Radiotherapy and Oncology最新文献

{"title":"Adapting radiation therapy to immunotherapy: Delineation and treatment planning of pre-operative immune-modulating breast iSBRT in 151 patients treated in the randomized phase II Neo-CheckRay trial","authors":"A.De Caluwé ,&nbsp;S. Bellal ,&nbsp;K. Cao ,&nbsp;K. Peignaux ,&nbsp;V. Remouchamps ,&nbsp;A. Baten ,&nbsp;E. Longton ,&nbsp;I. Bessieres ,&nbsp;J. Vu-Bezin ,&nbsp;Y. Kirova ,&nbsp;D.Van Gestel ,&nbsp;I. Desmoulins ,&nbsp;M. Ignatiadis ,&nbsp;E. Romano ,&nbsp;L. Buisseret ,&nbsp;M. Piccart ,&nbsp;C. Vandekerkhove ,&nbsp;A. Gulyban ,&nbsp;P. Poortmans","doi":"10.1016/j.radonc.2025.110836","DOIUrl":"10.1016/j.radonc.2025.110836","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The randomized multicentric phase II Neo-CheckRay trial investigated preoperative immune-modulating stereotactic body radiation therapy (iSBRT) 8 Gy x 3 fractions in combination with chemotherapy with or without the anti PD-L1 durvalumab and the anti-CD73 oleclumab in early-stage, high-risk, luminal B breast cancer. iSBRT was solely delivered to the primary breast cancer leveraging on its immune modulating potential to sustain an anti-tumour response. To avoid immunosuppression induced by radiation therapy (RT), the tumour draining lymph nodes (TDLN) were spared. Here, we present the constraints used in the Neo-CheckRay trial and a dosimetric analysis of all delivered treatment plans with a special focus on the dose to the TDLN.</div></div><div><h3>Materials and Methods</h3><div>Main constraints were the skin (D0.1 cc &lt; 19.2 Gy), chest wall (D1cc &lt; 15 Gy) and ipsilateral uninvolved breast (V24Gy &lt; 30 %). The dose to the TDLN was reduced by avoiding beams entering or exiting the TDLN. In the present work, the DICOM-RT data of all the patients treated in the Neo-CheckRay trial were collected (n = 151) to describe doses to the target volume, to the organs at risk and the TDLN. The TDLN volumes consisted of the internal mammary nodes (IMN) and the axilla levels I-IV including the interpectoral nodes.</div></div><div><h3>Results</h3><div>In 151 patients, the median V95% of the gross target volume (GTV) and planning target volume (PTV) were 97.4 % (90 % CI 26.5–100) and 95.5 % (56.1–100). The mean dose (dMean) to all TDLN volumes was &lt; 1 Gy. The highest dMean were to the IMN and axilla level 1: 0.8 Gy (90 % CI 0.1–2.7) and 0.6 Gy (0.0–3.9), respectively. The dMean to the involved lymph nodes, if present, was 0.3 Gy (0.0–5.0).</div></div><div><h3>Conclusion</h3><div>In the Neo-CheckRay trial, the predefined organs at risk dose constraints were feasible and the TDLN were adequately spared.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110836"},"PeriodicalIF":4.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid therapy vs. Multimodal analgesia in head and neck cancer (OPTIMAL-HN): Results of a randomized clinical trial","authors":"Sondos Zayed ,&nbsp;Pencilla Lang ,&nbsp;Nancy Read ,&nbsp;Rohann J.M. Correa ,&nbsp;Adam Mutsaers ,&nbsp;Christopher D. Goodman ,&nbsp;Krista D’Angelo ,&nbsp;Kelsey Kieraszewicz ,&nbsp;Danielle Vanwynsberghe ,&nbsp;Alika Kingsbury-Paul ,&nbsp;Kathlin Crewdson ,&nbsp;Jennifer Neeb ,&nbsp;Caitlin Carreau ,&nbsp;Eric Winquist ,&nbsp;Sara Kuruvilla ,&nbsp;Paul Stewart ,&nbsp;Dwight E. Moulin ,&nbsp;Andrew Warner ,&nbsp;David A. Palma","doi":"10.1016/j.radonc.2025.110831","DOIUrl":"10.1016/j.radonc.2025.110831","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT). With no well-established standard treatment, OPTIMAL-HN aimed to demonstrate the non-inferiority of multimodal analgesia (MMA; analgesic medications with different mechanisms of action) to opioid analgesia alone.</div></div><div><h3>Methods</h3><div>OPTIMAL-HN (ClinicalTrials.gov identifier: NCT04221165) was an open-label, non-inferiority, randomized clinical trial. We enrolled HNC patients receiving curative-intent RT/CRT and experiencing moderate ≥ 4/10 RIM pain. We randomized 1:1, stratified by RT vs. CRT, to opioids alone (standard arm) or MMA (pregabalin, acetaminophen, naproxen, and opioids if required). The primary endpoint was mean pain score (range: 0–10) during the last week of RT. Secondary endpoints included mean weekly opioid use, duration of opioid requirement, quality of life, weight loss, and toxicity. All analyses were pre-specified, including testing for superiority if non-inferiority was demonstrated.</div></div><div><h3>Results</h3><div>Forty-nine patients were enrolled, 25 in the opioid analgesia arm and 24 in the MMA arm. Median follow-up was 4.2 months. The primary endpoint, mean pain score during the last 7 days of RT, was 5.1 (95 % confidence interval [CI]: 4.1–6.1) in the opioid arm and 4.9 (95 % CI: 3.8–5.9) in the MMA arm (non-inferiority p = 0.039, superiority p = 0.72). Analyzing all pain scores from enrollment to 6-weeks post-RT, MMA demonstrated both non-inferiority and superiority compared to opioids alone (non-inferiority p = 0.0024, superiority p &lt; 0.001). One patient in the MMA arm was admitted with acute kidney injury, possibly related to the analgesic regimen. Arms were similar for all other secondary endpoints.</div></div><div><h3>Conclusions</h3><div>MMA demonstrates non-inferiority to opioid analgesia alone in managing RIM pain during the last week of RT and superiority when analyzing the post-RT time period. MMA should, therefore, be considered an effective mode of analgesia for HNC patients receiving RT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110831"},"PeriodicalIF":4.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric evaluation of variation in Library of plans selection for cervical cancer radiotherapy","authors":"Yvonne J.M. de Hond,&nbsp;Paul M.A. van Haaren,&nbsp;An-Sofie E. Verrijssen,&nbsp;Rob H.N. Tijssen,&nbsp;Coen W. Hurkmans","doi":"10.1016/j.radonc.2025.110835","DOIUrl":"10.1016/j.radonc.2025.110835","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim was to determine whether differences in treatment plan selection methods from a Library-of-Plans (LoP) on cone-beam computed tomography (CBCT) leads to significant discrepancies in total accumulated dose.</div></div><div><h3>Methods</h3><div>Ten cervical cancer patients were retrospectively analyzed on plan selection and dose distribution. Dose accumulation was performed using two different plan selection methods. 1) The clinical plan selections (i.e. plans as selected during actual treatment) and 2) automatic plan selection, which was based on the largest overlap between LoP clinical target volume (CTV) and (auto-)delineated CTV on CBCT. To evaluate the influence of daily plan selection on the treatment dose, the dose of selected plans was calculated on the daily CBCTs for all fractions and accumulated on the CT. The predefined clinical goals were used to determine if there was a relevant dose difference between the clinical LoP-selection, automatic LoP-selection, and selecting solely the default plan (i.e. full bladder plan with similar margins).</div></div><div><h3>Results</h3><div>Different methods of LoP-plan selection did not result in significant dose differences. However, the default non-LoP plan resulted in significant dose differences compared to LoP-selection methods, with a reduced target coverage (99 % vs 100 %) and higher V40Gy to the rectum (55 % vs 44 %) compared to the clinical selection, respectively.</div></div><div><h3>Conclusions</h3><div>LoP is robust to variations in plan selection and LoP outperforms non-LoP approaches in terms of target coverage and organs-at-risk (OAR) sparing. Therefore, LoP is a safe and efficient alternative to online adaptive replanning, particularly for longer fractionation schemes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110835"},"PeriodicalIF":4.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562120","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":"Severity of internal lymphedema in unilateral or bilateral radiotherapy patients: An exploratory study","authors":"Coralie Arends ,&nbsp;Pieter de Veij Mestdagh ,&nbsp;Abrahim Al-Mamgani ,&nbsp;Martijn Stuiver ,&nbsp;Lisette van der Molen ,&nbsp;Michiel van den Brekel","doi":"10.1016/j.radonc.2025.110834","DOIUrl":"10.1016/j.radonc.2025.110834","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Bilateral elective nodal irradiation (ENI) is part of the standard treatment for most head and neck cancers (HNC) that are treated with primary (chemo)radiotherapy. Recent studies indicate that unilateral radiotherapy can reduce radiation-related toxicities and improve quality of life. This study examines whether there is a difference in the prevalence and severity of internal lymphedema between patients with unilateral or bilateral radiotherapy.</div></div><div><h3>Materials and methods</h3><div>Internal lymphedema was scored on available laryngoscopy videos, using the revised Patterson scale, in patients included in a previous prospective study comparing uni- versus bilateral radiotherapy. Analysis was performed by descriptively comparing the variation in location and severity of internal lymphedema, and by calculating rank biserial correlation coefficients.</div></div><div><h3>Results</h3><div>Out of 100 potentially eligible patients, 41 patients with available good-quality laryngoscopy videos were included. Of these, twenty-three patients were treated with unilateral radiotherapy and 18 with bilateral radiotherapy. The median internal lymphedema score for all patients was 7 (range: 0–24). For the patients with unilateral radiotherapy, the median was 6 (range: 0–19), compared to 9.5 (range: 0–24) for the bilateral group. Nine patients had no internal lymphedema, six in the unilateral group and three in the bilateral group. The rank biserial correlation coefficients showed a negative correlation between lymphedema and unilateral radiotherapy for all regions in the larynx (range −0.19 to −0.63), and for the total lymphedema score −0.92 (95 % CI −0.97 to −0.82).</div></div><div><h3>Conclusion</h3><div>Internal lymphedema prevalent and severity are lower after unilateral radiotherapy for head and neck cancer, compared to the current standard of care bilateral radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110834"},"PeriodicalIF":4.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577287","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":"Predicting 30-day mortality with routine blood tests in patients undergoing palliative radiation therapy: A comparison of logistic regression and gradient boosting models","authors":"Tae Hoon Lee ,&nbsp;Sang Hoon Seo ,&nbsp;Hyunju Shin ,&nbsp;Hee Jung Son ,&nbsp;Kyunga Kim ,&nbsp;Yong Chan Ahn ,&nbsp;Hongryull Pyo ,&nbsp;Do Hoon Lim ,&nbsp;Hee Chul Park ,&nbsp;Won Park ,&nbsp;Dongryul Oh ,&nbsp;Jae Myoung Noh ,&nbsp;Jeong Il Yu ,&nbsp;Won Kyung Cho ,&nbsp;Nalee Kim ,&nbsp;Kyungmi Yang ,&nbsp;Tae Gyu Kim ,&nbsp;Haeyoung Kim","doi":"10.1016/j.radonc.2025.110830","DOIUrl":"10.1016/j.radonc.2025.110830","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to estimate the 30-day mortality (30D_M) and compare models for 30D_M prediction in patients undergoing palliative radiation therapy (RT).</div></div><div><h3>Materials and methods</h3><div>Data from 3,756 patients who underwent palliative RT between 2018 and 2020 at two institutions were retrospectively reviewed. From one institution, 3,315 patients were randomly assigned to the training (N = 2,652) and internal validation (N = 663) cohorts. The remaining 441 patients from the other institution constituted the external validation cohort. Nineteen features, including seven blood test features, were extracted from medical records. For 30D_M prediction, 4 models were constructed: logistic regression comprising all features (LRM-A) and 7 blood test features (LRM-B) and gradient boosting using all features (GBM-A) and 7 blood test features (GBM-B).</div></div><div><h3>Results</h3><div>The 30D_M rates were 10.6 %, 11.2 %, and 17.5 % in the training, internal validation, and external validation cohorts, respectively. GBM-B demonstrated a good value for the area under the receiver operating characteristic curve (AUC) (0.830–0.863). Among the four models, GBM-A exhibited the highest AUC values, although GBM-B still generally outperformed LRM-A and LRM-B. The 30D_M rates significantly differed across the four prognostic groups according to the quantile values of predictive probability of GBM-B: 0–0.8 % (1st quantile), 1.2–3.4 % (2nd quantile), 8.7–12.9 % (3rd quantile), and 31.1–36.6 % (4th quantile), respectively.</div></div><div><h3>Conclusions</h3><div>The 30D_M rates were successfully stratified into distinct prognostic groups by using the GBM-B model. The model could serve as a straightforward and objective tool for predicting mortality in patients undergoing palliative RT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110830"},"PeriodicalIF":4.9,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562119","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":"Commentary on feliciani Giacomo et al.’s study of comparison of HDR-brachytherapy and tomotherapy for the treatment of non-melanoma skin cancers of the head and neck","authors":"Elisa Placidi ,&nbsp;Bruno Fionda ,&nbsp;Enrico Rosa ,&nbsp;Luca Tagliaferri ,&nbsp;Marco De Spirito","doi":"10.1016/j.radonc.2025.110826","DOIUrl":"10.1016/j.radonc.2025.110826","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110826"},"PeriodicalIF":4.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543331","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":"Aims+Scope/Editorial Board/ Publication information","authors":"","doi":"10.1016/S0167-8140(25)00106-9","DOIUrl":"10.1016/S0167-8140(25)00106-9","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"205 ","pages":"Article 110811"},"PeriodicalIF":4.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel approaches to fiducial-guided SBRT for ultra-central thoracic oligometastases","authors":"Rajesh Thomas,&nbsp;Calvin Sidhu,&nbsp;Colin Tang","doi":"10.1016/j.radonc.2025.110827","DOIUrl":"10.1016/j.radonc.2025.110827","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110827"},"PeriodicalIF":4.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543332","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":"‘iCycle-pBAO’: Automated patient-specific beam-angle selection in proton therapy applied to oropharyngeal cancer","authors":"W. Kong ,&nbsp;M. Huiskes ,&nbsp;S.J.M. Habraken ,&nbsp;E. Astreinidou ,&nbsp;C.R.N. Rasch ,&nbsp;B.J.M. Heijmen ,&nbsp;S. Breedveld","doi":"10.1016/j.radonc.2025.110799","DOIUrl":"10.1016/j.radonc.2025.110799","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to develop a fully-automated patient tailored beam-angle optimisation approach for intensity-modulated proton therapy (IMPT). For oropharynx cancer patients, the dosimetric impact of increasing the number of fields from 4 to 12 was systematically assessed.</div></div><div><h3>Approach</h3><div>A total-beam-space heuristic was developed to simultaneously select optimal patient specific candidate beam directions, according to a cost-function that penalises dose to OARs involved in clinically used NTCPs. The method was dosimetrically validated by comparisons with fixed 4- and 6-field clinical beam-angle templates and equiangular configurations, including 72-field equiangular. The latter served as dosimetric ‘Utopia’ benchmark for the other evaluated beam configurations.</div></div><div><h3>Main result</h3><div>Using 4 optimised patient-specific fields instead of the clinical 4-field beam-angle template resulted in (xerostomia NTCP + dysphagia NTCP)-reductions for all patients, with averages of 3.0 %-point (range: 1.1–5.8) for grade 2 toxicity and 1.2 %-point (range: 0.3–2.8) for grade 3. For 6 fields these reductions were 2.4 %-point (range: 0.0–5.0) and 0.8 %-point (range: −0<em>.</em>1–2.1). Xerostomia NTCPs significantly reduced with increasing numbers of patient-specific fields with a levelling off at 10–12 fields with NTCP values that closely approached those for Utopia 72-field equiangular plans. Beam angle optimisation took 52 min.</div></div><div><h3>Conclusion</h3><div>Automated, patient-tailored beam-angle optimisation could enhance IMPT plans at acceptable optimisation times. Improvements compared to the clinical beam-angle templates were highly patient-specific.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110799"},"PeriodicalIF":4.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton FLASH-Arc therapy: Bridging feasibility to clinical Utility","authors":"Jiao Yu,&nbsp;Xin Chen","doi":"10.1016/j.radonc.2025.110807","DOIUrl":"10.1016/j.radonc.2025.110807","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110807"},"PeriodicalIF":4.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520380","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}