HR = 0.55, 95 % CI: 0.37–––0.82; HR = 0.69, 95 % CI: 0.48–––0.99), hHyper-RT (54 Gy/30f BID) and Hypo-RT (65 Gy/26f QD) improved PFS (HR = 0.70, 95 % CI: 0.49–––0.99; HR = 0.78, 95 % CI: 0.62–––0.98), whereas OS and PFS with Conv-RT was comparable to that of 45 Gy/30f BID. AE development was comparable among 45 Gy/30f, hHyper-RT, and Hypo-RT, whereas Conv-RT (45 Gy/25f QD) reduces the risk of esophagitis and grade 3–5 esophagitis (RR = 0.70, 95 % CI: 0.58–0.85; RR = 0.50, 95 % CI: 0.35–0.72). No significant difference was found for ORR, pneumonitis or grade 3–5 pneumonitis between the study arms.</div></div><div><h3>Conclusions</h3><div>Compared with 45 Gy/30f BID, hHyper-RT (54 Gy/30f BID and 60 Gy/40f BID) improved OS, while hHyper-RT (54 Gy/30f BID) and Hypo-RT (65 Gy/26f QD) prolonged PFS in LS-SCLC patients, with accepted toxicity.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110888"},"PeriodicalIF":4.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824430","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}