Radiotherapy and Oncology最新文献

{"title":"Prospective cohort study to validate esophageal dose constraints and predictive models for esophagitis in patients with breast cancer undergoing hypofractionated regional nodal radiotherapy","authors":"Dan-Qiong Wang ,&nbsp;Lei Yan ,&nbsp;Hong-Fen Wu ,&nbsp;Ya-Hua Zhong ,&nbsp;Xiao-Bo Huang ,&nbsp;Jing Jin ,&nbsp;Qiu-Zi Zhong ,&nbsp;Li-Na Zhao ,&nbsp;Xiao-Hong Wang ,&nbsp;Hao Jing ,&nbsp;Yu Tang ,&nbsp;Yong-Wen Song ,&nbsp;Ning-Ning Lu ,&nbsp;Bo Chen ,&nbsp;Yue-Ping Liu ,&nbsp;Shu-Nan Qi ,&nbsp;Yuan Tang ,&nbsp;Yi-Rui Zhai ,&nbsp;Wen-Wen Zhang ,&nbsp;Ning Li ,&nbsp;Shu-Lian Wang","doi":"10.1016/j.radonc.2025.111120","DOIUrl":"10.1016/j.radonc.2025.111120","url":null,"abstract":"<div><h3>Purpose</h3><div>Esophageal RV25 &lt; 20 % and AV35 &lt; 0.27 mL were reported as dose constraints predictive of grade ≥ 2 radiation esophagitis (RE) for breast cancer in our previous study. This prospective study aimed to validate the effectiveness of esophageal dose constraints and develop RE prediction models.</div></div><div><h3>Methods</h3><div>We enrolled 465 patients with breast cancer receiving 43.5 Gy in 15 fractions to the chest wall and nodal regions using IMRT/VMAT between January 2022 and February 2024. The esophagus was contoured from the cricoid cartilage level to the aortic arch’s lower margin. RE was assessed weekly during radiotherapy and at weeks 1 and 2 and months 3 and 6 post-RT using CTCAE v3.0. Analyzed esophageal dosimetric parameters: total volume, mean/max dose, the relative and absolute volumes receiving at least 5–45 Gy by 5 Gy increments (RV5–RV45 and AV5–AV45). Predictive models incorporating tumor laterality, internal mammary nodal irradiation (IMNI), and RV25 or AV35 thresholds were developed. Discrimination (AUC) and calibration [Hosmer-Lemeshow (H-L) test] were evaluated, and risk stratification was performed using decision tree analysis.</div></div><div><h3>Results</h3><div>The grade 2 RE incidence (23.7 %) was considerably lower than in a previous report (40.9 %), and no grade ≥ 3 RE was observed. Both models performed well (RV25 model: AUC, 0.688, H-L, <em>p</em> = 0.974; AV35 model: AUC, 0.651, H-L, <em>p</em> = 0.776). Risk factors for RE included left-side tumor, IMNI, and RV25 ≥ 20 % or AV35 ≥ 0.27 mL. Patients with no risk factors were classified as low risk, those with one risk factor as intermediate risk, and those with ≥ 2 risk factors as high risk. The grade ≥ 2 RE incidence differed significantly across groups (RV25: 14.8 % vs. 24.7 % vs. 48.3 %; AV35: 14.7 % vs. 23.7 % vs. 45.4 %).</div></div><div><h3>Conclusion</h3><div>Clinical validation confirmed the effectiveness of esophageal dose constraints and the predictive accuracy of the RV25 and AV35 models. Avoiding unnecessary IMNI and maintaining RV25 &lt; 20 % and AV35 &lt; 0.27 mL could reduce the risk for RE.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111120"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024204","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 significance of estimated radiation dose to immune cells in cancer patients undergoing thoracic irradiation: A meta-analysis","authors":"Chih-Wei Luan ,&nbsp;Yao-Te Tsai ,&nbsp;Kuan-Yin Chen ,&nbsp;Wing-Keen Yap","doi":"10.1016/j.radonc.2025.111123","DOIUrl":"10.1016/j.radonc.2025.111123","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Emerging evidence suggests that excessive radiation dose to immune cells may impair host immunity and negatively affect cancer prognosis. However, the prognostic impact of the estimated radiation dose to immune cells across different cancer types and treatment modalities remains inconclusive. This <em>meta</em>-analysis aimed to systematically evaluate the association between estimated radiation dose to immune cells and survival outcomes in patients with lung and esophageal cancers undergoing radiotherapy.</div></div><div><h3>Materials and methods</h3><div>We systematically searched PubMed, EMBASE, and Cochrane Library up to April 2025 following PRISMA guidelines. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model for overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), locoregional progression-free survival (LPFS), and distant metastasis-free survival (DMFS).</div></div><div><h3>Results</h3><div>Sixteen studies comprising 4511 patients were included, with 1073 patients diagnosed with esophageal cancer and 3438 with lung cancer. The pooled analysis demonstrated that higher estimated radiation dose to immune cells was significantly associated with inferior OS (HR = 1.228; 95 % CI, 1.135–1.329; p &lt; 0.001) and PFS (HR = 1.265; 95 % CI, 1.134–1.412; p &lt; 0.001). Similar associations were observed for DFS (HR = 1.227; 95 % CI, 1.009–1.492), LPFS (HR = 1.091; 95 % CI, 1.042–1.141), and DMFS (HR = 1.172; 95 % CI, 1.066–1.290). Subgroup analyses revealed consistent findings across tumor types, geographic regions, age groups, sample sizes, and the estimated radiation dose to immune cells cutoff values. Funnel plot asymmetry and statistical tests suggested potential publication bias; however, trim-and-fill analyses confirmed the robustness of the results. Sensitivity analyses further supported the stability of pooled estimates.</div></div><div><h3>Conclusions</h3><div>Higher estimated radiation dose to immune cells is linked to adverse survival outcomes. Immune-sparing radiotherapy strategies may improve prognosis and warrant further investigation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111123"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024120","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":"Dosiomics-guided deep learning for radiation esophagitis prediction in lung cancer: optimal region of interest definition via multi-branch fusion auxiliary learning","authors":"Xianwen Yu ,&nbsp;Yao Ai ,&nbsp;Wanyu Su ,&nbsp;Ziqing Xiang ,&nbsp;Jianping Wu ,&nbsp;Yiran Mu ,&nbsp;Yifan Yang ,&nbsp;Long Zhang ,&nbsp;Wenliang Yu ,&nbsp;Weihua Ni ,&nbsp;Juebin Jin ,&nbsp;Congying Xie ,&nbsp;Xiance Jin","doi":"10.1016/j.radonc.2025.111121","DOIUrl":"10.1016/j.radonc.2025.111121","url":null,"abstract":"<div><h3>Background</h3><div>Accurate delineation of regions of interest (ROIs) is critical for feature extraction and selection in radiomics-based prediction models.</div></div><div><h3>Purpose</h3><div>To develop a combined dosiomics and deep learning (DL) model for predicting grade ≥ 2 radiation esophagitis (RE) in lung cancer patients undergoing radiotherapy, we propose a multi-task auxiliary learning approach to define accurate and objective ROIs based on radiation dose distribution (RDD) images.</div></div><div><h3>Materials and Methods</h3><div>Lung cancer patients who underwent radiotherapy were gathered retrospectively from hospital 1 (January 2020 and December 2022) for model development. Two external validation sets were obtained retrospectively from hospital 2 (January 2021 and December 2022) and hospital 3 (January 2022 and December 2023), respectively. A dosiomics-guided deep learning (DGD) network using multi-task auxiliary learning to define accurate and objective ROIs was introduced by integrating dosiomic features with high-dimensional DL features for RE prediction.</div></div><div><h3>Results</h3><div>This study enrolled 488 patients from three hospitals: 235 in the training set, 101 in the internal validation set, 57 in the external validation set 1 and 95 in the external validation set 2, respectively. The dosiomics −guided ResNet34 combined with contrastive learning and auxiliary segmentation module achieved the best AUCs of 0.88 [95% CI: 0.76–0.95], 0.82 [95% CI: 0.65–0.96], 0.83 [95% CI: 0.74–0.92] in the internal validation set, external validation set 1, and external validation set 2, respectively.</div></div><div><h3>Conclusion</h3><div>The proposed DGD model leverages multi-task auxiliary learning to automatically define ROIs and effectively predict RE in lung cancer patients undergoing radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111121"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024135","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":"Impact of radiation dose on immune cells (EDIC) on oncologic outcome in small cell lung cancer (SCLC)","authors":"Hannah Sophie Penzl ,&nbsp;David Alexander Ziegler ,&nbsp;Markus Anton Schirmer ,&nbsp;Jona Bensberg ,&nbsp;Sonia Ziegler ,&nbsp;Benedikt Kieslich ,&nbsp;Carla Marie Zwerenz ,&nbsp;Andrea Hille ,&nbsp;Leif Hendrik Dröge ,&nbsp;Martin Leu ,&nbsp;Manuel Guhlich ,&nbsp;Lisa von Diest ,&nbsp;Laura Anna Fischer ,&nbsp;Mahalia Zoe Anczykowski ,&nbsp;Tobias Overbeck ,&nbsp;Alexander von Hammerstein-Equord ,&nbsp;Friederike Braulke ,&nbsp;Stefan Rieken ,&nbsp;Rami El Shafie","doi":"10.1016/j.radonc.2025.111122","DOIUrl":"10.1016/j.radonc.2025.111122","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy (RT) is an essential part of small-cell lung cancer (SCLC) treatment. It can however deplete circulating lymphocytes, impairing systemic immune surveillance and potentially reducing the efficacy of immune checkpoint inhibitors (ICIs). The Effective Dose to Immune Cells (EDIC) quantifies RT-induced immune suppression and has been linked to survival in non-small cell lung cancer (NSCLC), but its prognostic significance in SCLC remains unclear.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 220 patients with SCLC who received thoracic RT at a German tertiary cancer center between 2006 and 2020. EDIC was calculated from treatment plans using the model developed by Jin et al., which approximates the dose to circulating immune cells based on the dose to circulating blood. The primary endpoint was overall survival (OS), secondary endpoints were progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LPFS). Multivariable Cox regression identified independent prognostic factors.</div></div><div><h3>Results</h3><div>The median OS was 17.7 months (Q1–Q3: 11.6–38.8, 95 % CI: 16.0–19.3). In LD-SCLC, higher EDIC (&gt; 4.9 Gy) was independently associated with shorter OS (HR 1.62, p = 0.011), PFS (HR 1.57, p = 0.037), and DMFS (HR 1.72, p = 0.017), but not LPFS (p = 0.308). In contrast, EDIC showed no prognostic impact in ED-SCLC. Other independent prognostic factors in LD-SCLC included prophylactic cranial irradiation (HR 0.43, p &lt; 0.001) and bi-daily fractionation (HR 0.41, p = 0.002).</div></div><div><h3>Conclusion</h3><div>Higher EDIC is an independent negative prognostic factor in LD-SCLC, correlating with shorter OS, PFS, and DMFS, but had no prognostic relevance in ED-SCLC in this analysis. As immunotherapy becomes part of LD-SCLC treatment, immune-preserving RT strategies should be developed to optimize patient outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111122"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024210","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":"Prediction of metastasis-free survival in patients with localized prostate adenocarcinoma using primary tumor and lymph node radiomics from pre-treatment PSMA-PET/CT scans","authors":"Apurva Singh ,&nbsp;William Silva Mendes ,&nbsp;Sang-Bo Oh ,&nbsp;Ozan Cem Guler ,&nbsp;Aysenur Elmali ,&nbsp;Birhan Demirhan ,&nbsp;Amit Sawant ,&nbsp;Phuoc Tran ,&nbsp;Cem Onal ,&nbsp;Lei Ren","doi":"10.1016/j.radonc.2025.111119","DOIUrl":"10.1016/j.radonc.2025.111119","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To predict metastasis-free survival (MFS) for patients with prostate adenocarcinoma (PCa) treated with androgen deprivation therapy (ADT) and external radiotherapy using clinical factors and radiomics extracted from primary tumor and node volumes in pre-treatment PSMA PET/CT scans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials/Methods&lt;/h3&gt;&lt;div&gt;Our cohort includes 134 PCa patients (nodal involvement in 28 patients). Gross tumor volumes of primary tumor (GTVp) and nodes (GTVn) on CT and PET scans were segmented. A 5 mm expansion ring area outside primary tumor was defined. Z-score normalization was applied to radiomics features extracted from tumor and ring; dimension reduction was performed using Principal Components Analysis (PCA). For patients with only primary tumor, we took 3 principal components (PCs) from GTVp and one ring PC as representative radiomics components from CT and PET scans. For patients with nodes, we calculated weighted average (by volume) of radiomics from primary tumor and nodes, computed first 3 PCs and combined it with 1st PC from the ring. Radiomics PCs and clinical variables (age, Gleason score, initial prostate specific antigen value (i PSA), PSA_relapse) formed the predictors. Due to MFS data imbalance (metastasis-24, no metastasis-110), we performed 70:30 train-test split and applied imbalance correction to training data. Univariate Cox-regression was used to select top predictors (logistic regression p &lt; 0.05). Multivariate Cox-regression was performed on imbalance-corrected training data and fit on testing data (using predictors selected from training). Model 2 was built using clinical variables and radiomic PCs from primary tumors (GTVp, ring). Model 3 was built using clinical variables only. Binary classification analysis for prediction of five-year MFS was also performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Results of time-to-event analysis (MFS) were: Cox-regression c-scores: model1: train- 0.77 [0.72, 0.78]; test- 0.69 [0.64, 0.70]; model2: train- 0.72 [0.66, 0.73]; test- 0.63 [0.58, 0.64]; model3: train- 0.62 [0.57, 0.63]; test- 0.54 [0.51, 0.56]. The results of 5 year MFS classification analysis were [sensitivity, specificity, AUC]: model 1: train- [83.6 %, 91.3 %, 0.88]; test- [76.3 %, 82.5 %, 0.81]; model 2: train- [77.4 %, 85.1 %, 0.84]; test- [71.5 %, 78.2 %, 0.76]; model 3: train- [69.3 %, 78.2 %, 0.76]; test- [64.7 %, 72.6 %, 0.68]. The two cohorts of patients classified by model 1 showed statistically significant differences in their actual survival curves, demonstrating the efficacy of the classification. Integration of node with primary tumor-radiomics provides the best prognostic performance in MFS prediction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This is one of the first studies to explore the prognostic value of pre-treatment PSMA-PET, a relatively recent advancement in the care of prostate adenocarcinoma patients. Results demonstrated the potential of using imaging biomarkers from ","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111119"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024163","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":"GEOGRAPHIC PATTERNS OF BREAST CANCER CLINICAL TRIAL ENROLLMENT IN CANADA: AN ANALYSIS OF CCTG-REGISTERED TRIALS","authors":"Curtis Leclerc ,&nbsp;Alan Nichol ,&nbsp;Robert Olson","doi":"10.1016/S0167-8140(25)04726-7","DOIUrl":"10.1016/S0167-8140(25)04726-7","url":null,"abstract":"<div><h3>Purpose:</h3><div>Breast cancer clinical trials, with their large patient pool and widespread use of standard treatments like surgery, radiation, and chemotherapy, provide a valuable model for understanding the geographic patterns of clinical trials in Canada. Therefore, the purpose of this analysis was to explore the state of CCTG registered breast cancer clinical trials within Canada.</div></div><div><h3>Materials and Methods:</h3><div>We conducted a retrospective observational analysis of 7,005 participants enrolled in 16 CCTG-registered breast cancer clinical trials between 2000 and 2017. Participant accrual was assessed by province, city, and major cancer centre. Census Metropolitan Areas (CMAs), as defined by Statistics Canada, were used to identify urban recruitment patterns. Data were visualized using geographic information systems and analyzed descriptively to assess regional differences.</div></div><div><h3>Results:</h3><div>Clinical trial recruitment was highly centralized. 99.9% of participants were enrolled from CMA-designated urban centres, with only three patients recruited from non-CMA regions. Ontario, Quebec, and British Columbia accounted for over 80% of national accrual, with Ontario alone contributing 52.6%. The majority of trial enrollments originated from a small number of large urban academic centres, with minimal participation from rural or remote regions and none from the territories.</div></div><div><h3>Conclusions :</h3><div>Breast cancer clinical trial enrollment in Canada is highly concentrated in urban academic centres, leaving rural, remote, and northern populations significantly underrepresented. These findings underscore the urgent need for decentralized trial models, regional recruitment networks, and targeted investments in rural research infrastructure to ensure equitable access to clinical research across Canada.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S30"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099950","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 AND TOXICITIES FOLLOWING CONVENTIONAL RADIATION THERAPY FOR PITUITARY NEUROENDOCRINE TUMOURS (PITNETS)","authors":"Brandon Craig ,&nbsp;Inhwa Kim ,&nbsp;Anthony Lausch ,&nbsp;Aruz Mesci ,&nbsp;Jelena Lukovic ,&nbsp;Dana Keilty ,&nbsp;Richard Tsang ,&nbsp;Derek Tsang ,&nbsp;Michael Yan","doi":"10.1016/S0167-8140(25)04760-7","DOIUrl":"10.1016/S0167-8140(25)04760-7","url":null,"abstract":"<div><h3>Purpose:</h3><div>Radiation is an effective treatment modality for recurrent pituitary neuroendocrine tumours (PitNETs). Both stereotactic radiosurgery (SRS) and conventional radiation are the two main treatment paradigms for these tumours depending on the distance to the optic apparatus. The aim of the current study was to retrospectively assess outcomes and toxicities following conventional radiation in patients with PitNETs and eventually compare these findings to SRS cohorts.</div></div><div><h3>Materials and Methods:</h3><div>A single-centre, retrospective, population-based analysis was performed. Patients with functional and non-functional PitNETS treated with conventionally fractionated radiation (50 Gy in 25 fractions) between 2000-2023 were included. The primary outcome was local tumour control and secondary outcomes included various toxicities (hormonal, optic, vascular, edema, and second tumours).</div></div><div><h3>Results:</h3><div>194 patients met criteria and were included in the final analysis (100 females [52%] and 94 males [48%]). The median age at initial diagnosis was 47.2 years (range=13.9-92.yrs) and 134 (69%) tumours were non-functional. Most patients had 1-4 surgeries prior to radiation (98.5%). The median duration of follow-up after completion of radiation was 6.8 years (range=0.4-23.1yrs). Local recurrence was seen in 8 patients (4.1%), where 5 were functional (2.6%) and 3 were non-functional (1.5%). The median time to local recurrence following radiotherapy was 6.1 years (range=0.5-14.8yrs) and these patients were subsequently treated with gamma-knife radiotherapy (n=4), surgery (n=3), or convention radiation (n=1). Pituitary dysfunction requiring pituitary hormone replacement following radiation was seen in 42 patients (21.6%), and 76 patients (39.2%) were on pituitary replacement following surgery but prior to radiation. Of those requiring pituitary replacement, 30 (71.4%) were for hypothyroidism, 29 (69.0%) were for adrenal insufficiency, 10 (23.8%) were for hypogonadism, and 1 (2.5%) was for diabetes insipidus. The median time to initiating pituitary replacement was 5.6 years (range=0.2-19.8yrs). A secondary tumour (vestibular schwannoma) was seen in 1 patient (0.52%) twelve years following radiation. There was no optic, vascular or edematous toxicities.</div></div><div><h3>Conclusions:</h3><div>Here, we provide an updated, large population-based study to investigate conventionally fractionated radiotherapy for PitNETs, which confirms this technique is a safe and effective treatment. The main toxicity of this treatment is pituitary dysfunction that requires hormone replacement. Further analysis comparing conventional radiation to SRS is forthcoming.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S43"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099951","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":"EVALUATING THE TIME SAVINGS OF TARGET VOLUME AUTO-CONTOURING ASSISTANCE IN CERVICAL CANCER HDR BRACHYTHERAPY","authors":"Fletcher Barrett ,&nbsp;Philip McGeachy ,&nbsp;Tyler Meyer ,&nbsp;Ruth Fullerton ,&nbsp;Corrine Doll ,&nbsp;Nina Samson ,&nbsp;Tien Phan","doi":"10.1016/S0167-8140(25)04717-6","DOIUrl":"10.1016/S0167-8140(25)04717-6","url":null,"abstract":"<div><h3>Purpose:</h3><div>To assess the impact on contouring efficiency when an in-house machine learning (ML) model provides a starting point for the high-risk clinical target volume (HR-CTV) definition in high-dose-rate (HDR) cervical brachytherapy.</div></div><div><h3>Materials and Methods:</h3><div>T2-weighted MRIs with HR-CTV contours from patients receiving HDR cervical brachytherapy between 2016 and 2024 were used to develop and test an ML model. The model was built using PyTorch and architectures from the Medical Open Network for AI (MONAI). The final model was used to generate an HR-CTV contour on previously unseen MRIs, serving as a starting point for the radiation oncologist to edit until a clinically acceptable contour was achieved. Efficiency was assessed by having four radiation oncologists individually contour the HR-CTV offline, with and without model support, two months apart. Contouring time for both scenarios was compared to quantify the model’s impact on efficiency. The quality of the contour made with model support was assessed using the Sorensen-Dice similarity coefficient (DSC) against the same radiation oncologist’s contour without model support.</div></div><div><h3>Results:</h3><div>The retrospective dataset for model development included 103 patients (151 MRIs) and the testing dataset consisted of 5 patients (11 MRIs). During development and testing, the model achieved an average DSC of 0.75 and 0.70, respectively, when compared to the clinical contours used for brachytherapy. Contouring time with and without model support in the testing set was 5.1±2.7 and 8.7±4.5 minutes, respectively (p&lt;0.01), corresponding to a 3.6-minute absolute reduction, or a 38% decrease in contouring time with model support. The average DSC between the final contours made with and without support was 0.77±0.07.</div></div><div><h3>Conclusions:</h3><div>Target volume auto-contouring assistance with an ML model reduced the average time spent contouring the HR-CTV by 38% while maintaining contour quality. Future work will include a prospective study to validate the efficiency of this ML model in a real-time clinical setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S26"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099999","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":"ESTABLISHING A COLLABORATIVE AND EFFECTIVE IMAGE-GUIDED HEPATOBILIARY BRACHYTHERAPY PROGRAM: A MODEL FOR BROADER IMPLEMENTATION","authors":"Amandeep Taggar ,&nbsp;Moti Paudel ,&nbsp;Mackenzie Smith ,&nbsp;John Hudson ,&nbsp;Yee Ung ,&nbsp;Robyn Pugash ,&nbsp;Elizabeth David ,&nbsp;Chris Dey","doi":"10.1016/S0167-8140(25)04758-9","DOIUrl":"10.1016/S0167-8140(25)04758-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose:&lt;/h3&gt;&lt;div&gt;Cholangiocarcinoma is a rare malignancy and the leading cause of malignant biliary tract obstruction (MBTO), a condition associated with significant morbidity, including abdominal pain, jaundice, and eventual liver failure. Surgical resection is only feasible for a limited subset of patients, and elevated bilirubin levels often preclude systemic therapy. This study outlines the logistics and workflow of a successful image-guided bile duct intraluminal brachytherapy (ILBT) program designed to improve the quality of life (QOL) and clinical outcomes for patients with MBTO.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods:&lt;/h3&gt;&lt;div&gt;We describe the essential steps for implementing a successful image-guided ILBT program. Additionally, we retrospectively reviewed the first 40 patients enrolled in a prospective registry who underwent ILBT treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;The successful establishment of a brachytherapy program relies on three key components: (1) a dedicated team with brachytherapy expertise, (2) appropriate infrastructure and resources, and (3) strong multidisciplinary collaboration. Cancer centres with existing high-dose-rate (HDR) brachytherapy programs for prostate and gynecological malignancies already possess the necessary major equipment, including HDR afterloaders, treatment planning systems, shielded treatment room, and imaging modalities (CT/MRI/C-arm) for treatment planning and delivery. Therefore, the primary requirement for developing an ILBT program is fostering collaboration between hepatobiliary surgeons, medical oncologists, and interventional radiologists (IRs) to identify suitable patients. Given that most cancer centres are affiliated with hospitals that offer IR services, routine procedures such as stent placement and percutaneous drain insertion can facilitate ILBT delivery. Once a patient is deemed eligible, Interventional Radiology can place hilar biliary stents or a common bile duct stent, with preservation of percutaneous catheter access, enabling safe and effective brachytherapy administration (Figure 1). At our institution, the first two key components for establishing an ILBT program were already in place. A gastrointestinal radiation oncologist with expertise in brachytherapy played a pivotal role in fostering interdisciplinary collaboration among hepatobiliary surgeons, interventional radiologists, medical oncologists, and radiation oncology teams. The ILBT program was successfully implemented in March 2021, with an initial goal of treating one patient per month. As of December 2024, 42 patients have undergone image-guided ILBT. The median age was 77 years (range: 45–89). Tumour locations included the hilar region (n=21), common hepatic duct (n=5), mid bile duct (n=7), and distal common bile duct (n=5). The prescribed dose was 25 Gy, delivered in five daily fractions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions:&lt;/h3&gt;&lt;div&gt;Image-guided ILBT is a feasible and effective treatment modality ","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S42"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100007","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":"RANDOMIZATION IN OLIGOPROGRESSIVE DISEASE: CAN WE STILL RUN TRIALS, OR HAVE WE LOST EQUIPOISE?","authors":"Emily Boyer ,&nbsp;Marie-Pierre Campeau ,&nbsp;Edith Filion ,&nbsp;Toni Vu ,&nbsp;David Roberge ,&nbsp;Guila Delouya ,&nbsp;Cynthia Ménard ,&nbsp;Bertrand Routy ,&nbsp;Daniel Taussky ,&nbsp;Félix Nguyen ,&nbsp;Jean-Marc Bourque ,&nbsp;Nancy El-Bared ,&nbsp;Lara Hathout ,&nbsp;David Donath ,&nbsp;Maroie Barkati ,&nbsp;Normand Blais ,&nbsp;Houda Bahig","doi":"10.1016/S0167-8140(25)04756-5","DOIUrl":"10.1016/S0167-8140(25)04756-5","url":null,"abstract":"<div><h3>Purpose:</h3><div>Oligoprogressive disease presents a therapeutic challenge, with ongoing debate on whether patients should receive stereotactic ablative radiotherapy (SABR) or continue systemic treatment. This study evaluates the feasibility of ongoing randomized controlled trials (RCTs) by assessing randomization patterns and comparing baseline clinical characteristics of patients treated within a trial versus those receiving SABR off-trial.</div></div><div><h3>Materials and Methods:</h3><div>Two ongoing prospective trials investigate treatment strategies: SUPPRESS-Lung (NCT04405401), focusing on SABR for oligoprogressive lung cancer, and SUPPRESS-General (NCT04989725), including other histologies. A registry was simultaneously established for patients receiving SABR off-trial. This study compares randomization patterns and clinical characteristics between the two cohorts. Baseline characteristics were analyzed descriptively, with paired t-tests for continuous variables, considering p&lt;0.05 statistically significant.</div></div><div><h3>Results:</h3><div>Between June 2021 and January 2025, 72 patients were randomized in the trials, and 88 received treatment off-trial, totaling 160 patients. RCT patients represented 40% of the cohort, while 60% were treated off-trial. The distribution of randomized patients by disease site varied: 45% in lung cancer, 56% in breast cancer, 49% in gastrointestinal cancer, 75% in genitourinary cancer, and 50% in head and neck cancer. Randomized patients had a higher metastatic burden, with a mean of 2.4 progressive lesions (range: 1–5) compared to 1.1 (range: 1–3) in registry patients. The total metastatic lesions were 6.4 (range: 1–20) in RCT patients versus 2.4 (range: 0–20) in registry patients. Systemic treatment history was similar, with both groups averaging 1.4 prior treatment lines.</div></div><div><h3>Conclusions:</h3><div>RCT patients had greater disease burden. A significant portion of patients were treated off-trial, especially those with a single oligoprogressive lesion, raising concerns about the feasibility of randomized trials in this setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S41"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100204","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}