Radiotherapy and Oncology最新文献

{"title":"Quality assessment of 2705 treatment plans in the randomised Danish Breast Cancer Group Skagen trial 1","authors":"M.S. Thomsen ,&nbsp;E.L. Lorenzen ,&nbsp;J. Alsner ,&nbsp;S.L. Krogh ,&nbsp;E.S. Yates ,&nbsp;M. Berg ,&nbsp;K.I. Dybvik ,&nbsp;K. Boye ,&nbsp;C. Kirkove ,&nbsp;I. Jensen ,&nbsp;M.M.B. Nielsen ,&nbsp;V. Tømmerås ,&nbsp;P. Schilling ,&nbsp;S. Makocki ,&nbsp;M.P. Hasler ,&nbsp;K. Andersen ,&nbsp;L. Stick ,&nbsp;M.-B. Jensen ,&nbsp;B.V. Offersen ,&nbsp;on behalf of the DBCG RT Committee","doi":"10.1016/j.radonc.2025.111142","DOIUrl":"10.1016/j.radonc.2025.111142","url":null,"abstract":"<div><h3>Purpose</h3><div>Based on prospectively uploaded treatment plans, a comprehensive analysis of the radiation therapy (RT) in the DBCG Skagen trial 1 is presented.</div></div><div><h3>Methods</h3><div>From 2015 to 2021, 2963 breast cancer patients referred to adjuvant locoregional breast cancer RT after breast conserving surgery (BCS) or mastectomy were randomised to 50 Gy/25 fractions versus 40 Gy/15 fractions. Tumour-bed boost was simultaneous integrated boost (SIB). Delineated structure volumes were per ESTRO guidelines. Dosimetric data were obtained from the individual treatment plans.</div></div><div><h3>Results</h3><div>RT treatment plans from 2705 patients treated at 14 centres in 4 countries were analysed corresponding to 94 % of the per protocol patients. Overall, 1407 had BCS, 1298 had mastectomy, and 437 had SIB. The randomisation was balanced: 1329 (50 Gy) versus 1376 (40 Gy). All plans had target volume delineations per ESTRO guidelines. No significant differences were observed regarding delineated volumes nor regarding inter-centre variations per randomisation arm. Compliance to protocol constraints was generally high, however, the “hot-spot” dose compliance was higher in 50 Gy plans compared to 40 Gy plans due to stricter high dose constraints for the 40 Gy arm. The minimum coverage of target volumes was similar per randomisation arms. Respiratory gating technique was used in 83 % of the patients. When divided into subgroups per laterality and breathing technique, significantly higher lung and heart doses were detected in non-gated compared to gated plans.</div></div><div><h3>Conclusion</h3><div>A high degree of protocol compliance was documented in the DBCG Skagen trial 1. No differences were observed among the treatment plans in the two randomisation arms.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111142"},"PeriodicalIF":5.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors and clinical outcomes in a large cohort of head and neck adenoid cystic carcinoma patients treated with proton beam therapy: Insights from an Italian referral center.","authors":"Barbara Vischioni, Maria Bonora, Giulia Fontana, Sara Scardo, Laura Brighenti, Luca D'Ambrosio, Sara Ronchi, Rossana Ingargiola, Anna Maria Camarda, Sara Imparato, Nadia Facchinetti, Alessandro Vai, Mario Ciocca, Silvia Molinelli, Ester Orlandi","doi":"10.1016/j.radonc.2025.111143","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111143","url":null,"abstract":"<p><strong>Purpose: </strong>Headandneckadenoidcysticcarcinoma(ACC) is a rare tumor, challenging to be cured for the tendency to perineural invasion and local recurrence. Our study aimed to report clinical outcomes and prognostic factors in a large cohort of ACCpatientstreated with curative protontherapy(PT) at our center.</p><p><strong>Methods and materials: </strong>Between 2017 and 2022, 129 ACC patients were treated with curative PT, both in postoperative (n = 104: R0/R1 = 74, R2 = 30) and radical settings (n = 25), with 59.4-74.2 Gy Relative Biological Effectiveness dose, in 28-37 fractions. Survival outcomes, toxicities, and the impact of key cohort characteristics on outcomes and toxicities were evaluated (α = 0.05).</p><p><strong>Results: </strong>With 34 months of median follow-up, the Overall Survival (OS), Disease-Free Survival (DFS), Local Control (LC), and Distant Metastasis-Free Survival (DMFS) at 2-, 3-, and 5-years were 94.2 %, 89.4 %, and 86.7 %, 77.5 %, 76.4 % and 64 %, 92.4 %, 90.8 % and 84 %, 77.4 %, 76.3 % and 66.6 %, respectively. Advanced T stage (HR = 4.99, p = 0.002 and HR = 4.76, p = 0.022), and solid histologic subtype (HR = 3.27, p = 0.004 and HR = 3.76, p = 0.002) negatively impacted DFS and DMFS after confounders adjustment at multivariable analysis. As for DFS, at univariable analysis, surgical margins R0/R1 positively influenced the LC in comparison to the unresected patients (p = 0.042), while HR was similar for R2 and unresected patients (p = 0.8). The maximum toxicity grade recorded was G3, 11 acute and 9 late. No G3 brain radionecrosis were registered.</p><p><strong>Conclusions: </strong>PT was effective for ACC in our hands, with a limited toxicity burden. Identification ofprognosticfactorsis essential to address proper treatment. In unresectable cases, PT can be offered as alternative to debulking surgery.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111143"},"PeriodicalIF":5.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076034","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 \"Towards reliable feature interpretation in machine learning-based acute diarrhoea toxicity assessment\".","authors":"Ying Zhang, Charles-Antoine Collins Fekete, Maria A Hawkins","doi":"10.1016/j.radonc.2025.111139","DOIUrl":"10.1016/j.radonc.2025.111139","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111139"},"PeriodicalIF":5.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076046","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":"Re-irradiation in patients affected by prostate cancer and relapsing after previous definitive or postoperative radiotherapy. An international registry based study on behalf of Italian association of radiotherapy and clinical oncology (AIRO). (RE-START)","authors":"Giulio Francolini ,&nbsp;Vanessa Di Cataldo ,&nbsp;Saverio Caini ,&nbsp;Barbara A Jereczek-Fossa ,&nbsp;Giulia Marvaso ,&nbsp;Federico Mastroleo ,&nbsp;Eugenio Cammareri ,&nbsp;Daniela Alterio ,&nbsp;Marcin Miszczyk ,&nbsp;Wojciech Majewski ,&nbsp;Maja Hasterok ,&nbsp;Fabio Matrone ,&nbsp;Alessandra Donofrio ,&nbsp;Luca Triggiani ,&nbsp;Vittorio Morelli ,&nbsp;Liliana Belgioia ,&nbsp;Elisa D’angelo ,&nbsp;Rosario Mazzola ,&nbsp;Rossana Ingargiola ,&nbsp;Antonella Fontana ,&nbsp;Lorenzo Livi","doi":"10.1016/j.radonc.2025.111138","DOIUrl":"10.1016/j.radonc.2025.111138","url":null,"abstract":"<div><h3>Background</h3><div>Aiming to evaluate the long-term safety of re-irradiation approaches, the Italian Association for Radiotherapy and Clinical Oncology Oncology (AIRO) re-irradiation study group proposed the institution of a multicentric registry including prostate cancer patients undergoing re-irradiation for local relapse after postoperative or definitive RT.</div></div><div><h3>Materials and methods</h3><div>RESTART is an observational longitudinal study including patients with biochemical relapse according to EAU criteria after a previous course of definitive or postoperative RT, and treated for a macroscopic recurrence within the prostate or prostate bed visualized on PET-CT or magnetic resonance imaging (MRI). Patients were treated with stereotactic body radiotherapy (SBRT) or brachytherapy (BT), with fraction doses of at least 5 Gy for EBRT, and no other restrictions regarding fractionation schedule or total dose. Exclusion criteria consisted of the presence of regional nodal disease or distant metastases, persisting severe toxicities from previous RT or follow-up shorter than 6 months.</div></div><div><h3>Results</h3><div>Four hundred and thirty-three patients from 5 centers were included in the current analysis. Overall, 64.2 % and 90.3 % of patients did not report any acuteGU or GI toxicity. No treatment-related deaths were registered. LateG2 or G3 GU toxicity was reported in 16.2 and 4.8 % of patients, respectively. After a median follow-up of 54 months (95 % CI 26–78), 239 biochemical recurrences (55.2 %), 119 radiologically-confirmed regional or distant relapses (27.2 %), and 95 deaths (21.9 %) were recorded, respectively.</div></div><div><h3>Conclusion</h3><div>Results confirm the safety, feasibility, and efficacy of re-irradiation for prostate cancer, and provide insights about features associated with improved oncological outcomes after treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111138"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070401","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 of artificial intelligence-screened interstitial lung disease with radiation pneumonitis in locally advanced non-small cell lung cancer","authors":"Hannah Bacon ,&nbsp;Nicholas McNeil ,&nbsp;Tirth Patel ,&nbsp;Mattea Welch ,&nbsp;Xiang Y. Ye ,&nbsp;Andrea Bezjak ,&nbsp;Benjamin H. Lok ,&nbsp;Srinivas Raman ,&nbsp;Meredith Giuliani ,&nbsp;B.C. John Cho ,&nbsp;Alexander Sun ,&nbsp;Patricia Lindsay ,&nbsp;Geoffrey Liu ,&nbsp;Sonja Kandel ,&nbsp;Chris McIntosh ,&nbsp;Tony Tadic ,&nbsp;Andrew Hope","doi":"10.1016/j.radonc.2025.111144","DOIUrl":"10.1016/j.radonc.2025.111144","url":null,"abstract":"<div><h3>Purpose</h3><div>Interstitial lung disease (ILD) has been correlated with an increased risk for radiation pneumonitis (RP) following lung SBRT, but the degree to which locally advanced NSCLC (LA-NSCLC) patients are affected has yet to be quantified. An algorithm to identify patients at high risk for RP may help clinicians mitigate risk.</div></div><div><h3>Methods</h3><div>All LA-NSCLC patients treated with definitive radiotherapy at our institution from 2006 to 2021 were retrospectively assessed. A convolutional neural network was previously developed to identify patients with radiographic ILD using planning computed tomography (CT) images<em>.</em> All screen-positive (AI-ILD + ) patients were reviewed by a thoracic radiologist to identify true radiographic ILD (r-ILD). The association between the algorithm output, clinical and dosimetric variables, and the outcomes of grade ≥3 RP and mortality were assessed using univariate (UVA) and multivariable (MVA) logistic regression, and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>698 patients were included in the analysis. Grade (G) 0–5 RP was reported in 51 %, 27 %, 17 %, 4.4 %, 0.14 % and 0.57 % of patients, respectively. Overall, 23 % of patients were classified as AI-ILD+. On MVA, only AI-ILD status (OR 2.15, p = 0.03) and AI-ILD score (OR 35.27, p &lt; 0.01) were significant predictors of G3+RP. Median OS was 3.6 years in AI-ILD- patients and 2.3 years in AI-ILD+patients (NS). Patients with r-ILD had significantly higher rates of severe toxicities, with G3+RP 25 % and G5 RP 7 %. R-ILD was associated with an increased risk for G3+RP on MVA (OR 5.42, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Our AI-ILD algorithm detects patients with significantly increased risk for G3+RP.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111144"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070439","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":"High-Dose-Rate brachytherapy for salvage treatment of prostate cancer recurrence post-prostatectomy and radiotherapy: A multicenter retrospective analysis (HDR-REPOPRA) by UroGEC","authors":"Adam Kluska ,&nbsp;Artur J. Chyrek ,&nbsp;Benjamin Guix ,&nbsp;Patricia Willisch ,&nbsp;Tamer Soror ,&nbsp;Mateusz Bilski ,&nbsp;Ivan Garcia ,&nbsp;Teresa Guix ,&nbsp;Beatriz Vázquez ,&nbsp;Wojciech Burchardt ,&nbsp;Piotr Lelek ,&nbsp;Ricarda Merten ,&nbsp;Vratislav Strnad ,&nbsp;Iosif Strouthos ,&nbsp;Mario Terlizzi ,&nbsp;David Büchser ,&nbsp;Pierre Blanchard ,&nbsp;Alfonso Gomez- Iturriaga ,&nbsp;Piotr Wojcieszek","doi":"10.1016/j.radonc.2025.111145","DOIUrl":"10.1016/j.radonc.2025.111145","url":null,"abstract":"<div><h3>Background</h3><div>Local recurrence of prostate cancer following radical prostatectomy (RP) and adjuvant or salvage external beam radiotherapy (a/sEBRT) presents a therapeutic challenge. Salvage high-dose-rate brachytherapy (HDR-BT) is a promising modality, though evidence remains limited.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively analyzed 90 patients treated with salvage HDR-BT after RP and a/sEBRT across 10 UroGEC-ESTRO-affiliated European centers. Eligible patients had biopsy- or imaging-confirmed local recurrence and ECOG performance status 0–2. Primary endpoints were local recurrence-free survival (LRFS) and toxicity; secondary endpoints included biochemical failure-free survival (BFFS), metastasis-free survival (MFS), progression-free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>The median follow-up was 47 months. The 5-year LRFS was 81.1 %, BFFS 62 %, MFS 77.5 %, PFS 58.0 %, and OS 95.9 %. Biopsy-confirmed recurrence and use of androgen deprivation therapy (ADT) were associated with improved LRFS and PFS. Grade ≥3 genitourinary toxicity occurred in 5.5 % (acute) and 8.9 % (late) of patients; gastrointestinal grade 3 toxicity was observed in 1.1 %.</div></div><div><h3>Conclusion</h3><div>HDR-BT is a safe and effective salvage option for well-selected patients with local recurrence after RP and a/sEBRT. Our data support its feasibility, acceptable toxicity, and favorable oncologic outcomes. Biopsy confirmation and ADT use may improve results and should be considered in treatment planning. These findings warrant further prospective evaluation to optimize patient selection and refine salvage strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111145"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070422","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":"Dual benefits of new radiotherapy units: Improved access and reduced emissions","authors":"David Ali ,&nbsp;Max Piffoux","doi":"10.1016/j.radonc.2025.111137","DOIUrl":"10.1016/j.radonc.2025.111137","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiotherapy accessibility varies significantly within countries. Radiotherapy has a significant carbon footprint, primarily driven by patient transportation emissions in Europe.</div></div><div><h3>Objective</h3><div>This study aimed to determine if strategically located new Radiotherapy Units (RUs) and Linear Accelerator (LINAC) reallocation could simultaneously improve accessibility and reduce the carbon footprint of External Beam Radiotherapy (EBRT) in France.</div></div><div><h3>Methodology</h3><div>A national-scale Location-Allocation (LA) model, incorporating accessibility efficiency and equity, resource density, and greenhouse gas emissions, was used. Sensitivity analysis was used to assess the robustness of the results.</div></div><div><h3>Results</h3><div>We identified 27 potential locations for new RUs across 13 geographically independent clusters. Increase in emissions for the creation and maintenance is compensated with a mean carbon Return on Investment (ROI) of 4.6 years. Implementing the optimal RU within each cluster and reallocating LINACs would save an estimated 26,050 tons of CO2eq over a 10-year period, corresponding to ≈326 years in good health (DALYs) saved in the future. Public transport accessibility to an RU within 45 min would be gained for 405,487 individuals (0.6 %), and driving duration would improve for 3,301,705 (4.8 %). An additional 912 patients annually who currently do not receive radiotherapy due to excessive travel times (decay effect) would be treated.</div></div><div><h3>Conclusion</h3><div>Strategically located new Radiotherapy Units and LINAC reallocation can improve both accessibility and reduce the carbon footprint of EBRT. However, this latter benefit is limited and other more effective mitigation strategies should be considered concurrently.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111137"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070445","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":"Integrating radiomics and dosiomics with lung biologically equivalent dose for predicting symptomatic radiation pneumonitis after lung SBRT: A dual-center study","authors":"Yuxin Jiao ,&nbsp;Yawen Wen ,&nbsp;Shihong Li ,&nbsp;Hongbo Gao ,&nbsp;Di Chen ,&nbsp;Li Sun ,&nbsp;Guangwu Lin ,&nbsp;Yanping Ren","doi":"10.1016/j.radonc.2025.111129","DOIUrl":"10.1016/j.radonc.2025.111129","url":null,"abstract":"<div><h3>Background and purpose</h3><div>This study focused on developing and validating a composite model that integrates radiomic and dosiomic features based on a lung biologically equivalent dose segmentation approach to predict symptomatic radiation pneumonitis (SRP) following lung SBRT.</div></div><div><h3>Materials and methods</h3><div>A dual-centered cohorts of 182 lung cancer patients treated with SBRT were divided into training, validation, and external testing sets. Radiomic and dosiomic features were extracted from two distinct regions of interest (ROIs) in the planning computed tomography (CT) images and 3D dose distribution maps, which encompassed both the entire lung and biologically equivalent dose (BED) regions. Feature selection involved correlation filters and LASSO regularization. Five machine learning algorithms generated three individual models (dose-volume histogram [DVH], radiomic [R], dosiomic [D]) and three combined models (R + DVH, R + D, R + D + DVH). Performance was evaluated via ROC analysis, calibration, and decision curve analysis.</div></div><div><h3>Results</h3><div>Among the clinical and dosimetric factors, V_BED70 (α/β = 3 Gy) of the lung was recognized as an independent risk factor for SRP. BED-based radiomic and dosiomic models outperformed whole-lung models (AUCs: 0.806 vs. 0.674 and 0.821 vs. 0.647, respectively). The R + D + DVH trio model achieved the highest predictive accuracy (AUC: 0.889, 95 % CI: 0.701–0.956), with robust calibration and clinical utility.</div></div><div><h3>Conclusions</h3><div>The R + D + DVH trio model based on lung biologically equivalent dose segmentation approach outperforms other models in predicting SRP across various SBRT fractionation schemes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111129"},"PeriodicalIF":5.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145045863","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":"Efficacy and safety of twice-daily accelerated hyperfractionated re-irradiation for thoracic malignancies","authors":"Victoria L. Doss ,&nbsp;Cecilia F.P.M. de Sousa ,&nbsp;Elaina Hales ,&nbsp;Tinker Trent ,&nbsp;Esi Hagan ,&nbsp;Tsion Gebre ,&nbsp;Anas Obaideen ,&nbsp;Meti Negassa ,&nbsp;Dezhi Liu ,&nbsp;Chen Hu ,&nbsp;Akila N. Viswanathan ,&nbsp;Heng Li ,&nbsp;K.Ranh Voong ,&nbsp;Xun Jia ,&nbsp;Todd McNutt ,&nbsp;Rachel B. Ger ,&nbsp;Russell K. Hales","doi":"10.1016/j.radonc.2025.111130","DOIUrl":"10.1016/j.radonc.2025.111130","url":null,"abstract":"<div><h3>Introduction</h3><div>Balancing the demands for dose-escalated re-irradiation with toxicity to organs at risk (OARs) is a challenge. Twice-daily (BID) accelerated hyperfractionated re-irradiation (re-RT) is a potential solution, yet there is no guidance for its application for thoracic malignancies.</div></div><div><h3>Methods</h3><div>All BID thoracic re-RT cases at our institution since 2014 were reviewed. Prior radiation courses were deformably registered. Summary plan dosimetrics were extracted using per-voxel cumulative EQD2 (α/β = 3 for normal tissues). Maximum toxicity following BID re-RT was graded per CTCAE v5.0 and assessed for relationship to radiation. Local failure (LF), progression-free survival (PFS), and overall survival (OS) were measured and compared between subgroups based on histology, re-RT dose, and metastatic status.</div></div><div><h3>Results</h3><div>Sixty-four BID re-RT cases delivering at least 45 Gy in 30 fractions were reviewed. Fifty-eight patients (90.6 %) received a prior definitive course of radiation. The median first course EQD2 (α/β = 10) was 60.2 Gy. Median follow-up after re-RT was 14.2 months. Median OS was 18.5 months from completion of BID re-RT, and 59.0 % of patients had sustained local control at two years. Ten patients (15.6 %) experienced grade ≥3 toxicity. There were no grade 4 toxicities. There was one grade 5 event possibly attributable to re-RT. Of 24 OAR doses exceeding American Radium Society (ARS) and American College of Radiology (ACR) cumulative dose recommendations for re-RT, one case was associated with grade ≥3 toxicity.</div></div><div><h3>Conclusions</h3><div>Accelerated hyperfractionated BID re-RT is safe and effective for thoracic re-RT, providing durable local control and favorable survival outcomes with acceptable toxicity.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111130"},"PeriodicalIF":5.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055666","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":"Outcomes of local therapies for recurrent and radiation-associated soft tissue sarcomas of the extremities and trunk: is there a role for re-irradiation?","authors":"Reinhardt Krcek ,&nbsp;Anthony M. Griffin ,&nbsp;Charles N. Catton ,&nbsp;Peter W.M. Chung ,&nbsp;Brian O’Sullivan ,&nbsp;Amy Parent ,&nbsp;Siyer Roohani ,&nbsp;David B. Shultz ,&nbsp;Philip Wong ,&nbsp;Peter C. Ferguson ,&nbsp;Kim Tsoi ,&nbsp;Jay S. Wunder ,&nbsp;David G. Kirsch","doi":"10.1016/j.radonc.2025.111136","DOIUrl":"10.1016/j.radonc.2025.111136","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Managing locally relapsed soft tissue sarcomas (STS) after prior radiotherapy (RT) and radiation-associated sarcomas (RAS) is challenging. Limb-sparing surgery without repeated RT may be suboptimal in anatomically constrained cases, while amputation compromises function and quality of life. This study evaluates outcomes of patients treated with re-irradiation plus surgery versus surgery alone.</div></div><div><h3>Material and methods</h3><div>This retrospective cohort study included patients treated at a single sarcoma centre (Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto) for locally relapsed STS after prior RT and surgery, or for RAS, diagnosed between October 1985 and August 2024. Treatment and outcome data were analyzed to compare local control, limb preservation, complications, distant failure, and overall survival between patients receiving re-irradiation plus surgery versus surgery alone.</div></div><div><h3>Results</h3><div>A total of 93 patients with recurrent STS and 13 with RAS were analyzed. RT for re-irradiation was mostly administered preoperatively using a twice-daily (BID) fractionation scheme. The 5-year local control rate for recurrent STS was 82.8 % in the re-irradiation plus surgery group and 67.9 % in the surgery-only group (p = 0.336). The 5-year limb preservation rate was significantly higher with re-irradiation (80.8 %) versus surgery alone (40.2 %) (p &lt; 0.001). Complications requiring intervention were more frequent with re-irradiation for relapses (13/43 vs. 3/50, p = 0.002). Freedom from distant failure and overall survival (OS) at 5 years were similar between the groups (65.1 vs. 71.7 % and 57.3 % vs. 55 %). The 5-year OS after RAS diagnosis was 75.2 %, with five complications, four local failures, and four patients developing distant failure during follow-up.</div></div><div><h3>Conclusion</h3><div>Re-irradiation combined with surgery represents a viable alternative to amputation or surgery alone in selected patients with locally relapsed STS or RAS, with high rates of limb salvage and acceptable toxicity.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111136"},"PeriodicalIF":5.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055732","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}