Radiotherapy and Oncology最新文献

{"title":"Design and pre-trial dose planning quality assurance of the Nordic trial of inhomogeneous dose escalated radiotherapy for patients with limited disease small cell lung cancer: NIELS","authors":"Sara Linde ,&nbsp;Ditte S. Møller ,&nbsp;Mai-Britt Linaa ,&nbsp;Ane Appelt ,&nbsp;Erik Almhagen ,&nbsp;Kenneth F. Hofland ,&nbsp;Marianne M. Knap ,&nbsp;Charlotte Kristiansen ,&nbsp;Lotte H. Land ,&nbsp;Christina Larsen ,&nbsp;Nina Levin ,&nbsp;Karin Lindberg ,&nbsp;Mikkel D. Lund ,&nbsp;Lars Merring-Mikkelsen ,&nbsp;Tine B. Nielsen ,&nbsp;Wiviann Ottosson ,&nbsp;Gitte F. Persson ,&nbsp;Hella M.B. Sand ,&nbsp;Morten H. Suppli ,&nbsp;Fernanda Villegas ,&nbsp;Lone Hoffmann","doi":"10.1016/j.radonc.2025.110946","DOIUrl":"10.1016/j.radonc.2025.110946","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The NIELS trial will examine if inhomogeneous dose-escalated radiotherapy up to a mean dose of 80 Gy in 40 fractions (fx), twice-daily delivered (BID), for patients with limited disease small cell lung cancer can improve overall survival. Because of the inherent risks of dose-escalation, pre-trial QA is particularly important. This study aims to examine the feasibility of the NIELS trial planning approach in a multicenter setting.</div></div><div><h3>Materials and methods</h3><div>The NIELS trial will randomize patients between standard dose radiotherapy (60 Gy/40fx BID) and inhomogeneous dose-escalated radiotherapy (up to 80 Gy/40fx BID). Five representative patient cases were distributed to seven Nordic centers for pre-trial QA planning of a standard and an escalated dose plan. Targets for escalation were primary tumor (GTVp) and involved lymph nodes (GTVn). We evaluated inter-center variation in achievable dose-escalation and doses to organs at risk (OAR).</div></div><div><h3>Results</h3><div>All targets could be escalated beyond the standard dose, with a median mean dose of 79.6 Gy [76.9–81.0] and 75.8 Gy [68.3–81.1] for GTVp and GTVn. Some targets could not be fully escalated due to OAR proximity. Three separate breaches of mandatory OAR constraints were observed in 35 escalated dose plans. There was a statistical difference in mean lung dose between standard and escalated plans, though clinically small, with a median inter-patient difference of 0.3 Gy. There were no differences in mean doses to the heart and esophagus.</div></div><div><h3>Conclusion</h3><div>Inhomogeneous dose-escalation as planned in the NIELS trial is feasible, and the dose-escalation can be performed respecting the OAR constraints in a multi-center setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110946"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132871","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":"Investigating the therapeutic potential of FLASH radiotherapy – a treatment planning study","authors":"Filip Hörberger ,&nbsp;Kristoffer Petersson ,&nbsp;Sofie Ceberg ,&nbsp;Sven Bäck ,&nbsp;Gabriel Adrian ,&nbsp;Crister Ceberg","doi":"10.1016/j.radonc.2025.110947","DOIUrl":"10.1016/j.radonc.2025.110947","url":null,"abstract":"<div><h3>Purpose/Background</h3><div>Ultra-high dose rate radiotherapy (RT) has shown potential for differential normal tissue (NT) sparing (a phenomenon termed the “FLASH effect”), particularly for larger fraction doses (&gt;5 Gy). However, transitioning to hypofractionation may increase late-reacting NT toxicity, counteracting the FLASH effect. This study evaluates whether FLASH-RT can provide netsparing for organs at risk (OARs) and NT within the PTV under the assumption of standard-of-care dose-conformity.</div></div><div><h3>Material/Methods</h3><div>Five patients per tumor-site (breast, head-and-neck, prostate, and glioblastoma) were analyzed. Using the Linear-Quadratic model, dose-distributions with higher dose per fraction were derived from standard schedules while maintaining tumor control efficacy. FLASH-modified dose-distributions were simulated voxel-by-voxel using logistic regression-based dose-modifying factors modeled from preclinical data. These plans were converted to standard fractionation equivalents for radiobiological comparisons of NT damage. Netsparing was defined as the difference in OAR dose-volume histogram parameters between standard and FLASH-modified plans, normalized to the prescribed dose. Commonly used <em>α/β</em>-ratios for tumors and late-reacting NT were applied.</div></div><div><h3>Results</h3><div>The netsparing for OARs and PTV varied strongly by tumor location. Breast and prostate cases showed positive netsparing, indicating that the FLASH effect outweighed increased toxicity. Even under a conservative scenario (higher <em>α/β</em>_T vs. <em>α/β</em>_NT), most OARs showed positive netsparing. In glioblastoma and head-and-neck cases, no netsparing was observed, indicating increased toxicity even with FLASH induced NT-sparing.</div></div><div><h3>Conclusion</h3><div>FLASH-RT appears to be beneficial for tumor sites where <em>α/β</em>_T ≲ <em>α/β</em>_NT, such as breast and prostate. However, not all tumor sites may benefit from FLASH-RT, highlighting the need for site-specific consideration for FLASH-RT implementation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110947"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132882","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":"Transforming the management of radiotherapy-induced hypothyroidism in nasopharyngeal carcinoma through an Innovative individualized radiation dosage model: A multicenter retrospective analysis","authors":"Jianming Ding ,&nbsp;Xiaoyan Yin ,&nbsp;Yuhao Lin ,&nbsp;Xiyi Liao ,&nbsp;Lisha Chen ,&nbsp;Jiabiao Hong ,&nbsp;Linghui Yan ,&nbsp;Sijia Chen ,&nbsp;Xueting Yan ,&nbsp;Zirong Li ,&nbsp;Kai Hu ,&nbsp;Ruiping Zhai ,&nbsp;Chuanben Chen ,&nbsp;Zhaodong Fei","doi":"10.1016/j.radonc.2025.110943","DOIUrl":"10.1016/j.radonc.2025.110943","url":null,"abstract":"<div><h3>Purpose</h3><div>Current guidelines for thyroid radiation dose prescription lack uniformity and fail to consider the unique characteristics of individual patients. This study aimed to develop an individualized thyroid dosing regimen to enhance thyroid protection during radiotherapy.</div></div><div><h3>Methods and Materials</h3><div>In this study, we enrolled 621 patients with nasopharyngeal carcinoma (NPC) across four distinct cancer centers, stratifying the data into a training cohort and two external validation cohorts. The specific clinical characteristic-matched tolerated dose values were fitted using binary logistic regression and time-to-event Cox methods in the training cohort. The TSH-volume index (TVI), calculated as thyroid-stimulating hormone (TSH) level divided by thyroid volume (TV), was introduced as a novel parameter. A radiation-induced hypothyroidism (RIHT) parameter was developed using the volume of thyroid spared at the tolerated dose (VStd) and compared with classical normal tissue complication probability (NTCP) and machine learning models using the area under the curve (AUC) and concordance index (C-index).</div></div><div><h3>Results</h3><div>The follow-up periods spanned 28 (range, 1–66), 33.5 (range, 3–82), and 17 months (range, 2–56), respectively, across these cohorts. RIHT was observed in 27.7 % and 35.3 % of patients at 2 and 3 years in the training cohort, respectively; 30.0 % and 41.5 % in the external validation cohort 1; and 27.2 % and 38.0 % in the external validation cohort 2. Univariable analysis identifies sex, equivalent uniform dose (EUD), TV, TSH, and the TVI as predictors of RIHT, while multivariable analysis confirms EUD and TVI as independent prognostic factors. The TVI-based VStd parameter outperformed the VS40, VS45, and VS50 indices (representing volumes spared at 40 Gy, 45 Gy, and 50 Gy, respectively), classical NTCP models, and even machine learning models in predictive performance. To enhance clinical applicability, we have developed a thyroid dose prescription table based on TVI.</div></div><div><h3>Conclusions</h3><div>We developed a high-accuracy model for individualized thyroid dosing in NPC radiotherapy. The model, supported by a clinically relevant table, offers a customized approach to thyroid protection, enhancing both predictive accuracy and clinical utility.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110943"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132897","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":"Intrafraction motion stability of open vs. closed facemasks in head and neck radiotherapy: Insights from the OPEN phase III trial","authors":"Ciaran Malone ,&nbsp;Samantha Ryan ,&nbsp;Jill Nicholson ,&nbsp;Roisin O ’Maolalai ,&nbsp;Rebecca O’Donovan ,&nbsp;Orla McArdle ,&nbsp;Frances Duane ,&nbsp;John Armstrong ,&nbsp;Lorna Keenan ,&nbsp;Aisling Glynn ,&nbsp;Ruth Woods ,&nbsp;Brendan McClean ,&nbsp;Sinead Brennan","doi":"10.1016/j.radonc.2025.110941","DOIUrl":"10.1016/j.radonc.2025.110941","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This OPEN (Optimising Patient Experience in Head and Neck Radiotherapy) phase III trial sub-study, aimed to evaluate intrafraction motion in head and neck (H&amp;N) cancer patients using three different facemask designs. Specifically, we compared intrafraction motion among patients immobilized with a closed facemask or one of two open-face designs, utilizing pre-/post-cone-beam computed tomography (CBCT) and surface-guided radiation therapy (SGRT).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A pre-planned interim analysis on the first 56 patients enrolled in the OPEN trial was conducted as a safety checkpoint. In the OPEN trial, patients are randomised into three arms: closed facemask, 3-point open facemask, or 5-point open facemask. Intrafraction motion was assessed using both CBCT and SGRT. CBCT provided deviations in translational and rotational dimensions based on bony alignment, while SGRT offered continuous monitoring of surface motion. Intrafraction motion metrics, (i.e. mean, standard deviation, maximum absolute deviation, and the 95th percentile of surface motion) were recorded for each open mask patient using SGRT data to fully quantify motion variation during treatment. The 95th percentile of SGRT deviations was used for direct comparison with CBCT motion data. Bayesian analysis was conducted to determine the equivalence of motion across mask types and measurement techniques. Margins to account for intrafraction motion were calculated across mask types using Van Herk’s formulism.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean CBCT deviations were less than 0.4 mm and 0.2 degrees, while SGRT recorded 95th percentile deviations of 0.4 mm and 0.8 degrees over all patients. SGRT detected transient maximum deviations not captured by CBCT, particularly in the yaw axis. However, these differences were transient. Bayesian analysis showed no clinically significant differences in intrafraction motion between mask types or measurement methods. No correlation was found between SGRT and CBCT measured motion within the small range of motion recorded. No difference in intrafraction margin requirements were found between arms. Based on CBCT-measured intrafraction motion, margins of 1.8 mm, 1.7 mm, and 1.3 mm were calculated for the vertical (VRT), lateral (LAT), and longitudinal (LNG) directions, respectively, to account for intrafraction motion for all mask types, with SGRT confirming that patient motion during treatment remained within these margins.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Intrafraction motion, as measured by both CBCT and SGRT, remains within clinically acceptable limits and yields similar PTV margins across both open and closed mask types. Intrafraction PTV margins were found to be comparable across all mask types. The use of SGRT allowed for the detection of transient deviations and rotational differences that were not detected using CBCT alone. Overall, these findings confirm that both 3-point and 5-point open-fac","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110941"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131182","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":"Deep learning Radiopathomics based on pretreatment MRI and whole slide images for predicting overall survival in locally advanced nasopharyngeal carcinoma","authors":"Xiaochun Yi ,&nbsp;Xiaoping Yu ,&nbsp;Congrui Li ,&nbsp;Junjian Li ,&nbsp;Hui Cao ,&nbsp;Qiang Lu ,&nbsp;Junjun Li ,&nbsp;Jing Hou","doi":"10.1016/j.radonc.2025.110949","DOIUrl":"10.1016/j.radonc.2025.110949","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop an integrative radiopathomic model based on deep learning to predict overall survival (OS) in locally advanced nasopharyngeal carcinoma (LANPC) patients.</div></div><div><h3>Materials and methods</h3><div>A cohort of 343 LANPC patients with pretreatment MRI and whole slide image (WSI) were randomly divided into training (n = 202), validation (n = 91), and external test (n = 50) sets. For WSIs, a self-attention mechanism was employed to assess the significance of different patches for the prognostic task, aggregating them into a WSI-level representation. For MRI, a multilayer perceptron was used to encode the extracted radiomic features, resulting in an MRI-level representation. These were combined in a multimodal fusion model to produce prognostic predictions. Model performances were evaluated using the concordance index (C-index), and Kaplan-Meier curves were employed for risk stratification. To enhance model interpretability, attention-based and Integrated Gradients techniques were applied to explain how WSIs and MRI features contribute to prognosis predictions.</div></div><div><h3>Results</h3><div>The radiopathomics model achieved high predictive accuracy in predicting the OS, with a C-index of 0.755 (95 % CI: 0.673–0.838) and 0.744 (95 % CI: 0.623–0.808) in the training and validation sets, respectively, outperforming single-modality models (radiomic signature: 0.636, 95 % CI: 0.584–0.688; deep pathomic signature: 0.736, 95 % CI: 0.684–0.810). In the external test, similar findings were observed for the predictive performance of the radiopathomics, radiomic signature, and deep pathomic signature, with their C-indices being 0.735, 0.626, and 0.660 respectively. The radiopathomics model effectively stratified patients into high- and low-risk groups (<em>P</em> &lt; 0.001). Additionally, attention heatmaps revealed that high-attention regions corresponded with tumor areas in both risk groups.</div></div><div><h3>Conclusion</h3><div>The radiopathomics model holds promise for predicting clinical outcomes in LANPC patients, offering a potential tool for improving clinical decision-making.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110949"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132775","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 radiosensitizing effect of Caffeic Acid Phenethyl Ester in breast cancer is dependent on p53 status","authors":"Èlia Prades-Sagarra,&nbsp;Fleur A.P. Geurts,&nbsp;Rianne Biemans,&nbsp;Natasja G. Lieuwes,&nbsp;Ala Yaromina,&nbsp;Ludwig J. Dubois","doi":"10.1016/j.radonc.2025.110945","DOIUrl":"10.1016/j.radonc.2025.110945","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiotherapy is one of the standard treatments for breast cancer, but causes adverse effects in normal tissues, narrowing the therapeutic window. Caffeic Acid Phenethyl Ester (CAPE) has been proposed to have cytotoxic and radiosensitizing effects in cancer cells, whilst protective properties in normal tissues. We have investigated the anti-tumour effects of CAPE in breast cancer <em>in vitro</em> and <em>in vivo</em> and provided evidence regarding its radioprotective effect.</div></div><div><h3>Materials and methods</h3><div>Cytotoxic and radiosensitizing effects were determined <em>in vitro</em> in luminal A, HER2+ and triple negative breast cancer and in normal breast cell lines by cell viability and clonogenic survival assays, respectively. Effects on cell metabolism, mitochondrial function and inflammation were investigated. CAPE anti-tumour effects were also investigated <em>in vivo</em> in a MDA-MB-231 tumour-bearing mouse model.</div></div><div><h3>Results</h3><div>Cell viability decreased upon CAPE treatment in a dose dependent manner (IC₅₀ 53.5 ± 33.7 µM). CAPE shifted cellular metabolism towards glycolysis (p &lt; 0.05) and induced mitochondrial membrane depolarization (p &lt; 0.01). CAPE sensitized only p53 mutated or deficient cell lines to radiotherapy (p &lt; 0.05), but not p53 proficient lines. In normal breast cells, CAPE increased the surviving fraction upon radiation (p = 0.03). NF-κB activity was decreased in p53 mutant cancer cells (p &lt; 0.01), but increased in p53 proficient lines (p &lt; 0.01) upon CAPE treatment. Combination of radiotherapy and CAPE resulted in increased survival (22 days) compared to control (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Our findings highlight that CAPE could widen the therapeutic window in breast cancer with non-functional p53, by radiosensitizing the tumour cells while protecting the normal tissue.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110945"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131126","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":"Modification of the microstructure of the CERN- CLEAR-VHEE beam at the picosecond scale modifies ZFE morphogenesis but has no impact on hydrogen peroxide production","authors":"Houda Kacem ,&nbsp;Louis Kunz ,&nbsp;Pierre Korysko ,&nbsp;Jonathan Ollivier ,&nbsp;Pelagia Tsoutsou ,&nbsp;Adrien Martinotti ,&nbsp;Vilde Rieker ,&nbsp;Joseph Bateman ,&nbsp;Wilfrid Farabolini ,&nbsp;Gérard Baldacchino ,&nbsp;Billy W. Loo Jr. ,&nbsp;Charles L. Limoli ,&nbsp;Manjit Dosanjh ,&nbsp;Roberto Corsini ,&nbsp;Marie-Catherine Vozenin","doi":"10.1016/j.radonc.2025.110942","DOIUrl":"10.1016/j.radonc.2025.110942","url":null,"abstract":"<div><h3>Background</h3><div>FLASH radiotherapy has emerged as a promising advancement in radiation oncology, demonstrating the potential to minimize normal tissue toxicity while preserving tumoricidal efficacy. However, the precise beam parameters required for clinical translation remain to be fully defined.</div></div><div><h3>Methods</h3><div>To optimize beam parameters for clinical application, we employed Very High Energy Electrons (VHEE) at the CLEAR facility, capable of targeting deep-seated tumors. These were used alongside a FLASH-validated Intermediate Energy Electron (IIE) beam and a 160–225 keV X-ray beam, collectively delivering dose rates from 1 Gy/min to 10¹¹ Gy/s. High-throughput chemical assays investigated the radiochemical effects across this dose rate range, while zebrafish embryos provided an <em>in vivo</em> model to evaluate biological responses and developmental outcomes. This study offers the first comprehensive analysis of FLASH effects across a wide spectrum of dose rates and temporal parameters, from early physico-chemical interactions to complex biological systems.</div></div><div><h3>Results</h3><div>Data from CLEAR demonstrated that beam intensity, particularly bunch charge, is a critical determinant of the FLASH effect, and uncovered an unforeseen biological response when electrons are delivered over the picosecond timescale.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that scanning strategies employing high intensity beamlets may be optimal for the clinical implementation of FLASH radiotherapy. These insights are pivotal for guiding the development of future FLASH protocols in radiation oncology.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110942"},"PeriodicalIF":4.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128556","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":"Optimizing radiotherapy for anal Cancer: A call for sub-structure-based dose constraints.","authors":"Jie Pang","doi":"10.1016/j.radonc.2025.110937","DOIUrl":"10.1016/j.radonc.2025.110937","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110937"},"PeriodicalIF":4.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120459","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":"Response to \"Optimizing radiotherapy for anal cancer: A call for sub-structure based dose constraints\".","authors":"Katrine S Storm, Karen Lise G Spindler, Gitte F Persson, Camilla Kronborg, Eva Serup-Hansen","doi":"10.1016/j.radonc.2025.110938","DOIUrl":"10.1016/j.radonc.2025.110938","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110938"},"PeriodicalIF":4.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094734","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":"Dose-intensified SBRT for vertebral oligometastases: results from a prospective clinical trial","authors":"Matthias Guckenberger ,&nbsp;Lotte Wilke ,&nbsp;Charlotte Billiet ,&nbsp;Susanne Rogers ,&nbsp;Ciro Franzese ,&nbsp;Daniel Schnell ,&nbsp;Mateusz Spałek ,&nbsp;Daniel M. Aebersold ,&nbsp;Hossein Hemmatazad ,&nbsp;Thomas Zilli ,&nbsp;Judit Boda-Heggemann ,&nbsp;Brigitta G. Baumert ,&nbsp;Jean-Jacques Stelmes ,&nbsp;Franziska Nägler ,&nbsp;Philipp Gut ,&nbsp;Christian Weiß ,&nbsp;Alessio Bruni ,&nbsp;Frank Zimmermann ,&nbsp;Robert Förster ,&nbsp;Jörg Zimmer ,&nbsp;Indira Madani","doi":"10.1016/j.radonc.2025.110940","DOIUrl":"10.1016/j.radonc.2025.110940","url":null,"abstract":"<div><h3>Purpose</h3><div>To prospectively evaluate safety and efficacy of dose-intensified multifraction SBRT using a simultaneous-integrated boost concept for vertebral oligometastases.</div></div><div><h3>Material and Methods</h3><div>Data from 128 patients with 143 vertebral oligometastases (≤5 distant metastases in total) treated with dose-intensified SBRT (48.5 Gy/10 [with epidural involvement] or 40 Gy/5 [without epidural involvement]) in the randomized and non-randomized arms of a phase 3 clinical trial conducted at 18 international centers between 2016 and 2023 were analyzed.</div></div><div><h3>Results</h3><div>The median age of all patients was 68 years; 77 patients (60.2%) had breast and prostate cancer. Of 143 vertebral metastases, 23 (16.1%) and 22 metastases (15.4%) had epidural and paraspinal tumor involvement, respectively. The median follow-up time was 24 months. At 2 years, cumulative incidence of local failure (4 failures) was 5.3%. There were 4 (2.8%) baseline and 8 (5.6%) <em>de novo</em> vertebral compression fractures (VCFs). Two-year OS was 82.2% (95% CI, 74.9–89.6%). There was no grade ≥ 4 adverse events (AE) and the crude rate of grade 3 AEs was 5.5%; no myelopathy or plexopathy was observed. On multivariate analysis, only non-breast or non-prostate cancer (HR, 7.91; 95%, CI 1.79–35.03; 2-sided <em>P</em> = 0.01) were found to be prognostic for adverse OS. No prognostic factors for VCF were identified. Epidural and paraspinal involvement were not found to be prognostic for treatment outcome.</div></div><div><h3>Conclusions</h3><div>Dose-intensified SBRT for vertebral oligometastases is effective and safe, even in high-risk patients with epidural or paraspinal involvement.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110940"},"PeriodicalIF":4.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085758","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}