Radiotherapy and Oncology最新文献

{"title":"Aims+Scope/Editorial Board/ Publication information","authors":"","doi":"10.1016/S0167-8140(26)00397-X","DOIUrl":"10.1016/S0167-8140(26)00397-X","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"219 ","pages":"Article 111558"},"PeriodicalIF":5.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148167790","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":"Cost-utility-analysis of molecular-integrated-profile for women with (high)intermediate risk endometrial cancer − PORTEC-4a an international, randomised, phase 3 trial","authors":"Anne Sophie V.M. van den Heerik ,&nbsp;Nanda Horeweg ,&nbsp;Marie A.D. Haverkort ,&nbsp;Nienke Kuijsters ,&nbsp;Stefan Kommoss ,&nbsp;Friederike L.A. Koppe ,&nbsp;Marlies E. Nowee ,&nbsp;Henrike Westerveld ,&nbsp;Maria A.A. de Jong ,&nbsp;Filip Frühauf ,&nbsp;Jeltsje S. Cnossen ,&nbsp;Jan Willem M. Mens ,&nbsp;Jannet C. Beukema ,&nbsp;Cyrus Chargari ,&nbsp;Charles Gillham ,&nbsp;Dorine S.J. Tseng ,&nbsp;Katrien Vandecasteele ,&nbsp;Moritz Hamann ,&nbsp;Mandy Kiderlen ,&nbsp;Stephan Polterauer ,&nbsp;Wilbert B. van den Hout","doi":"10.1016/j.radonc.2026.111406","DOIUrl":"10.1016/j.radonc.2026.111406","url":null,"abstract":"<div><h3>Purpose</h3><div>The international PORTEC-4a trial demonstrated that individualised adjuvant treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes.</div></div><div><h3>Patients and methods</h3><div>Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data.</div></div><div><h3>Results</h3><div>All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile arm and 197 in standard arm. QALYs were comparable (<em>p</em> = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile arm compared to standard arm (€11,898 vs €13,047, <em>p</em> = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (€9,995 vs €11,926, <em>p</em> &lt; 0<em>.</em>01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, <em>p</em> = 0<em>.</em>17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective.</div></div><div><h3>Conclusion</h3><div>Individualised adjuvant treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111406"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100423","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 robustness-inclusive comparison of proton- versus photon-based whole-pelvic radiotherapy for prostate cancer within a randomised clinical trial","authors":"Sofie Tilbæk ,&nbsp;Stine Elleberg Petersen ,&nbsp;Liliana Stolarczyk ,&nbsp;Kasper Lind Laursen ,&nbsp;Steffen Bjerre Hokland ,&nbsp;Susan BlakNyrup Biancardo ,&nbsp;Kirsten Legaard Jakobsen ,&nbsp;Rasmus Havelund ,&nbsp;Terje Andersen ,&nbsp;Bjarke Mortensen ,&nbsp;Christine Vestergård Madsen ,&nbsp;Anders Schwartz Vittrup ,&nbsp;Henriette Lindberg ,&nbsp;Dorthe Yakymenko ,&nbsp;Jimmi Søndergaard ,&nbsp;Ludvig Paul Muren","doi":"10.1016/j.radonc.2026.111404","DOIUrl":"10.1016/j.radonc.2026.111404","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Proton therapy offers potentially improved normal tissue sparing compared to photon-based whole-pelvic radiotherapy (WPRT) for high-risk prostate cancer, but its sensitivity to anatomical and setup variations raises concerns about robustness. The aim of this study was – within the setting of a multicentre randomised clinical trial – to explore whether the dose-volume advantages of proton therapy persisted when subject to inter-fractional variation.</div></div><div><h3>Materials and methods</h3><div>Five patients treated with WPRT at a national proton centre were included. Comparative photon plans were created independently by five photon therapy centres. Nominal proton and photon plans were evaluated alongside recalculated plans on two repeat computed tomography scans per patient and with robustness scenarios simulating geometric uncertainties. Dose-volume metrics for target volumes and normal tissues were compared between the two modalities using linear mixed effects models accounting for patient and centre variability.</div></div><div><h3>Results</h3><div>Target coverage was consistently robust for both modalities across all plan types. Proton therapy resulted in significantly reduced bowel <em>V</em>_35Gy by 11.2 percentage points (95% CI [4.1:18.4], p = 0.01) and bowel mean dose by 13.9  Gy (95% CI [9.5:18.4], p &lt; 0.001). Bladder mean dose was also lower with proton therapy (reduced by 18.4  Gy, p = 0.02). These advantages remained consistent across nominal, recalculated, and uncertainty scenario plans. No consistent modality-related differences were observed for high-dose normal tissue metrics.</div></div><div><h3>Conclusion</h3><div>Within this robustness-inclusive multicentre comparison study, proton-based WPRT maintained target coverage comparable to photon therapy and consistently reduced low- and intermediate-dose exposure to normal tissues, while demonstrating preserved robustness under the influence of inter-fractional variation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111404"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087010","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":"MRI-based multilevel radiomics and transformer features for predicting radiation-induced carotid artery injury after nasopharyngeal carcinoma radiotherapy: A multicenter study","authors":"Heng Zhang ,&nbsp;Jiangyi Ding ,&nbsp;Longzhen Zhang ,&nbsp;Jun Li ,&nbsp;Mingjun Ding ,&nbsp;Liang Li ,&nbsp;Xiaoxiao Hou ,&nbsp;Wei Chen ,&nbsp;Kangkang Sun ,&nbsp;Nannan Cao ,&nbsp;Ziyi Wang ,&nbsp;Kai Xie ,&nbsp;Xia He ,&nbsp;Xinye Ni","doi":"10.1016/j.radonc.2026.111390","DOIUrl":"10.1016/j.radonc.2026.111390","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop and validate an MRI–based fusion model (Rad–SRad–SwinT) integrating conventional radiomics (Rad), subregional radiomics (SRad), and Transformer–derived deep learning features (Swin Transformer, SwinT) to predict post–radiotherapy radiation–induced carotid artery injury (RICAI) in nasopharyngeal carcinoma (NPC).</div></div><div><h3>Materials and methods</h3><div>In this multicenter retrospective study, 500 NPC patients from four hospitals were allocated to training (n = 274), internal testing (n = 118), and external testing cohorts (n = 108). Rad features were extracted from MRI–defined carotid artery regions of interest, SRad features from K-means–derived subregions, and deep features from a SwinT backbone. Single-source and fusion models were developed. Discrimination (AUC), classification (ACC/SEN/SPE), calibration (Brier score and calibration curves), reclassification (NRI/IDI), and interpretability (SHAP) were assessed.</div></div><div><h3>Results</h3><div>RICAI was observed in 48.5%, 48.3%, and 54.6% of the training, internal testing, and external testing cohorts, respectively. Among single–source models, SwinT and SRad showed comparable performance, with Rad slightly inferior; all outperformed the clinical model. The fused Rad–SRad–SwinT achieved the best performance, with AUCs of 0.814 (95% CI: 0.737–0.891) in internal testing and 0.871 (95% CI: 0.794–0.932) in external testing, alongside favorable classification in external testing (ACC 0.815, SEN 0.763, SPE 0.878) and good calibration (Brier score 0.148). NRI/IDI analyses indicated significantly improved reclassification versus single-source models. SHAP analyses demonstrated that SwinT-derived features contributed most to model decisions, followed by SRad and Rad, supporting complementary gains from deep semantic representation and subregional heterogeneity quantification.</div></div><div><h3>Conclusion</h3><div>Integrating multilevel radiomics with Transformer–derived deep learning features enhances prediction of RICAI after NPC radiotherapy and shows promise as a noninvasive risk–stratification tool.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111390"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053362","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":"Dosimetric long-term safety analysis of stereotactic arrhythmia radiotherapy for refractory ventricular tachycardia","authors":"Wiert F. Hoeksema ,&nbsp;Martijn H. van der Ree ,&nbsp;Jorrit Visser ,&nbsp;Cheryl Teres ,&nbsp;Joost J.C. Verhoeff ,&nbsp;Pieter G. Postema ,&nbsp;Etienne Pruvot ,&nbsp;Brian V. Balgobind ,&nbsp;Luis Schiappacasse","doi":"10.1016/j.radonc.2026.111435","DOIUrl":"10.1016/j.radonc.2026.111435","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Stereotactic arrhythmia radiotherapy (STAR) is a promising treatment for therapy-refractory ventricular tachycardia (VT), and is associated with a substantial reduction in VT burden with only modest short-term toxicity. However, detailed organ-of-interest dosimetry and long-term safety data remain scarce.</div></div><div><h3>Materials and methods</h3><div>To study the association between dosimetry and safety after STAR, we conducted a two-centre, two-platform study on dose to (extra)cardiac organs-of-interest. Patients with therapy-refractory VT were treated with a single fraction of 20–25 Gy and underwent follow-up according to local protocol. Treatment-related adverse events (AEs) were assessed and differences in dose between patients with and without severe AEs were compared.</div></div><div><h3>Results</h3><div>Twenty-six patients were included (median age 67 years (range 47–83), 88% male, 50% nonischaemic cardiomyopathy). During a median follow-up of 36 months (7–60), seven patients died, two underwent heart transplantation, and two underwent redo-STAR. Six treatment-related severe AEs were observed, all of which were manageable. The mean heart dose was significantly higher in patients with (n = 2) compared to patients without severe pericardial effusion (10.3 and 11.2 vs 6.1 (2.8–13.4) Gy, P = 0.025).</div></div><div><h3>Conclusion</h3><div>During long-term follow-up, six manageable treatment-related severe AEs were observed, while no treatment-related deaths occurred. Although no STAR-specific dose guidance could yet be defined, routine echocardiographic follow-up focused at valvular dysfunction and pericardial effusion are recommended. Larger, prospective studies are needed to further define the long-term safety profile of STAR and to develop evidence-based dose guidance and follow-up recommendations.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111435"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158170","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 primary radiotherapy on the psychosocial well-being of patients with locally advanced cervical cancer (IMPRaCC study)","authors":"Sofia Spampinato ,&nbsp;Sezen Kutluyer ,&nbsp;Saliha Almaz ,&nbsp;Nicoline Schuur ,&nbsp;Jobert Sturm ,&nbsp;Miranda E.M.C. Christianen ,&nbsp;Jan Willem Mens ,&nbsp;Helena C. van Doorn ,&nbsp;Henrike Westerveld","doi":"10.1016/j.radonc.2026.111405","DOIUrl":"10.1016/j.radonc.2026.111405","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment for locally advanced cervical cancer (LACC), and especially brachytherapy, can be physically and psychologically demanding for patients. The IMPRaCC study (Impact of primary Radiotherapy on the psychosocial well-being of patients with LACC) aimed to investigate risk factors, peak moments of distress, and unmet needs.</div></div><div><h3>Material and methods</h3><div>Analyses of EORTC-C30 questionnaires in a cohort of LACC patients (2019–2024) were combined with semi-structured interviews 4–16 weeks post-treatment. Questionnaires were collected at baseline, during treatment, and regularly throughout follow-up up to two years. Linear-mixed models evaluated changes in scores from baseline. Scores were also compared to a healthy reference population. Logistic regression identified factors associated with deteriorations in emotional (EF) and social functioning (SF) and fatigue during treatment and follow-ups. Interviews were evaluated using thematic analyses.</div></div><div><h3>Results</h3><div>Among 142 LACC patients, baseline EF and SF during treatment were impaired compared to the reference population, but improved in follow-up. Deteriorations in EF, SF and fatigue were more frequent during treatment (18.6%, 48.8%, 62.8%) than follow-up (10.4%, 25%, 34.4%). Psychiatric history was associated with worse SF during treatment, while being in a relationship and psychological support were protective factors. Brachytherapy delivered in four <em>vs</em>. three fractions seemed to be associated with worse EF, SF and fatigue. Interviews with 13 patients revealed emotional distress, especially before brachytherapy, and need for clear and consistent communication across multiple healthcare professionals.</div></div><div><h3>Conclusion</h3><div>Psychiatric history assessments, psychological support, and consistent communication support tailored care for LACC patients. Brachytherapy regimens of three fractions may further reduce psychosocial distress.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111405"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100480","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":"Role of the radiation therapist in cancer survivorship care: An integrative systematic review","authors":"Mary-Ann Carmichael ,&nbsp;Catherine Paterson ,&nbsp;Andi Agbejule ,&nbsp;Sue Robins ,&nbsp;Raymond J. Chan ,&nbsp;Nicolas H. Hart ,&nbsp;Fiona Crawford-Williams","doi":"10.1016/j.radonc.2026.111413","DOIUrl":"10.1016/j.radonc.2026.111413","url":null,"abstract":"<div><h3>Background and purpose</h3><div>As cancer survival rates continue to improve, optimising the provision of quality cancer survivorship care is paramount. Radiation therapists (RTTs) play a pivotal role in the delivery of cancer treatment, but their involvement in providing cancer survivorship care has yet to be explored or understood. This systematic review aimed to examine the role of the RTT within the Quality of Cancer Survivorship Framework across the cancer care continuum.</div></div><div><h3>Methods</h3><div>Five databases were searched from inception until August 2025. Studies were included if they described or evaluated survivorship care interventions delivered by RTTs, whether within formal roles (e.g. advanced practice) or as part of routine clinical practice. Studies were also included if they reported on RTTs knowledge, attitudes or skills related to survivorship care, defined as care and support provided from diagnosis onwards across the cancer care continuum.</div></div><div><h3>Results</h3><div>Thirty-eight articles met the inclusion criteria. Sixteen articles reported RTT-delivered survivorship care interventions, and twenty-two articles reported RTT knowledge, attitudes and skills related to survivorship care. Most studies fit within three domains: surveillance and management of psychosocial effects (n = 23), surveillance and management of physical effects (n = 7), and health promotion and disease prevention (n = 7). RTTs expressed willingness to be involved in survivorship care, however highlighted barriers, including limited time and lack of knowledge and training that restricted their involvement.</div></div><div><h3>Conclusions</h3><div>RTT survivorship specific roles are lacking, however RTTs can play a valuable role in the provision of survivorship care for patients during and after treatment. Barriers to RTTs providing this care include lack of knowledge, training, and time.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111413"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106973","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 tumor DNA-Methylome derived signature of Hypoxia Identifies HPV-negative head and neck cancer patients at risk for distant metastasis after postoperative radiochemotherapy (PORT-C)","authors":"Bouchra Tawk ,&nbsp;Gordana Halec ,&nbsp;Katrin Rein ,&nbsp;Christian Schwager ,&nbsp;Maximillian Knoll ,&nbsp;Ute Wirkner ,&nbsp;Thomas Held ,&nbsp;Fabian Weykamp ,&nbsp;Jakob Liermann ,&nbsp;Juliane Hoerner-Rieber ,&nbsp;Ina Kurth ,&nbsp;Panagiotis Balermpas ,&nbsp;Claus Rödel ,&nbsp;Maximilian Fleischmann ,&nbsp;Annett Linge ,&nbsp;Steffen Löck ,&nbsp;Fabian Lohaus ,&nbsp;Ingeborg Tinhofer ,&nbsp;Mechthild Krause ,&nbsp;Martin Stuschke ,&nbsp;Amir Abdollahi","doi":"10.1016/j.radonc.2026.111433","DOIUrl":"10.1016/j.radonc.2026.111433","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Tumor hypoxia is a predictive biomarker of treatment resistance in patients with head and neck squamous cell carcinoma (HNSCC). We previously reported the discovery of a tumor DNA methylation signature of hypoxia (Hypoxia-M), identifying HNSCC patients at risk for local recurrence (LR), all event progression, and death after primary radiochemotherapy (RCHT). We further validate Hypoxia-M in an independent cohort of HNSCC patients who underwent surgical resection followed by postoperative radiochemotherapy (PORT-C)</div></div><div><h3>Methods</h3><div>Hypoxia-M was validated in HPV-negative HNSCC patients (n = 134) homogeneously treated with PORT-C in the frame of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG) multicenter biomarker trial. DNA methylation was profiled using Illumina450K technology. The performance of Hypoxia-M was integrated with previously reported biomarkers, including gene expression signatures (GES) of hypoxia, a methylome-based HPV-Independent Classifier of disease Recurrence (HICR), and immune cell score using immunohistochemistry (CD3/CD8/PD-L1/PD1).</div></div><div><h3>Results</h3><div>Hypoxia-M was independently prognostic for overall survival (OS, HR = 2.34, p = 0.03) and distant metastasis (DM, HR = 4.3, p = 0.001), but not for LR after PORT-C. Hypoxia-M remained significant after adjusting for patientś age, gender, smoking status, tumor stage, and high-risk features (ECE&amp;/R1 resection). Hypoxia-M status was inversely associated with CD8 T-cell infiltration. Patient stratification improved by integrating previously reported biomarkers, with Hypoxia-M demonstrating independent prognostic performance.</div></div><div><h3>Conclusions</h3><div>The prognostic utility of Hypoxia-M was validated in an independent cohort. Our results highlighted a difference in recurrence patterns of hypoxic tumors treated in the primary setting (local recurrence) versus postoperatively (distant metastasis) and the utility of Hypoxia-M for identifying the main pattern of recurrence.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111433"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166524","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 radiation dose to pulmonary vein substructures and post-treatment atrial fibrillation following neoadjuvant chemoradiotherapy for esophageal squamous cell cancer","authors":"Zhongqin Huang ,&nbsp;Wei-Xiang Qi ,&nbsp;Shuyan Li ,&nbsp;Huan Li ,&nbsp;Lu Cao ,&nbsp;Han Zhao ,&nbsp;Lei Yao ,&nbsp;Jiayi Chen ,&nbsp;Shengguang Zhao","doi":"10.1016/j.radonc.2026.111436","DOIUrl":"10.1016/j.radonc.2026.111436","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether incidental radiation dose to pulmonary vein (PV) substructures---known arrhythmogenic sites---was associated with increased risk of atrial fibrillation (AF) in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemoradiotherapy (nCRT).</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 209 ESCC patients treated with nCRT. PV substructures (LSPV, LIPV, RSPV, RIPV) were contoured on radiotherapy planning scans, and dose-volume histogram parameters were extracted. AF events were ascertained through systematic cardiac monitoring. Multivariate competing risk regression was employed to assess associations between PV doses and AF, with adjustment for cardiovascular risk factors, surgical resection as a time-dependent covariate, and mortality as a competing risk.</div></div><div><h3>Results</h3><div>Among 209 patients (84.9% male; median age 66 years), the 2-year cumulative incidence of AF was 8.89%, with a median time to AF of 13 months. Among the 25 AF events, 15 (60%) occurred after esophagectomy, with a median time from surgery to AF of 2.1 months. On univariate analysis, age, hypertension, LIPV-∼Dmax∼, RSPV-∼Dmax∼, and coronary heart disease (CHD) were associated with AF. In the multivariable model, LIPV-∼Dmax remained an independent predictor (adjusted HR = 3.16, 95% CI: 1.19–8.42, p = 0.021) after adjustment for age (HR = 3.66, p = 0.009), CHD (HR = 2.59, p = 0.019), and surgical resection. Patients with LIPV-∼Dmax∼ &gt;28.87 Gy had a significantly higher AF incidence (12.3%) than those below this threshold (p = 0.008). Moreover, AF was associated with inferior 2-year recurrence-free survival (36.9% vs. 78.6%, p = 0.0051) and inferior 2-year overall survival (58.3% vs. 82.1%, p = 0.012).</div></div><div><h3>Conclusion</h3><div>Maximum dose to the LIPV was independently associated with increased AF risk and worse survival outcomes in ESCC patients receiving nCRT. These results highlighted the potential value of LIPV-sparing radiotherapy techniques and enhanced AF surveillance in this population. External validation in larger prospective cohorts was needed before firm clinical guidelines can be established.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111436"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158184","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":"Secondary outcomes of the TROG 99.03 randomized trial of systemic therapy after involved-field radiotherapy in early-stage follicular lymphoma, including toxicity, relapse and second malignancy data","authors":"Philippa Johnstone ,&nbsp;Mathias Bressel ,&nbsp;John F. Seymour ,&nbsp;Surender Juneja ,&nbsp;Haris Ahmad ,&nbsp;Michael MacManus","doi":"10.1016/j.radonc.2026.111388","DOIUrl":"10.1016/j.radonc.2026.111388","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The recently-updated TROG 99.03/ALLGLow5 multicentre randomised controlled trial showed that long-term progression-free survival (PFS) in early-stage (I-II) follicular lymphoma (ESFL) after involved-field radiotherapy (IFRT) was dramatically improved by adjuvant rituximab-cyclophosphamide/vincristine/prednisolone (R-CVP) but not CVP. Secondary analyses are presented here.</div></div><div><h3>Materials and methods</h3><div>We analysed toxicity of RT and RT plus systemic therapy, outcomes for discontinuous stage II disease, second malignancy risks, prognostic impact of indeterminate bone marrow (BM) aggregates and the effect of rituximab on histological transformation. BM trephines from 55 patients from the pre-rituximab era were centrally reviewed.</div></div><div><h3>Results</h3><div>As previously-reported, 150 patients were randomised to IFRT (n = 75) or IFRT plus systemic therapy (n = 75). After 11.3 years median follow-up, IFRT + R-CVP was associated with improved PFS compared to IFRT or IFRT + CVP (HR 0.36, p = 0.01). Short-term RT-related grade I-II toxicity occurred in &gt;90%, but toxicity after &gt;6 months was rare. Worst acute systemic therapy toxicity was G1 (16 patients, G2 31 and G3 20) with 3 grade 3 neuropathies. R-CVP and CVP were equally toxic. Only 2 of 5 patients with non-contiguous stage II relapsed. Of 64 relapsed patients, 39 commenced salvage therapies and 17 had second progressions. Second malignancies showed no relationship to irradiated-volumes or systemic therapy use. Indeterminate BM aggregates did not worsen PFS.</div></div><div><h3>Conclusion</h3><div>The improvement in PFS, reduced salvage therapy requirements, and prevention of histological transformation with R-CVP outweigh its significant but transient toxicity, supporting its justifiable use. Patients with indeterminate BM lymphoid aggregates or non-contiguous stage II FL may merit consideration for curative-intent treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111388"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044115","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}