Radiotherapy and Oncology最新文献

{"title":"Evaluating risk factors for skeletal-related events among bone metastases from solid tumors","authors":"Justin Leu ,&nbsp;Lakshmi Rekha Narra ,&nbsp;Ted Gooley ,&nbsp;Nathan Cross ,&nbsp;Winston Vuong ,&nbsp;Hiba Khan ,&nbsp;John Kang ,&nbsp;Jonathan T. Yang ,&nbsp;Clemens Grassberger ,&nbsp;Erin F. Gillespie","doi":"10.1016/j.radonc.2025.111048","DOIUrl":"10.1016/j.radonc.2025.111048","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Skeletal-related events (SRE) are a major source of morbidity and mortality across cancer types. Identification of risk factors for SRE and association with survival would facilitate more targeted preventive treatment.</div></div><div><h3>Materials and Methods</h3><div>This retrospective cohort study included patients with bone metastases from solid tumors undergoing systemic imaging from February-March 2022 who had not received radiation within one year. Survival was analyzed using Cox models, and multi-state models assessed factors linked to SRE with death as a competing risk. Outcomes were SRE (including radiation for pain) and all-cause death. Variables included tumor type, metastasis site, and trial eligibility.</div></div><div><h3>Results</h3><div>Among 410 patients (median age 67 years; 48% male), 162 (40%) experienced SRE over a median follow-up of 26.8 months. Seventy-five (18%) received radiation for pain alone. Experiencing any type of SRE (HR 1.98, 95% CI 1.47 – 2.67, p&lt;0.001) or radiation for pain alone (HR 2.14, 95% CI 1.57 – 2.92, p&lt;0.001) were both associated with increased mortality. Patients eligible for a trial of early radiation were more likely to develop SRE (HR 1.67, 95% CI 1.18 – 2.37, p=0.004). Prostate cancer histology (HR 1.70, p=0.02) and metastases to the hip/acetabulum (HR 2.55, p=0.02) were associated with SRE.</div></div><div><h3>Conclusion</h3><div>Patients treated with radiation for pain alone demonstrated similar risk of death as those experiencing any type of SRE, supporting the inclusion of radiation in endpoint definitions. Prostate cancer type and hip/acetabulum metastasis location may help identify patients and lesions at elevated SRE risk, informing future preventive strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"211 ","pages":"Article 111048"},"PeriodicalIF":4.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675581","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":"Non-cisplatin concurrent agents plus definitive radiotherapy for locally advanced head and neck cancer: A network meta-analysis of randomized studies","authors":"Fausto Petrelli ,&nbsp;Francesca Trevisan ,&nbsp;Massimiliano Nardone ,&nbsp;Daniela Carioli ,&nbsp;Angela Gasparini ,&nbsp;Chiara Bramati ,&nbsp;Lorenza Bruschieri ,&nbsp;Valentina Riboldi ,&nbsp;Vincenzo Capriotti ,&nbsp;Agostina De Stefani ,&nbsp;Luigi Lorini ,&nbsp;Daniele Spada ,&nbsp;Veronica Lonati ,&nbsp;Paolo Bossi","doi":"10.1016/j.radonc.2025.111033","DOIUrl":"10.1016/j.radonc.2025.111033","url":null,"abstract":"<div><h3>Introduction</h3><div>Head and neck squamous cell carcinoma (HNSCC) poses a significant clinical challenge, particularly in its locally advanced stages. Cisplatin-based, definitive, chemoradiotherapy (CRT) is recognized as the preferred treatment strategy, providing substantial survival benefits and currently achieving the best locoregional control (LRC). However, the toxicity profile of cisplatin, which includes nephrotoxicity, neurotoxicity, and ototoxicity, restricts its application in patients with comorbidities or those of advanced age. Emerging alternatives such as carboplatin, taxanes, cetuximab, and immune checkpoint inhibitors (ICIs) are gaining attention. This study undertakes a network <em>meta</em>-analysis (NMA) to assess the effectiveness and safety of these agents in conjunction with definitive RT.</div></div><div><h3>Methods</h3><div>The inclusion criteria targeted definitive RT in conjunction with non-cisplatin systemic therapies, compared to RT with or without cisplatin in adult HNSCC patients. The outcomes evaluated included overall survival (OS), progression-free survival (PFS), and locoregional control (LRC). Statistical methodologies, including the Surface Under the Cumulative Ranking Curve (SUCRA), were employed to rank the treatment protocols.</div></div><div><h3>Results</h3><div>The analysis incorporated 29 randomized controlled trials assessing 18 treatment modalities. Three cisplatin-based regimens combined with RT consistently demonstrated superior efficacy in OS, ranking as the 3 most effective option for OS, followed by weekly docetaxel combined with RT. Non-cisplatin alternatives such as mitomycin C-based regimens + RT, and methotrexate + RT, demonstrated promising efficacy. For PFS, they ranked first and second, with SUCRA scores of 83 % and 79 %, respectively. Regarding LRC, mitomycin C-based regimens + RT and weekly docetaxel + RT emerged as the top two options, achieving SUCRA scores of 97 % and 93 %, respectively. Cetuximab and ICIs combined with RT ranked lowest across all assessed outcomes.</div></div><div><h3>Conclusion</h3><div>While cisplatin remains the standard of care, carboplatin, mitomycin C-based, and weekly docetaxel + RT regimens present viable alternatives as concurrent agents during RT for patients with stage III-IV HNSCC who are not eligible for cisplatin. It is imperative to develop tailored treatment strategies to enhance clinical outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111033"},"PeriodicalIF":4.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650258","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":"Reirradiation dose constraints in clinical practice: Results of an international survey","authors":"Joep Stroom ,&nbsp;Myriam Ayadi ,&nbsp;Anja Aarberg ,&nbsp;Vera Batel ,&nbsp;Cemile Ceylan ,&nbsp;Sinéad Cleary ,&nbsp;Carlo Greco ,&nbsp;Lone Hoffmann ,&nbsp;Andrew Jackson ,&nbsp;Colin Kelly ,&nbsp;Charles Mayo ,&nbsp;Chrysanthi Michailidou ,&nbsp;Donna H Murrell ,&nbsp;Sarah Muscat ,&nbsp;Christopher JH Pagett ,&nbsp;Kelly C Paradis ,&nbsp;Jaime Perez-Alija ,&nbsp;Ellen Yorke ,&nbsp;Ali Zaila ,&nbsp;Nick West","doi":"10.1016/j.radonc.2025.111030","DOIUrl":"10.1016/j.radonc.2025.111030","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the increasing frequency of reirradiation (reRT) in cancer treatment, a critical lack of reliable dose constraint data remains. This study addresses this gap by collating current reRT constraints used in clinical practice across multiple centers, facilitating the development of more consistent and safer reRT guidelines.</div></div><div><h3>Materials and methods</h3><div>A comprehensive survey collected data on reRT patient numbers, dose constraints, sources, and dose summation methods for 30 OARs. Information also included PRV margins, tissue recovery factors (TRF) with time intervals, α/β values, near-D_max definitions, and dose constraints in EQD2Gy for first and reRT courses. The relative difference (X_reRT) between cumulative reRT and first course constraints was calculated. Constraints with data from at least 7 centers were included for further analysis.</div></div><div><h3>Results</h3><div>A median of 6 % of treatments in 17 participating centers were reRT. Most centers derived reRT constraints from the literature (81 %) or first course constraints (68 %). In total 209 cumulative near-D_max values for 19 OARs fulfilled n ≥ 7, yielding a median inter-center variation of 21 % (IQR). While α/β values were relatively consistent, substantial variations were seen in near-D_max volume definition, TRF, and PRV margins. The median X_reRT was 26 %, primarily attributed to the TRF which had a median value of 23 %.</div></div><div><h3>Conclusions</h3><div>This multi-centre survey identified a concerning median inter-centre variation of 21 % in cumulative reRT dose constraints, indicating substantial heterogeneity in current clinical practices. Further prospective studies with rigorous and standardized dose reporting are essential to refine reRT guidelines, enhancing patient safety and treatment efficacy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111030"},"PeriodicalIF":4.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650259","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":"Shifting away from elective nodal irradiation in HNSCC: What do we know and Where are we heading?","authors":"Julian Biau ,&nbsp;Vincent Grégoire ,&nbsp;Silke Tribius ,&nbsp;Pierre Blanchard ,&nbsp;Pierluigi Bonomo ,&nbsp;Jon Cacicedo ,&nbsp;Sue S. Yom","doi":"10.1016/j.radonc.2025.111046","DOIUrl":"10.1016/j.radonc.2025.111046","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111046"},"PeriodicalIF":4.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637881","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":"Repositioning Radiation Oncology at the centre of integrated oncology care: A manifesto of the European Society for Radiotherapy and Oncology (ESTRO)","authors":"Icro Meattini ,&nbsp;Marianne C. Aznar ,&nbsp;Luca Boldrini ,&nbsp;Kerstin Borgmann ,&nbsp;Catharine H. Clark ,&nbsp;Corinne Faivre-Finn ,&nbsp;Elizabeth Forde ,&nbsp;Uulke A. van der Heide ,&nbsp;Barbara Alicja Jereczek-Fossa ,&nbsp;Núria Jornet ,&nbsp;Anna M. Kirby ,&nbsp;Piet Ost ,&nbsp;Ivica Ratosa ,&nbsp;Kari Tanderup ,&nbsp;Esther G.C. Troost ,&nbsp;Alessandro J. Cortese ,&nbsp;Matthias Guckenberger","doi":"10.1016/j.radonc.2025.111035","DOIUrl":"10.1016/j.radonc.2025.111035","url":null,"abstract":"<div><div>Modern oncology increasingly relies on integrated, multimodality care, yet radiation oncology remains undervalued in strategic frameworks despite its central therapeutic role. This ESTRO manifesto calls for a repositioning of radiation oncology as a core discipline in cancer care, scientifically, clinically, and politically. The field now extends beyond beam delivery to encompass systemic therapy integration, personalised strategies based on biology and imaging, and active participation in clinical decision-making and guideline development. Radiation oncology contributes to treatment sequencing, synergistic combinations, and innovation in areas such as radioligand therapy and artificial intelligence. ESTRO’s initiatives, including education, research networks, and oncopolicy engagement, underscore the discipline’s broad scope and societal value. Strategic partnerships with Pharma and MedTech, alongside a renewed emphasis on equitable access, are essential to sustaining progress. ESTRO invites all stakeholders to recognise radiation oncology as fundamental to the design, delivery, and evolution of modern cancer therapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111035"},"PeriodicalIF":4.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634387","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":"Further Data to Support Clinical Integration of Nodal Hypofractionation: A Commentary on the FAST-Forward Nodal Sub-study","authors":"Gonca Altınışık İnan,&nbsp;İpek Pınar Aral","doi":"10.1016/j.radonc.2025.111036","DOIUrl":"10.1016/j.radonc.2025.111036","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111036"},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626977","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":"Less might be more: Enhancing clinical translation of DenseNet for OPC prognosis through selective imaging fusion","authors":"Chong Cheng,&nbsp;Xin Chen","doi":"10.1016/j.radonc.2025.111043","DOIUrl":"10.1016/j.radonc.2025.111043","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"211 ","pages":"Article 111043"},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626978","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":"NTCP models based on CT-guided online adaptive SBRT for abdominal lymph node oligometastases","authors":"Lucy A. van Werkhoven,&nbsp;Maaike T.W. Milder,&nbsp;Mischa S. Hoogeman,&nbsp;Remi A. Nout,&nbsp;Joost J. Nuyttens","doi":"10.1016/j.radonc.2025.111027","DOIUrl":"10.1016/j.radonc.2025.111027","url":null,"abstract":"<div><h3>Background and purpose</h3><div>This study prospectively analyzed the correlation between dose and toxicity in CT-guided online adaptive stereotactic body radiotherapy for abdominal and pelvic lymph node (A-P LN) oligometastases. The aim was to design an NTCP model to predict acute gastrointestinal (GI) toxicity.</div></div><div><h3>Materials and methods</h3><div>Patients with oligometastatic A-P LN received 45 Gy in five fractions. Three treatment plans were created using a pre-treatment diagnostic CT scan. After a pre-fraction in-room CT scan, the radiotherapy technologist used a decision tree to select the optimal plan. Dose volume histogram (DVH) parameters (Dmax, D0.2 cc, D0.5 cc, D1cc D2cc D5cc and D10cc) were extracted from the fraction CT with the selected library plan. The DVH-parameters were analyzed and used for NTCP modelling based on logistic regression analysis.</div></div><div><h3>Results</h3><div>In total, 55 treatments were performed in 52 patients. No acute or late grade ≥ 3 GI toxicity was observed, while 20 (36.4 %) patients experienced one or more acute grade ≤ 2 GI toxicities. The median dose to the gastrointestinal organs (GIO) was significantly higher across all DVH parameters in patients with toxicity. The NTCP model predicted a 50 % chance of acute grade ≤ 2 GI toxicity at a D0.5 cc of 57 EQD210.</div></div><div><h3>Conclusion</h3><div>Significant correlations between GI dose parameters D0.2 cc, D0.5 cc, D1cc D2cc, and D5cc and acute grade ≤ 2 GI toxicity were found. These models have the potential to demonstrate the extent to which toxicity rates can be reduced by lowering the dose.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111027"},"PeriodicalIF":4.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626979","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 systematic review and meta-analysis with focus on radiotherapy of pediatric standard-risk medulloblastoma: New strategies are needed to improve survival and reduce side-effects","authors":"Anneli Edvardsson ,&nbsp;Birgitta Lannering ,&nbsp;Jenny Gorgisyan ,&nbsp;Per Munck af Rosenschöld ,&nbsp;Thomas Björk-Eriksson","doi":"10.1016/j.radonc.2025.111045","DOIUrl":"10.1016/j.radonc.2025.111045","url":null,"abstract":"<div><div>We explored the impact of different radiotherapy (RT) treatment modalities and prescriptions on outcomes for standard risk pediatric medulloblastoma patients (MB-SR). A systematic review and <em>meta</em>-analysis were performed. Primary MB-SR patients, aged 3–21 years treated with cranio-spinal axis and tumor boost RT during 1995–2024 were included. Data on progression-free and overall survival outcomes (PFS and OS) and side-effects were extracted. Trial efforts for MB-SR have focused on mitigation of side-effects through de-escalation of RT, with practically unchanged PFS and OS during the past 30 years. The three major changes firstly reduced radiation dose to the cranio-spinal axis, secondly reduced boost volume from the entire posterior fossa to only the tumor volume with margin and finally the importance of increased conformity. Sixteen different studies and 2002 patients were included in pooled random-effects models, revealing a 5-year PFS and OS of 76.9 % and 83.8 %, respectively. However, new strategies are needed to further improvement of survival and reduced side-effects.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"211 ","pages":"Article 111045"},"PeriodicalIF":5.3,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144626976","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":"Comparing adaptive and dose redistributed radiotherapy to conventional radiotherapy in head and neck cancer – Quality of life results from the phase III ARTFORCE trial","authors":"Anna Liza M.P. de Leeuw ,&nbsp;Frank J.P. Hoebers ,&nbsp;Jordi Giralt ,&nbsp;Yungan Tao ,&nbsp;Chris H.J. Terhaard ,&nbsp;Lip Wai Lee ,&nbsp;Signe Friesland ,&nbsp;Roel J.H.M. Steenbakkers ,&nbsp;Lisa Tans ,&nbsp;Mutamba T. Kayembe ,&nbsp;Simon R van Kranen ,&nbsp;Harry Bartelink ,&nbsp;Coen R.N Rasch ,&nbsp;Jan-Jakob Sonke ,&nbsp;Olga Hamming-Vrieze","doi":"10.1016/j.radonc.2025.111044","DOIUrl":"10.1016/j.radonc.2025.111044","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compared patient-reported quality of life (QoL) between patients with head and neck cancer treated with either FDG/PET-guided dose redistribution with scheduled treatment adaptation (rRT) or conventional radiotherapy (cRT).</div></div><div><h3>Methods</h3><div>QoL outcomes were assessed at baseline, directly after radiotherapy and at 6-month, 1-, 2-, and 5-year follow up using the EORTC QLQ C30, EORTC QLQ HN35 and EQ-5D-5L. Linear mixed-effects models (LMMs) were used for longitudinal analysis including fixed effects for baseline QoL scores, trial arm, time, an interaction term between trial arm and time and random effects for patients.</div></div><div><h3>Results</h3><div>142 out of 221 patients (64 %) filled out at least one QoL questionnaire and were included for analysis. QoL was overall comparable between trial arms, with exception of a significant increase in sticky saliva complaints at 1 year and decreased global health status at 2 years in cRT compared to rRT. In the majority of the other LMMs, patients’ QoL was significantly associated with their baseline QoL values and initial QoL deterioration observed after treatment was followed by improvement throughout follow up.</div></div><div><h3>Conclusions</h3><div>In line with the primary results of the trial (ARTFORCE, NCT01504815), dose redistribution combined with scheduled treatment adaptation showed comparable QoL outcome to conventional radiotherapy. Overall, QoL was mostly determined by patients’ individual baseline QoL and improved at 6 months of follow up. These results confirm that this dose redistribution strategy is a safe strategy to increase dose to tumor subregions.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111044"},"PeriodicalIF":4.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144619943","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}