Radiotherapy and Oncology最新文献

{"title":"Cost-effectiveness of a nurse-led sexual rehabilitation intervention for women treated with radiotherapy for gynaecological cancer in a randomized trial.","authors":"Isabelle Suvaal, Wilbert B van den Hout, Susanna B Hummel, Jan-Willem M Mens, Charlotte C Tuijnman-Raasveld, Laura A Velema, Henrike Westerveld, Jeltsje S Cnossen, An Snyers, Ina M Jürgenliemk-Schulz, Ludy C H W Lutgens, Jannet C Beukema, Marie A D Haverkort, Marlies E Nowee, Remi A Nout, Cor D de Kroon, Helena C van Doorn, Carien L Creutzberg, Moniek M Ter Kuile","doi":"10.1016/j.radonc.2024.110683","DOIUrl":"10.1016/j.radonc.2024.110683","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the cost-effectiveness of a nurse-led sexual rehabilitation intervention with standard care in women treated with external beam radiotherapy, with or without brachytherapy, for gynaecological cancers.</p><p><strong>Methods: </strong>Eligible women were randomly assigned to the intervention (n = 112) or standard care (n = 117). Primary endpoint was sexual functioning at 12-months post-radiotherapy, assessed by the Female Sexual Function Index (FSFI). Nurses documented frequency and duration of intervention sessions, patients reported sexual healthcare and functioning at 1, 3, 6, and 12-months. Costs were related to quality-adjusted-life-years (QALYs) using the EuroQol-5 Dimensions and visual analogue scale, and to sexual functioning improvement at 12-months. T-tests compared mean QALYs and costs, with multiple imputation for missing data.</p><p><strong>Results: </strong>The nurse-led intervention added €172 per patient, including training costs and 4-5 sessions. Other sexual rehabilitation costs were higher in the standard care group (€107 versus €141, p = 0.02). Total costs were €478 for the intervention group and €357 for standard care (p = 0.03). Valued at €20.000 per QALY, the intervention was 60 %-70 % likely to be cost-effective and less than 50 % likely to be cost-effective in terms of improved sexual functioning.</p><p><strong>Conclusion: </strong>The nurse-led sexual rehabilitation intervention is not more cost-effective than standard care, however with low costs in both groups. Since costs for standard care were slightly lower, it is preferred from a health-economic perspective. It includes detailed patient education and a dedicated sexual rehabilitation session within the first three months post-radiotherapy, which is better provided at lower cost by a trained nurse.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110683"},"PeriodicalIF":4.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829752","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":"Corrigendum to \"Parallel explorations in LA-NSCLC: Chemoradiation dose-response optimisation considering immunotherapy and cardiac toxicity sparing\" [Radiother. Oncol. 200 (2024) 110477].","authors":"Huei-Tyng Huang","doi":"10.1016/j.radonc.2024.110666","DOIUrl":"https://doi.org/10.1016/j.radonc.2024.110666","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"110666"},"PeriodicalIF":4.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829756","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":"Incorporating patient-specific prior clinical knowledge to improve clinical target volume auto-segmentation generalisability for online adaptive radiotherapy of rectal cancer: A multicenter validation.","authors":"Nicole Ferreira Silvério, Wouter van den Wollenberg, Anja Betgen, Lisa Wiersema, Corrie A M Marijnen, Femke Peters, Uulke A van der Heide, Rita Simões, Martijn P W Intven, Erik van der Bijl, Tomas Janssen","doi":"10.1016/j.radonc.2024.110667","DOIUrl":"10.1016/j.radonc.2024.110667","url":null,"abstract":"<p><strong>Background & purpose: </strong>Deep learning (DL) based auto-segmentation has shown to be beneficial for online adaptive radiotherapy (OART). However, auto-segmentation of clinical target volumes (CTV) is complex, as clinical interpretations are crucial in their definition. The resulting variation between clinicians and institutes hampers the generalizability of DL networks. In OART the CTV is delineated during treatment preparation which makes the clinician intent explicitly available during treatment. We studied whether multicenter generalisability improves when using this prior clinical knowledge, the pre-treatment delineation, as a patient-specific prior for DL models for online auto-segmentation of the mesorectal CTV.</p><p><strong>Material & methods: </strong>We included intermediate risk or locally advanced rectal cancer patients from three centers. Patient-specific weight maps were created by combining the patient-specific CTV delineation on the pre-treatment scan with population-based variation of likely inter-fraction mesorectal CTV deformations. We trained two models to auto-segment the mesorectal CTV on in-house data, one with (MRI + prior) and one without (MRI-only) priors. Both models were applied to two external datasets. An external baseline model was trained without priors from scratch for one external center. Performance was evaluated on the DSC, surface Dice, 95HD and MSD.</p><p><strong>Results: </strong>For both external centers, the MRI + prior model outperformed the MRI-only model significantly on the segmentation metrics (p-values < 0.01). There was no significant difference between the external baseline model and the MRI + prior model.</p><p><strong>Conclusion: </strong>Adding patient-specific weight maps makes the CTV segmentation model more robust to institutional preferences. Performance was comparable to a model trained locally from scratch. This makes this approach suitable for generalization to multiple centers.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110667"},"PeriodicalIF":4.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829753","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":"Interferon signaling is enhanced by ATR inhibition in glioblastoma cells irradiated with X-rays, protons or carbon ions.","authors":"Gro Elise Rødland, Mihaela Temelie, Adrian Eek Mariampillai, Ana Maria Serban, Nina Frederike Jeppesen Edin, Eirik Malinen, Lilian Lindbergsengen, Antoine Gilbert, François Chevalier, Diana I Savu, Randi G Syljuåsen","doi":"10.1016/j.radonc.2024.110669","DOIUrl":"10.1016/j.radonc.2024.110669","url":null,"abstract":"<p><strong>Background and purpose: </strong>Interferon (IFN) signaling plays an important role in antitumor immune responses. Inhibitors of the DNA damage response, such as ATR inhibitors, can increase IFN signaling upon conventional radiotherapy with X-rays. However, it is not known whether such inhibitors also enhance IFN signaling after irradiation with high linear energy transfer (LET) particles.</p><p><strong>Materials and methods: </strong>Human glioblastoma U-251 and T98G cells were irradiated with X-rays, protons (LET: 4.8 and 41.9 keV/µm) and carbon ions (LET: 28 and 73 keV/µm), with and without ATR inhibitor (VE-822) or ATM inhibitor (AZD1390). DNA damage signaling and cell cycle distribution were analyzed by immunoblotting and flow cytometry, and radiosensitivity was assessed by clonogenic survival assay. IFN-β secretion was measured by ELISA, and STAT1 activation was examined by immunoblotting.</p><p><strong>Results: </strong>High-LET protons and carbon ions caused stronger activation of the DNA damage response compared to low-LET protons and X-rays at similar radiation doses. G2 checkpoint arrest was abrogated by the ATR inhibitor and prolonged by the ATM inhibitor after all radiation types. The inhibitors increased radiosensitivity, as measured after X- and carbon ion irradiation. ATR inhibition increased IFN signaling following both low-LET and high-LET irradiation. ATM inhibition also increased IFN signaling, but to a lesser extent. Notably, both cell lines secreted significantly more IFN-β when the inhibitors were combined with high-LET compared to low-LET irradiation.</p><p><strong>Conclusion: </strong>These findings indicate that DNA damage response inhibitors can enhance IFN signaling following X-, proton and carbon ion irradiation, with a strong positive dependency on LET.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110669"},"PeriodicalIF":4.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829754","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 proton RBE and the distal edge effect for acute and late normal tissue damage in vivo.","authors":"Cathrine Bang Overgaard, Fardous Reaz, Christina Ankjærgaard, Claus E Andersen, Mateusz Sitarz, Per Poulsen, Harald Spejlborg, Jacob G Johansen, Jens Overgaard, Cai Grau, Niels Bassler, Brita Singers Sørensen","doi":"10.1016/j.radonc.2024.110668","DOIUrl":"10.1016/j.radonc.2024.110668","url":null,"abstract":"<p><strong>Background and purpose: </strong>In proton therapy, a relative biological effectiveness (RBE) of 1.1 is used toreach an isoeffective biological response between photon and proton doses. However, the RBE varies with biological endpoints and linear energy transfer (LET), two key parameters in radiotherapy. Few in vivo studies have investigated the increasing RBE with increasing LET. This study aims to test the hypothesis that the RBE varies between endpoints and has a distal edge effect in vivo.</p><p><strong>Materials and methods: </strong>Unanesthetized micewere restrainedin jigs where their right hind legs were irradiated with a single dose of protons at the center (LET, _all = 5.3 keV/μm) and distal edge (LET, _all = 7.6 keV/μm) of a spread-out Bragg peak (SOBP). 6 MV photons were used as reference. The acute damage and skin toxicity were scored daily until day 30, and the late damage was evaluated using a joint contracture assay for one year after treatment.</p><p><strong>Results: </strong>An acute damage RBE of 1.06 ± 0.02(1.02-1.10) and late damage RBE of 1.16 ± 0.08(1.00-1.32) were found, displaying an enhanced RBE for late damage in the center SOBP. The distal edge RBE for acute and late damage was 1.15 ± 0.02(1.10-1.19) and 1.26 ± 0.09(1.07-1.43), showing a similar center-to-distal edge RBE enhancement of 8 % and 9 % for acute and late damage.</p><p><strong>Conclusion: </strong>The findings demonstrate an increased RBE for late damage than acute damage and the distal edge effect is evident with increased RBE at the distal end of the proton SOBP in vivo.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110668"},"PeriodicalIF":4.9,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829755","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 prognostic significance of sarcopenia in patients treated with definitive radiotherapy: A systematic review.","authors":"Alexander J Vickers, Dónal M McSweeney, Ananya Choudhury, Jamie Weaver, Gareth Price, Alan McWilliam","doi":"10.1016/j.radonc.2024.110663","DOIUrl":"10.1016/j.radonc.2024.110663","url":null,"abstract":"<p><p>Sarcopenia describes the degenerative loss of muscle mass and strength, and is emerging as a pan-cancer prognostic biomarker. It is linked with increased treatment toxicity, decreased survival and significant healthcare financial burden. Systematic analyses of sarcopenia studies have focused on outcomes in patients treated surgically or with systemic therapies. There are few publications concerning patients treated with radiotherapy. This manuscript presents a pan-cancer systematic review of the association between sarcopenia and survival outcomes in patients treated with definitive (chemo-)radiotherapy. A literature search was performed, with 26 studies identified, including a total of 5,784 patients. The prognostic significance of sarcopenia was mixed. This may reflect lack of consensus in methods used to measure skeletal muscle mass and define sarcopenia. Many papers analyse small samples and present sarcopenia cutoffs optimised on the local population, which may not generalise to external populations. Recent advances in artificial intelligence allow for automatic measurement of body composition by segmenting the muscle compartment on routinely collected imaging. This provides opportunity for standardisation of measurement methods and definitions across populations. Adopting sarcopenia diagnosis into clinical workflows could reduce futile treatments and associated financial burden, by reducing treatment toxicities, and improving treatment completion, patient survival, and quality-of-life after cancer.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110663"},"PeriodicalIF":4.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795089","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":"Ninety-day mortality following curative intent radiotherapy for stage I-III lung cancer in the Netherlands.","authors":"Krista C J van Doorn-Wink, Pieter E Postmus, Dirk de Ruysscher, Ronald A M Damhuis","doi":"10.1016/j.radonc.2024.110661","DOIUrl":"10.1016/j.radonc.2024.110661","url":null,"abstract":"<p><strong>Background and purpose: </strong>The 90-day mortality following lung cancer treatment is a common performance indicator. The aim of this study was to investigate 90-day mortality following (chemo)radiotherapy for stage I-III lung cancer to evaluate the applicability of this outcome indicator in this patient population.</p><p><strong>Materials and methods: </strong>The Netherlands National Cancer Registry was queried for this retrospective population-based study. Early mortality rates from the start and end of radiotherapy are reported with 95% confidence intervals (CI). The association between clinical characteristics and 90-day mortality was evaluated with multivariable logistic regression analysis.</p><p><strong>Results: </strong>18,355 Patients treated between 2015 and 2020 were included. The 90-day mortality was 2.56% in stages I-II and 4.60% in stage III, was significantly higher in males, elderly patients and patients with a poor performance status and independent of facility volume. In stage I-II, 90-day mortality was lower after stereotactic versus conventional radiotherapy (2.0% versus 5.25%, OR 0.5 (95%CI 0.4-0.7)). In stage III, mortality decreased from 5.26% in 2015-2016 to 3.73% in 2019-2020 (OR 0.7 (95% CI 0.5-0.9)) and was lower after concurrent versus sequential chemoradiotherapy (3.4% versus 5.9%, OR 1.5 (95%CI 1.2-1.9)). Early mortality increased to 3.20% in stages I-II and 6.70% in stage III when calculated from the end of radiotherapy.</p><p><strong>Conclusion: </strong>Short-term mortality rates following curative intent radiotherapy for lung cancer in the Netherlands are low and independent of facility volume. It was demonstrated that 90-day mortality is an arguable indicator to monitor radiotherapy quality and that standardization of definitions and relevant case-mix factors is warranted.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110661"},"PeriodicalIF":4.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795087","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":"Prolonged interval hypofractionated radiotherapy facilitates better antitumor immunity.","authors":"Jie Xiao, Shilong Shao, Yue Deng, Dan Wang, Yi Liu, Shanshan He, Yue Zhao, Wenjun Liao, Jun Zhang, Mu Yang, Shichuan Zhang","doi":"10.1016/j.radonc.2024.110664","DOIUrl":"10.1016/j.radonc.2024.110664","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of hypofractionated radiotherapy (Hypo-RT) with different interfraction intervals on tumor growth, immune response, and synergistic effects with anti-PD-1 immunotherapy.</p><p><strong>Methods: </strong>The mouse MC38 colon cancer model was utilized. Various radiation regimens were designed to investigate the effects of fraction interval and fraction size on tumor growth, immune mobilization, and combination effects with anti-PD-1 immunotherapy.</p><p><strong>Results: </strong>For a fixed-dose experiment, the 6 × 5 Gy for every other day (qod) regimen demonstrated an equivalent effect on tumor growth compared to the 6 × 5 Gy once daily (qd) regimen, while the 6 × 5 Gy for twice weekly (biw) regimen failed to inhibit tumor growth. Both qod and biw regimens induced an enhanced immune response, unlike the qd regimen. For a fixed biologically equivalent dose experiment, 6 × 5 Gy qod, 4 × 7 Gy biw, and 2 × 11 Gy once weekly (qw) regimens exhibited similar tumor suppression to the 12 × 3 Gy qd regimen. The long-interval Hypo-RT regimens significantly mobilized host immunity, whereas 12 × 3 Gy qd did not. The peripheral and intratumoral T cells increased as the fraction interval and size increased. All Hypo-RT regimens combined with anti-PD-1 immunotherapy demonstrated higher intratumoral CD8 + T cells and more effective tumor growth delay compared to the 12 × 3 Gy qd regime.</p><p><strong>Conclusions: </strong>The current study suggested that a prolonged inter-fraction interval with an increased fraction size in Hypo-RT may be a promising option to balance the therapeutic effect on tumor and immune activation.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110664"},"PeriodicalIF":4.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795088","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 dose prediction to approach Erasmus-iCycle dosimetric plan quality within seconds for instantaneous treatment planning.","authors":"Joep van Genderingen, Dan Nguyen, Franziska Knuth, Hazem A A Nomer, Luca Incrocci, Abdul Wahab M Sharfo, András Zolnay, Uwe Oelfke, Steve Jiang, Linda Rossi, Ben J M Heijmen, Sebastiaan Breedveld","doi":"10.1016/j.radonc.2024.110662","DOIUrl":"10.1016/j.radonc.2024.110662","url":null,"abstract":"<p><strong>Background and purpose: </strong>Fast, high-quality deep learning (DL) prediction of patient-specific 3D dose distributions can enable instantaneous treatment planning (IP), in which the treating physician can evaluate the dose and approve the plan immediately after contouring, rather than days later. This would greatly benefit clinical workload, patient waiting times and treatment quality. IP requires that predicted dose distributions closely match the ground truth. This study examines how training dataset size and model size affect dose prediction accuracy for Erasmus-iCycle GT plans to enable IP.</p><p><strong>Materials and methods: </strong>For 1250 prostate patients, dose distributions were automatically generated using Erasmus-iCycle. Hierarchically Densely Connected U-Nets with 2/3/4/5/6 pooling layers were trained with datasets of 50/100/250/500/1000 patients, using a validation set of 100 patients. A fixed test set of 150 patients was used for evaluations.</p><p><strong>Results: </strong>For all model sizes, prediction accuracy increased with the number of training patients, without levelling off at 1000 patients. For 4-6 level models with 1000 training patients, prediction accuracies were high and comparable. For 6 levels and 1000 training patients, the median prediction errors and interquartile ranges for PTV V_95%, rectum V₇₅_Gy and bladder V₆₅_Gy were 0.01 [-0.06,0.15], 0.01 [-0.20,0.29] and -0.02 [-0.27,0.27] %-point. Dose prediction times were around 1.2 s.</p><p><strong>Conclusion: </strong>Although even for 1000 training patients there was no convergence in obtained prediction accuracy yet, the accuracy for the 6-level model with 1000 training patients may be adequate for the pursued instantaneous planning, which is subject of further research.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110662"},"PeriodicalIF":4.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795086","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 prognostic and predictive model based on deep learning to identify optimal candidates for intensity-modulated radiotherapy alone in patients with stage II nasopharyngeal carcinoma: A retrospective multicenter study.","authors":"Jiong-Lin Liang, Yue-Feng Wen, Ying-Ping Huang, Jia Guo, Yun He, Hong-Wei Xing, Ling Guo, Hai-Qiang Mai, Qi Yang","doi":"10.1016/j.radonc.2024.110660","DOIUrl":"10.1016/j.radonc.2024.110660","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate a prognostic and predictive model integrating deep learning MRI features and clinical information in patients with stage II nasopharyngeal carcinoma (NPC) to identify patients with a low risk of progression for whom intensity-modulated radiotherapy (IMRT) alone is sufficient.</p><p><strong>Methods: </strong>This multicenter, retrospective study enrolled 999 patients with stage II NPC from two centers. 3DResNet was used to extract deep learning MRI features and eXtreme Gradient Boosting model was employed to integrate the pre-trained features and clinical information to obtain an overall score for each patient. Based on the optimal cutoff value of the overall score, patients were stratified into high- and low- risk groups. Model performance was evaluated using concordance indexes (C-indexes), the area under the curve (AUC) values and calibration tests. Survival curves were used to analyze the clinical benefits of additional chemotherapy in each risk group.</p><p><strong>Results: </strong>The combined model achieved a concordance index of 0.789 (95 % confidence interval [CI] 0.787-0.791), 0.768 (95 % CI 0.764-0.771), and 0.804 (95 % CI 0.801-0.807) for the training, internal validation, and external test cohorts, respectively, demonstrating a statistically significant improvement compared to the MRI model, T Stage, and N Stage. An overall score of < 0.405 in patients was significantly associated with a low risk of progression. In the low-risk group, patients treated with IMRT alone had comparable or even superior progression-free survival (PFS) compared to those who received additional chemotherapy.</p><p><strong>Conclusion: </strong>The model demonstrated a satisfactory prognostic and predictive performance for PFS. Patients with stage II NPC were stratified into different risk groups to help identify optimal candidates who could benefit from IMRT alone.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110660"},"PeriodicalIF":4.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791783","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}