Radiotherapy and Oncology最新文献

{"title":"Systematic review of MRI alterations in the brain following proton and photon radiation therapy: Towards a uniform European Particle Therapy Network (EPTN) definition","authors":"Lieselotte Lauwens ,&nbsp;Marvin F. Ribeiro ,&nbsp;Catharina M.L. Zegers ,&nbsp;Morton Høyer ,&nbsp;Claire Alapetite ,&nbsp;Malin Blomstrand ,&nbsp;Valentin Calugaru ,&nbsp;Dario Di Perri ,&nbsp;Alberto Iannalfi ,&nbsp;Carola Lütgendorf-Caucig ,&nbsp;Frank Paulsen ,&nbsp;Alida A. Postma ,&nbsp;Alejandra Méndèz Romero ,&nbsp;Beate Timmermann ,&nbsp;Esther G.C. Troost ,&nbsp;Hiska L. van der Weide ,&nbsp;Gillian A. Whitfield ,&nbsp;Semi Harrabi ,&nbsp;Maarten Lambrecht ,&nbsp;Daniëlle B.P. Eekers","doi":"10.1016/j.radonc.2025.110936","DOIUrl":"10.1016/j.radonc.2025.110936","url":null,"abstract":"<div><div>Magnetic resonance imaging (MRI) often demonstrates alterations following cranial radiotherapy (RT), which may result in clinical symptoms and diagnostic uncertainty, and thus potentially impact treatment decisions. The potential differences in MRI alterations after proton and photon RT, has raised concerns regarding the relative biological effectiveness of proton therapy. To provide an overview of MRI alterations in the brain post-RT and to explore differences between photon and proton RT, a systematic review adhering to the PRISMA guidelines was conducted, focusing on the assessment methods and definitions across studies. A systematic search of three electronic databases was performed using the concepts ‘normo-fractionated radiotherapy ‘, ‘MRI alterations’ and ‘brain, skull base or head and neck tumours in adult and paediatric populations’. Data extraction and quality assessment was performed on articles meeting the predefined criteria by two independent reviewers. Out of 5887 screened studies, 94 met the inclusion criteria. These studies were categorized based on confinement of the MRI alterations to temporal lobe, brainstem, or across the entire brain. Additional subclassification was performed based on MRI sequences evaluated or by the nature of the alterations, with pseudoprogression generally reserved for glioma patients. While many papers exist on MRI alterations in the brain after RT, this review highlights significant inconsistencies in the terminology and definitions, limiting the comparability of findings across studies. Our results highlight the need for and facilitate the development of a standardized framework for describing MRI alterations after RT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110936"},"PeriodicalIF":4.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948709","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":"Proton beam therapy for mediastinal Hodgkin lymphoma: A prospective study of clinical efficacy and safety","authors":"Kateřina Dědečková ,&nbsp;Michal Andrlik ,&nbsp;Heidi Móciková ,&nbsp;Lucia Kaliská ,&nbsp;Simona Zapletalová ,&nbsp;Jiří Kubeš ,&nbsp;Sarah Al-Hamami ,&nbsp;David J. Cutter ,&nbsp;Georgios Ntentas ,&nbsp;Vladimír Vondráček ,&nbsp;Barbora Ondrová ,&nbsp;Jana Marková ,&nbsp;Ľubica Gahérová ,&nbsp;Lekaá Mohammadová ,&nbsp;Vít Procházka ,&nbsp;Jozef Michalka ,&nbsp;Alice Sýkorová ,&nbsp;Juraj Ďuraš ,&nbsp;Jan Kořen ,&nbsp;Matěj Navrátil ,&nbsp;Jana Prausová","doi":"10.1016/j.radonc.2025.110931","DOIUrl":"10.1016/j.radonc.2025.110931","url":null,"abstract":"<div><h3>Background</h3><div>Proton beam therapy using pencil beam scanning is an advanced radiotherapy technique that utilises proton beams to precisely target tumours. It is known for its enhanced ability in sparing healthy tissue and potentially reducing toxicity. Clinical experience with pencil beam scanning in the treatment of mediastinal Hodgkin lymphoma remains limited.</div></div><div><h3>Patients and methods</h3><div>This study aimed to evaluate the toxicity and outcomes of a prospectively observed cohort. A total of 162 patients were irradiated between May 2013 and December 2020, with a median age of 32 years (range: 18.4–79.2) and followed up until April 2024. The median applied dose was 30 GyE (range: 20–40). Deep inspiration breath hold was used in 146 patients to enhance targeting precision.</div></div><div><h3>Results</h3><div>The disease-free survival, overall survival and local control rates were 95.1 %, 98.8 % and 98.8 %, respectively. The median follow-up was 59.1 months (range: 4–120.1). The most common acute toxicities observed were oesophageal and skin toxicity. Grade 1 oesophageal mucositis occurred in 76 patients (47 %), grade 2 in 16 patients (10 %). Dermatitis of grade 1 and 2 was observed in 65 (40 %) and 4 (3 %) patients respectively. Grade 1 pulmonary toxicity presented in 8 patients (4.9 %), and grade 2 in one patient (0.6 %). The most predominant late toxicity was grade 2 hypothyroidism in 37 patients (23 %). Three patients (1.8 %) underwent coronary interventions during follow-up, and one patient was diagnosed with hepatocellular carcinoma 3 months post-RT. No unexpected acute or late toxicities were observed.</div></div><div><h3>Conclusion</h3><div>Proton beam therapy using pencil beam scanning is a safe and effective technique in terms of toxicity and local control, even when irradiating mediastinal targets.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110931"},"PeriodicalIF":4.9,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021761","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":"Patient- and clinician-assessed five-year normal tissue effects following one-week versus three-week axillary radiotherapy for breast cancer: Results from the phase III FAST-Forward trial randomised nodal sub-study","authors":"A. Murray Brunt ,&nbsp;Fay H. Cafferty ,&nbsp;Duncan Wheatley ,&nbsp;Mark A. Sydenham ,&nbsp;Anna M. Kirby ,&nbsp;Charlotte E. Coles ,&nbsp;Jaymini Patel ,&nbsp;Abdulla Alhasso ,&nbsp;Charlie Chan ,&nbsp;Susan Cleator ,&nbsp;Helen Fleming ,&nbsp;Daljit Gahir ,&nbsp;Andy Goodman ,&nbsp;Clare Griffin ,&nbsp;Joanne S. Haviland ,&nbsp;Cliona Kirwan ,&nbsp;Zohal Nabi ,&nbsp;Karen Poole ,&nbsp;Elinor Sawyer ,&nbsp;Judith Sinclair ,&nbsp;Judith M. Bliss","doi":"10.1016/j.radonc.2025.110915","DOIUrl":"10.1016/j.radonc.2025.110915","url":null,"abstract":"<div><h3>Background and purpose</h3><div>FAST-Forward showed that 26 Gray (Gy) in 5 fractions (Fr) over one week adjuvant radiotherapy to breast or chest wall was as safe and effective as a three-week schedule (40 Gy/15Fr) for early breast cancer. The nodal sub-study investigated whether a one-week schedule is safe for adjuvant axillary radiotherapy.</div></div><div><h3>Materials and methods</h3><div>In this randomised, non-inferiority, non-blinded sub-study (ISRCTN19906132), patients with invasive breast cancer (pT1-3, pN1-3a, M0) following surgery requiring axillary radiotherapy (any or all levels 1–4) were randomised to 40 Gy/15Fr (three weeks, control), 26 Gy/5Fr or 27 Gy/5Fr (one week) atlas-based radiotherapy planning, including quality assurance. The 27 Gy/5Fr group closed early due to three-year main trial normal tissue effects suggesting 26 Gy/5Fr would be optimal; this analysis focusses on comparison between 26 Gy/5Fr and control. Primary endpoint was five-year patient-reported moderate or marked arm or hand swelling, aiming to exclude a 10 % increase (assuming 10 % incidence with control; 90 % power, one-sided α = 0.05, n = 172 per group).</div></div><div><h3>Results</h3><div>469 patients were randomised from 50 UK centres (182 40 Gy/15Fr, 183 26 Gy/5Fr, 104 27 Gy/5Fr). Median age 61 years; 250 (54 %) and 182 (39 %) had grade 2 and 3 tumours respectively; 261 (56 %) had axillary dissection. Of those who completed a five-year questionnaire, 11/107 (10 %) 40 Gy/15Fr and 13/116 (11 %) 26 Gy/5Fr reported moderate or marked arm or hand swelling, difference 1 % (90 % confidence interval −6%, 8 %, p = 0.49). Other arm and shoulder symptoms were similar between groups with no cases of brachial plexopathy.</div></div><div><h3>Conclusion</h3><div>Five-year patient-reported normal tissue effects suggest 26 Gy/5Fr/1-week hypofractionation is safe for breast cancer patients requiring adjuvant axillary radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110915"},"PeriodicalIF":4.9,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948954","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":"Local recurrence with and without a tumour-bed boost: A post-hoc analysis of the DBCG IMN2 study","authors":"Anders W. Mølby Nielsen ,&nbsp;Lise B.J. Thorsen ,&nbsp;Demet Özcan ,&nbsp;Louise W. Matthiessen ,&nbsp;Else Maae ,&nbsp;Marie Louise H. Milo ,&nbsp;Mette H. Nielsen ,&nbsp;Trine Tramm ,&nbsp;Jens Overgaard ,&nbsp;Birgitte V. Offersen ,&nbsp;on behalf of the DBCG RT Committee","doi":"10.1016/j.radonc.2025.110905","DOIUrl":"10.1016/j.radonc.2025.110905","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In early-stage breast cancer, a tumour-bed boost (TBB) reduces the risk of local recurrence (LR) by around 50 % but increases the risk of breast induration. LR incidences of 3 % at 5 years and 6 % at 10 years have been proposed as thresholds where benefits outweigh the potentially detrimental effects of a TBB. Therefore, this post-hoc analysis of the Danish Breast Cancer Group (DBCG) IMN2 study aimed to investigate LR rates according to prognostic risk factors to identify indications for a TBB.</div></div><div><h3>Material and methods</h3><div>From the DBCG IMN2 study, 2,430 node-positive patients operated with breast-conserving surgery were included for analysis. They received irradiation to the residual breast and regional nodes with or without internal mammary node irradiation according to laterality. Radiotherapy was 3D-conformal. TBB was delivered sequentially as 10 Gy/5 Fx (41–49 years) and 16 Gy/8 Fx (≤ 40 years or margin &lt; 2 mm). Patients with and without a TBB were analysed separately. Prespecified subgroups included known prognostic risk factors.</div></div><div><h3>Results</h3><div>Median follow-up was 13.7 years, and the cumulative incidence of LR was 1.7 % (95 % CI, 1.2–2.2) at 5 years and 3.6 % (95 % CI, 2.9–4.3) at 10 years.</div><div>In patients ≥ 50 years, 1,872 patients were treated without a TBB. Among these, 145 patients with an ER-/HER2- tumour had a 10-year cumulative incidence of LR of 8.3 % (95 % CI, 4.5–13.5). No other subgroups exceeded 6 % at 10 years.</div></div><div><h3>Conclusion</h3><div>Our results suggest that node-positive patients 50 years or older with an ER-/HER2- tumour may obtain a clinically relevant benefit from a TBB.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110905"},"PeriodicalIF":4.9,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948953","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-based auto-contouring of organs/structures-at-risk for pediatric upper abdominal radiotherapy","authors":"Mianyong Ding ,&nbsp;Matteo Maspero ,&nbsp;Annemieke S. Littooij ,&nbsp;Martine van Grotel ,&nbsp;Raquel Davila Fajardo ,&nbsp;Max M. van Noesel ,&nbsp;Marry M. van den Heuvel-Eibrink ,&nbsp;Geert O. Janssens","doi":"10.1016/j.radonc.2025.110914","DOIUrl":"10.1016/j.radonc.2025.110914","url":null,"abstract":"<div><h3>Purposes</h3><div>This study aimed to develop a computed tomography (CT)-based multi-organ segmentation model for delineating organs-at-risk (OARs) in pediatric upper abdominal tumors and evaluate its robustness across multiple datasets.</div></div><div><h3>Materials and methods</h3><div>In-house postoperative CTs from pediatric patients with renal tumors and neuroblastoma (n = 189) and a public dataset (n = 189) with CTs covering thoracoabdominal regions were used. Seventeen OARs were delineated: nine by clinicians (Type 1) and eight using TotalSegmentator (Type 2). Auto-segmentation models were trained using in-house (Model-PMC-UMCU) and a combined dataset of public data (Model-Combined).</div><div>Performance was assessed with Dice Similarity Coefficient (DSC), 95 % Hausdorff Distance (HD95), and mean surface distance (MSD). Two clinicians rated clinical acceptability on a 5-point Likert scale across 15 patient contours. Model robustness was evaluated against sex, age, intravenous contrast, and tumor type.</div></div><div><h3>Results</h3><div>Model-PMC-UMCU achieved mean DSC values above 0.95 for five of nine OARs, while the spleen and heart ranged between 0.90 and 0.95. The stomach-bowel and pancreas exhibited DSC values below 0.90. Model-Combined demonstrated improved robustness across both datasets. Clinical evaluation revealed good usability, with both clinicians rating six of nine Type 1 OARs above four and six of eight Type 2 OARs above three. Significant performance differences were only found across age groups in both datasets, specifically in the left lung and pancreas. The 0–2 age group showed the lowest performance.</div></div><div><h3>Conclusion</h3><div>A multi-organ segmentation model was developed, showcasing enhanced robustness when trained on combined datasets. This model is suitable for various OARs and can be applied to multiple datasets in clinical settings.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110914"},"PeriodicalIF":4.9,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932164","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":"Esophagus-sparing radiotherapy for complicated spinal metastases (ESO-SPARE). A randomized phase III clinical trial","authors":"Anna Mann Nielsen ,&nbsp;Michael R.T. Laursen ,&nbsp;Laura A. Rechner ,&nbsp;Sebastian Moretto Krog ,&nbsp;Katrine S Storm ,&nbsp;Wiviann Ottosson ,&nbsp;Vanja R Gram ,&nbsp;Morten H. Suppli ,&nbsp;Patrik Sibolt ,&nbsp;Ivan R. Vogelius ,&nbsp;Claus P. Behrens ,&nbsp;Gitte Persson","doi":"10.1016/j.radonc.2025.110906","DOIUrl":"10.1016/j.radonc.2025.110906","url":null,"abstract":"<div><h3>Background</h3><div>Patients receiving palliative radiotherapy (RT) for complicated spinal metastases in the cervical and thoracic spine may develop dysphagia due to esophageal and pharyngeal irradiation. This phase III trial investigated if esophagus/pharynx-sparing VMAT/IMRT could reduce patient-reported peak dysphagia without affecting ambulatory function compared to standard VMAT/IMRT.</div></div><div><h3>Methods</h3><div>This dual-center, single-blind, phase III trial (NCT05109819) randomized adult patients with complicated spinal metastases (C1-T12) receiving 1–10 fraction RT to either conventional or esophagus/pharynx-sparing VMAT/IMRT. Patient-reported outcomes (PRO-CTCAE) were collected daily for five weeks, and EQ-5D-5L, EORTC-QLQ-C30, weight, and analgesic use were assessed weekly for nine weeks. Co-primary endpoints were peak dysphagia (first five weeks) and ambulatory function (EQ-5D-5L mobility) at nine weeks, analyzed by Wilcoxon rank-sum test. The association between esophageal dosimetric parameters and “severe-or-worse” dysphagia was assessed.</div></div><div><h3>Results</h3><div>From May 2021–April 2024, 188 patients were randomized (standard: 92 included, 60 analyzed; esophagus-sparing: 96 included, 70 analyzed). Fourteen esophagus-sparing patients did not receive the intended intervention. These patients were recategorized as standard for per-protocol analysis. Dysphagia (any grade) occurred in 64 % (standard) and 55 % (esophagus-sparing) of patients. Intention-to-treat analysis found no differences in peak dysphagia (p = 0.20) or ambulatory status (p = 0.30). Per-protocol analysis found significant difference in peak dysphagia (p = 0.50). Dosimetric parameters (D0.027 cc-D5cc, V15Gy–V25Gy) correlated with “severe-or-worse” dysphagia.</div></div><div><h3>Conclusion</h3><div>Esophagus-sparing VMAT/IMRT did not reduce peak dysphagia in the intention-to-treat analysis but showed a significant benefit in the per-protocol analysis. Higher esophageal dose and larger irradiated volumes correlated with risk of “severe-or-worse” dysphagia, suggesting that esophagus/pharynx-sparing RT may particularly benefit patients receiving high-dose, large-field radiation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110906"},"PeriodicalIF":4.9,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948318","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":"Radiographic classification of mandibular osteoradionecrosis: A blinded prospective multi-disciplinary interobserver diagnostic performance study","authors":"Zaphanlene Kaffey ,&nbsp;Sarah Mirbahaeddin ,&nbsp;Kareem Wahid ,&nbsp;Serageldin Kamel ,&nbsp;Michael Vouffo ,&nbsp;Adegbenga O. Otun ,&nbsp;Zayne Belal ,&nbsp;Ruth A. Aponte Wesson ,&nbsp;Patrick P. Carriere ,&nbsp;Cem Dede ,&nbsp;Anastasios Maniakas ,&nbsp;Ryan P. Goepfert ,&nbsp;Adam S. Garden ,&nbsp;Anna Lee ,&nbsp;Karen Y. Choi ,&nbsp;Joani M. Christensen ,&nbsp;Christie Lincoln ,&nbsp;Gohar S. Manzar ,&nbsp;Stephanie O. Dudzinski ,&nbsp;Rehema Thomas ,&nbsp;Laia Humbert-Vidan","doi":"10.1016/j.radonc.2025.110917","DOIUrl":"10.1016/j.radonc.2025.110917","url":null,"abstract":"<div><h3>Background &amp; Purpose</h3><div>Osteoradionecrosis (ORN) of the jaw is a severe complication affecting up to 15% of head and neck cancer patients treated with radiotherapy. The ClinRad system, endorsed by ASCO/ISOO/MASCC, incorporates radiographic features for ORN severity classification, but variability in imaging use and specialty expertise may impact diagnostic accuracy. This study benchmarks physician performance in diagnosing and staging ORN across specialties and imaging modalities.</div></div><div><h3>Materials &amp; Methods</h3><div>A retrospective diagnostic validation study was conducted at MD Anderson Cancer Center, involving 20 physicians from oral oncology, radiation oncology, surgery, and neuroradiology. Participants reviewed 85 de-identified imaging sets (CT and orthopantogram (OPG)) from 30 patients with confirmed ORN, diagnosing and staging cases using the ClinRad system. ROC analysis assessed diagnostic accuracy, while intra- and inter-observer agreement was measured using Cohen’s and Fleiss kappa statistics.</div></div><div><h3>Results</h3><div>Paired CT-OPG imaging significantly improved diagnostic performance across specialties (p &lt; 0.001), with AUC values ranging from 0.79 (residents) to 0.98 (surgeons). However, inter- and intra-rater agreement remained low, with median Fleiss kappa values of 0.22, 0.13, and 0.05 for ClinRad stages 0/1, 2, and 3, respectively. No specialty demonstrated significantly superior diagnostic accuracy (p &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>This study establishes a benchmark for radiographic ORN detection, revealing diagnostic variability across specialties. Findings emphasize the need for standardized imaging protocols, interdisciplinary training, and multimodal imaging to improve diagnostic accuracy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110917"},"PeriodicalIF":4.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916393","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":"Homogeneous and heterogeneous boosting in prostate radiotherapy: Treatment planning and target dosimetry comparison","authors":"Yutong Zhao ,&nbsp;Annette Haworth ,&nbsp;Scott Williams ,&nbsp;Simon Goodall ,&nbsp;Ben Hug ,&nbsp;Michelle Krawiec ,&nbsp;Jonathan Sykes ,&nbsp;Jeremy Croker ,&nbsp;Jeremy Booth ,&nbsp;Andrew Le ,&nbsp;Shrikant Deshpande ,&nbsp;Richard Walther ,&nbsp;Pejman Rowshanfarzad ,&nbsp;Martin A. Ebert","doi":"10.1016/j.radonc.2025.110916","DOIUrl":"10.1016/j.radonc.2025.110916","url":null,"abstract":"<div><h3>Background</h3><div>Delivering a homogeneous dominant intra-prostatic lesion (DIL) boost enables improved tumour control in prostate radiotherapy. Opportunities for further escalation of tumour control probability (TCP) may be presented by heterogeneously boosting the DIL according to the known spatially-varying characteristics of the disease.</div></div><div><h3>Purpose</h3><div>To investigate the practical limits and robustness of treatment planning for both homogeneous and heterogeneous DIL boost.</div></div><div><h3>Materials and methods</h3><div>The tumour cell distribution maps, representing voxel-wise distributions of estimated prostate tumour cell numbers, of three high-risk patients with various DIL volumes in a cohort of 63 patients were selected. Heterogeneous, structure-based prescriptions, which maximize TCP, were derived for DIL boosts for each patient. Treatment plans were generated for all patients for seven treatment modalities. The resulting homogeneous DIL boost plans and heterogeneous DIL boost plans were evaluated and compared.</div></div><div><h3>Results</h3><div>In total, 42 plans were generated, including 21 plans produced for a homogeneous DIL boost and for a heterogeneous DIL boost, respectively, without violating any dose constraints. For more than 50% of heterogeneous DIL boost plans, a TCP increase could be achieved relative to plans produced for a homogeneous DIL boost. Compared to a homogeneous DIL boost, intensity modulated proton therapy (IMPT) has the potential to maximize the likelihood of effective toxicity-free treatment by implementing heterogeneous DIL boost.</div></div><div><h3>Conclusion</h3><div>Heterogeneous DIL boost implemented by structure-based prescriptions enabled higher TCP improvements for the majority of plans produced for a homogeneous DIL boost.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110916"},"PeriodicalIF":4.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918396","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":"Radiation-induced rhinosinusitis in patients with nasopharyngeal carcinoma","authors":"Si-Yuan Chen ,&nbsp;Xiao-Tong Duan ,&nbsp;Rui-Ling Xie ,&nbsp;Ya-Qian Han ,&nbsp;Xing-Yuan Shi ,&nbsp;Shun-Lan Wang ,&nbsp;Yi-Jun Hua ,&nbsp;Rui You ,&nbsp;Tian-Liang Xia ,&nbsp;Zheng Wu ,&nbsp;Su-Bin Wang ,&nbsp;Xiong-Zou ,&nbsp;Hui-Feng Li ,&nbsp;Zheng-Kai Feng ,&nbsp;Xi Ding ,&nbsp;Ruo-Qi Xie ,&nbsp;Jiong-Lin Liang ,&nbsp;Yan-Feng Ouyang ,&nbsp;Lan Peng ,&nbsp;Chen-Mei Gu ,&nbsp;Ming-Yuan Chen","doi":"10.1016/j.radonc.2025.110913","DOIUrl":"10.1016/j.radonc.2025.110913","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy (RT) is the primary treatment for nasopharyngeal carcinoma (NPC), while its impact on sinonasal mucosa is unclear. We aimed to investigate the progression of sinus mucosal inflammation pre- and post-RT in NPC patients and aid in the prevention and treatment of radiation-induced rhinosinusitis (RiRS).</div></div><div><h3>Methods</h3><div>This study was based on a prospective cohort with 1410 NPC patients. RiRS was evaluated by the Lund-Mackay score (LMS). A prediction model incorporating clinicopathological factors, radiomics features, and dosimetric parameters was developed using least absolute shrinkage regression and validated internally and externally using the area under the receiver operating characteristic curve, calibration tests, and decision curve analysis. LMS trajectories were analyzed using latent-class growth analysis.</div></div><div><h3>Results</h3><div>1017 patients with a median follow-up of 106.5 months were enrolled. Before RT, 7.5 % of patients (n = 76) had rhinosinusitis, which has increased to 47.2 % after RT. The V30Gy of the sinuses (relative sinus volume receiving doses &gt; 30 Gy), pre-RT LMS abnormalities, and tumor invasion of sphenoidal base independently influenced RiRS. The prediction model based on these three factors exhibited good discrimination and calibration. Three distinct trajectories of RiRS were identified: increasing LMS, decreasing LMS with a high starting score, and decreasing LMS with a low starting score. V70Gy showed significant association with the LMS trajectories.</div></div><div><h3>Conclusion</h3><div>RiRS is a common complication in NPC patients, influenced by radiation dose in the sinuses, baseline sinus mucosa status, and tumor invasion. Patients with large sinus volumes receiving high radiation doses are more likely to develop RiRS.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110913"},"PeriodicalIF":4.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918445","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":"4748 Re-envisioning re-irradiation workflows with enhanced radiation therapist expertise","authors":"Michael Velec,&nbsp;Alvin Cuni,&nbsp;Neva Pang,&nbsp;Yat Tsang","doi":"10.1016/S0167-8140(25)04049-6","DOIUrl":"10.1016/S0167-8140(25)04049-6","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Pages S63-S64"},"PeriodicalIF":4.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144105153","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}