Radiotherapy and Oncology最新文献

{"title":"18F-FDG PET/CT directed radiotherapy dose escalation in locally advanced esophageal cancer (LAEC), a phase I study","authors":"Ningning Cheng,&nbsp;Zhixiao Chen,&nbsp;Ying Chen,&nbsp;Ye Hu,&nbsp;Zijie Wang,&nbsp;Xuming Chen,&nbsp;Qianqian Liu,&nbsp;Tingfeng Chen","doi":"10.1016/j.radonc.2025.111176","DOIUrl":"10.1016/j.radonc.2025.111176","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To determine the maximum tolerated dose (MTD) of hyperfractionated radiotherapy (HFRT) boost for residual metabolic disease (RMD) as defined by PET/CT following SCRT with concurrent paclitaxel (P) and carboplatin (C) for locally advanced esophageal cancer (LAEC).</div></div><div><h3>Materials and methods</h3><div>Eligible patients received standard chemoradiation therapy(SCRT) with weekly paclitaxel and carboplatin plus preirradiation PET/CT-guided intensity-modulated radiotherapy (IG-IMRT). Patients with RMD received HFRT boost concurrent with the same chemotherapy. Boost doses were escalated using a modified Fibonacci design. Dose limiting toxicity (DLT) was defined as grade ≥4 esophagitis, grade ≥3 non-hematological toxicity (except nausea/vomiting), or grade ≥4 hematological toxicity lasting &gt;7 days. MTD was the highest dose with ≤1 pts experiencing DLT.</div></div><div><h3>Results</h3><div>21pts were assessable. SCRT was well-tolerated. 4 pts achieved complete metabolic response (CMR). DLT occurred at 28.8 and 36 Gy. The MTD wasn’t reached. The most common acute grade ≥ 3 toxicities were esophagitis (17 %), neutropenia (24 %). Late toxicity included grade 1 or 2 esophageal stricture (n = 5). Overall response rate was 88 %. With median follow-up of 9 months, local–regional failure only occurred in 1pt.</div></div><div><h3>Conclusion</h3><div>36 Gy HFRT boost to PET/CT-defined RMD after 50 Gy SCRT using IG-IMRT, resulting in a total composite tumor dose of 86 Gy (BED 100.32 Gy), can be safely delivered concurrent with weekly P/C. MTD remains to be defined.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111176"},"PeriodicalIF":5.3,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200906","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":"From rugged ridges to radiotherapy ROIs: Translating topographical metrics to Surface-Guided Radiation Therapy regions of Interest in radiotherapy","authors":"Ciaran Malone ,&nbsp;Samantha Ryan ,&nbsp;Jill Nicholson ,&nbsp;Sinead Brennan ,&nbsp;Orla McArdle ,&nbsp;Ruth Woods ,&nbsp;Aodh MacGairbhith ,&nbsp;James Waldron ,&nbsp;Clodagh Callagh ,&nbsp;Rachel Harwood ,&nbsp;Brendan McClean ,&nbsp;Frances Duane ,&nbsp;Gerard G. Hanna","doi":"10.1016/j.radonc.2025.111173","DOIUrl":"10.1016/j.radonc.2025.111173","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether geography-derived topographical metrics (e.g., slope, aspect, elevation change and ruggedness) provide a quantitative, reproducible description of SGRT ROI surface quality. We pre-specified feasibility criteria: (i) monotonic, directionally consistent changes with controlled smoothing on synthetic surfaces; and (ii) separation of distributions between clinically distinct ROIs (breast size; full- vs limited-face).</div></div><div><h3>Methods</h3><div>Quantitative topographical metrics were identified for investigation including Slope, Aspect, Vector Ruggedness Measure (VRM), Topographic Position Index (TPI) and Terrain Ruggedness Index (TRI). First, synthetic breast-like and face-like surfaces were generated in Python using Perlin noise. Each surface was progressively smoothed and analysed for metric response to surface complexity. Second, three surface captures were exported from the AlignRT SGRT system: a small breast, a large breast and a face, which was cropped to produce a limited‐face and a full‐face surface. Histograms and 3D maps visualized metric distributions for each ROI.</div></div><div><h3>Results</h3><div>Slope, Aspect, TPI, and TRI effectively captured surface variations in both synthetic and patient data, identifying useful topographical features for SGRT. VRM remained low, relative to typical rugged geological terrain, indicating limited value for smooth skin surfaces. For the synthetic surfaces, increased smoothing compressed slope values toward zero, narrowed Aspect spreads, and lowered TRI/TPI variability. For patient/volunteer surfaces, the small-breast ROI showed fewer slope and aspect regions, and the large-breast ROI had broader slope and aspect ranges, and higher TRI/TPI, reflecting more pronounced local folds. Full‐face ROIs exhibited wider slope/TRI/TPI ranges than limited‐face ROIs.</div></div><div><h3>Conclusion</h3><div>Geography-derived metrics quantify ROI surface variation and meet pre-specified feasibility criteria and may help personalise and optimise ROI selection for individual patient anatomy. These results provide a quantitative foundation for ROI design and training; prospective studies are required to link metric thresholds to setup and intrafraction performance.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111173"},"PeriodicalIF":5.3,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200901","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":"Importance of 3D-TSE imaging for patients with brain metastasis treated with SRS alone","authors":"Eyub Y. Akdemir ,&nbsp;Joseph DiStefano ,&nbsp;Kevin J. Abrams ,&nbsp;Charif Sidani ,&nbsp;Margaret C. Chaneles ,&nbsp;Matthew D. Hall ,&nbsp;Robert H. Press ,&nbsp;D Jay Wieczorek ,&nbsp;Ranjini Tolakanahalli ,&nbsp;Alonso N. Gutierrez ,&nbsp;Michael W. McDermott ,&nbsp;Yazmin Odia ,&nbsp;Minesh P. Mehta ,&nbsp;Rupesh Kotecha","doi":"10.1016/j.radonc.2025.111172","DOIUrl":"10.1016/j.radonc.2025.111172","url":null,"abstract":"<div><div>This study evaluates the clinical utility of 3D turbo spin echo (3D-TSE) imaging in stereotactic radiosurgery (SRS) planning for brain metastases, examining the value of adding 3D-TSE to MPRAGE. Dual-sequence MRI (MPRAGE + 3D-TSE) significantly prolonged time to distant intracranial failure (DIF) in whole brain radiotherapy (WBRT)-naïve patients (n = 308, 11.4 vs. 6.8 months, p = 0.03), but not in patients previously treated with WBRT and salvaged with SRS (n = 39, 6.5 vs. 5.6 months, p = 0.76). Additional lesion detection attributed to 3D-TSE imaging was greater in WBRT-naïve (19.6 %) than in post-WBRT patients (12.0 %) (p &lt; 0.001). The dual-sequence imaging may improve time to distant failure in the modern era for most patients treated with primary stereotactic radiosurgery and should be integrated into the SRS workflow.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111172"},"PeriodicalIF":5.3,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200928","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":"Probabilistic evaluation guided IMPT planning with realistic setup and range uncertainties improves the trade-off between OAR sparing and target coverage in neuro-oncological patients","authors":"Jenneke I. de Jong ,&nbsp;Steven J.M. Habraken ,&nbsp;Jesús Rojo-Santiago ,&nbsp;Danny Lathouwers ,&nbsp;Zoltán Perkó ,&nbsp;Sebastiaan Breedveld ,&nbsp;Mischa S. Hoogeman","doi":"10.1016/j.radonc.2025.111171","DOIUrl":"10.1016/j.radonc.2025.111171","url":null,"abstract":"<div><h3>Objective</h3><div>Scenario-based evaluation in proton therapy often relies on a small number of error scenarios, leading to limited insight into the DVH values under uncertainty and suboptimal trade-offs. In this study, we investigated if re-optimization based on probabilistic evaluation improves the trade-off between OAR sparing and target coverage in neuro-oncological patients.</div></div><div><h3>Materials and methods</h3><div>22 neuro-oncological patients were included. 18 met their original target goals (group A), while in 4, target coverage was compromised to spare OARs (group B).</div><div>The probabilistic goal for the CTV was calibrated to be consistent with PTV-based photon plans, resulting in D_99.8%,CTV = 0.95D_pres with a 90 % confidence level. The probabilistic OAR constraints were set to meet the clinical constraints with a 95 % confidence level.</div><div>For both groups, the clinical plans were re-optimized, keeping the clinical objectives and constraints, but reducing robustness for the CTV objective (group A) to meet the probabilistic goal, or for the dose-limiting OAR objectives (group B) without exceeding the constraints.</div><div>For the original and re-optimized plans, polynomial chaos expansion was applied to simulate 10,000 fractionated treatments, deriving probability distributions for relevant DVH parameters.</div></div><div><h3>Results</h3><div>For group A, re-optimization resulted in a population median decrease of 8.2 (range: 0.4–20.8) Gy RBE in the total OAR-related clinical goal values.</div><div>For group B, re-optimization resulted in a population median increase of 2.7 (range: 1.3–6.8) Gy RBE in the D_99.8%,CTV. The population median V_95%,CTV improved from 97.4 % to 99.1 %.</div></div><div><h3>Conclusion</h3><div>We demonstrated that probabilistic evaluation guided IMPT planning enables either OAR sparing or target coverage enhancement.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111171"},"PeriodicalIF":5.3,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A predictive model based on the dosimetric parameters of the parotid stem cell region to assess the recovery of radiation-induced xerostomia in long-term survivors of nasopharyngeal carcinoma after radical radiotherapy","authors":"Mai Zhang ,&nbsp;Jie Gong ,&nbsp;Yong Zhu ,&nbsp;Zhi-Hua Yang ,&nbsp;Yong-Chun Zhou ,&nbsp;Jing Hu ,&nbsp;Hui Guo ,&nbsp;Hai-Liang Li ,&nbsp;Quan Shi ,&nbsp;Zhong-Fei Wang ,&nbsp;Chang-Hao Liu ,&nbsp;Ning Su ,&nbsp;Li-Na Zhao ,&nbsp;Mei Shi ,&nbsp;Jian Zang","doi":"10.1016/j.radonc.2025.111163","DOIUrl":"10.1016/j.radonc.2025.111163","url":null,"abstract":"<div><h3>Background</h3><div>For nasopharyngeal carcinoma (NPC) patients with bilateral parotids near high − dose areas, more research is needed on how radiation to the parotid stem cell region (SCR) impacts xerostomia. This multicenter study aims to explore SCR radiation dosimetric parameters and clinical factors that influence recovery from radiation-induced xerostomia in long-term survivors.</div></div><div><h3>Methods</h3><div>We analyzed 648 NPC patients from four Chinese centers who underwent radical radiotherapy. Recovery was assessed via patient-reported (PRO) and physician-assessed (PAO) outcomes. The Cox proportional hazards model identified key clinical and dosimetric factors for recovery, aiming to develop an integrated prediction model. Prognostic performance was evaluated with time-dependent area under the receiver operating characteristic curve (AUC), and Cumulative incidence curve estimated recovery across different risk groups.</div></div><div><h3>Results</h3><div>Patients were randomly allocated to training and validation sets at 7:3. Multivariate COX analysis identified age (<em>p</em>=0.000), induction chemotherapy (<em>p</em>=0.003), SCR Dmean (<em>p</em>=0.047), and SCR V20 (<em>p</em>=0.000) as key predictors for xerostomia recovery. A nomogram model using these factors outperformed individual ones in predicting xerostomia recovery for PRO recovery, 3-year/5-year AUC was 0.77/0.806 (training) and 0.773/0.81 (validation); for PAO recovery, it was 0.756/0.786 (training) and 0.748/0.786 (validation). Based on the median score derived from the model, the entire cohort was stratified into high-risk and low-risk groups. Notably, the low-risk group demonstrated a significantly higher recovery rate in both the training set and validation set (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>A model combining SCR dosimetry and clinical factors effectively predicts xerostomia recovery.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111163"},"PeriodicalIF":5.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186566","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":"Failure pattern and salvage in head and neck cancer of unknown primary: A national study by DAHANCA","authors":"Signe Bergliot Nielsen ,&nbsp;Morten Horsholt Kristensen ,&nbsp;Anne Ivalu Sander Holm ,&nbsp;Ruta Zukauskaite ,&nbsp;Christian Rønn Hansen ,&nbsp;Christina Caroline Plaschke ,&nbsp;Anita Birgitte Gothelf ,&nbsp;Bob Smulders ,&nbsp;Eva Samsøe Hinsby ,&nbsp;Martin Skovmos Nielsen ,&nbsp;Patrik Sibolt ,&nbsp;Nina Munk Lyhne ,&nbsp;Maria Andersen ,&nbsp;Mohammad Farhadi ,&nbsp;Hanne Primdahl ,&nbsp;Christian Maare ,&nbsp;Jørgen Johansen ,&nbsp;Christian Godballe ,&nbsp;Thomas Kjærgaard ,&nbsp;Jens Overgaard","doi":"10.1016/j.radonc.2025.111162","DOIUrl":"10.1016/j.radonc.2025.111162","url":null,"abstract":"<div><h3>Background</h3><div>Failure patterns in patients with head and neck squamous cell carcinoma of unknown primary (HNSCCUP) depend on disease etiology and treatment type and extent. Treatment strategies may include radiotherapy to address any potential mucosal tumor sites, or alternatively, the omission of mucosal irradiation to permit targeted intervention should a primary tumor subsequently emerge. The Danish 2013 guidelines employed both strategies based on N-classification and Epstein-Barr Virus status, but not Human Papilloma Virus (HPV) status. The present study aimed to analyze failure patterns in a complete, nationwide Danish cohort of patients with HNSCCUP, with a focus on HPV status, treatment targets, and salvage outcomes.</div></div><div><h3>Materials &amp; Methods</h3><div>All HNSCCUP patients treated in the period 2014 to 2020, were identified in the DAHANCA database. An image-based pattern of failure analysis was conducted to evaluate the extent of primary treatment coverage at sites of recurrence.</div></div><div><h3>Results</h3><div>In a consecutive cohort of 254 HNSCCUP patients, 43 % had HPV-associated disease (p16 positivity). Treatment modalities included definitive neck dissection (dND) (n = 60) and treatment regiments involving intensity modulated radiotherapy (IMRT, n = 194); either postoperative or primary IMRT with or without adjuvant chemotherapy. 71 patients (28 %) experienced failure within 5 years. Anatomical localization of emerging primaries depended on HPV status and primary treatment modality. Higher rates of emerging primaries were seen in the dND group (35 %) compared to the IMRT group (6 %), with salvage treatment resulting in cure rates of 78 % and 27 %, respectively. Most regional failures in the IMRT group originated within elective clinical target volumes (89 %). No significant difference in loco-regional failure was observed when comparing the dND group with the IMRT group, when including salvage effects.</div></div><div><h3>Conclusion</h3><div>The study findings support a personalized treatment strategy guided by HPV status and highlight the importance of including salvage outcomes in treatment efficacy analyses.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111162"},"PeriodicalIF":5.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186598","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":"National indication protocol for proton radiotherapy in esophageal cancer patients in the Netherlands","authors":"Christina T Muijs ,&nbsp;Yvonne L.B. Klaver ,&nbsp;Joost Nuyttens ,&nbsp;Irene M Lips ,&nbsp;Karin Muller ,&nbsp;Gati Mulder- Ebrahimi ,&nbsp;Frank J.W.M. Dankers ,&nbsp;Rob Verhoeven ,&nbsp;Ewoud Schuit ,&nbsp;Maaike Berbee","doi":"10.1016/j.radonc.2025.111164","DOIUrl":"10.1016/j.radonc.2025.111164","url":null,"abstract":"<div><h3>Background</h3><div>Chemoradiotherapy (CRT) plays a key role in treating esophageal cancer (EC) but is associated with significant toxicity. Proton radiotherapy (PRT) may reduce this risk by limiting radiation dose to organs at risk. In the Netherlands, PRT is reimbursed only when eligibility criteria defined in a National Indication Protocol for Proton Therapy (NIPP) are met. This study describes the development and implementation of such a protocol for EC based on model-based selection.</div></div><div><h3>Materials and Methods</h3><div>A national multidisciplinary working group was formed aiming to develop the NIPP protocol through literature review, evaluation of prediction models, external model validation, and stakeholder engagement.</div></div><div><h3>Results</h3><div>Cardiac events and overall survival were identified as the most clinically relevant endpoints. As no existing models met the quality criteria for model-based selection, a validated 2-year mortality prediction model originally developed for lung cancer was externally validated in EC patients treated with definitive (dCRT) or neoadjuvant (nCRT) CRT. The model performed well after updates to the intercept (both cohorts) and slope (nCRT). Model-based selection was defined as a ≥ 5 % predicted absolute reduction in 2-year mortality with PRT versus photon radiotherapy, using Mean Heart Dose (MHD) and Gross Tumor Volume (GTV) as predictors. Additional selection criteria included WHO performance status 0–2 and exclusion of cT4, cN3, or cM1 status. The NIPP was approved by the Dutch Society of Radiation Oncology in June 2021 and by the Dutch Health Care Institute in October 2021. National implementation and prospective outcome evaluation are ongoing via the ProTRAIT registry.</div></div><div><h3>Conclusion</h3><div>A national indication protocol enabling model-based selection for PRT in EC was successfully implemented in the Netherlands. The NIPP describes eligibility criteria for proton therapy reimbursement and enables reimbursement for individual patients who are expected to benefit from PRT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111164"},"PeriodicalIF":5.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145177912","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 of metastatic lesion radiotherapy in de novo metastatic nasopharyngeal carcinoma patients receiving local regional radiotherapy and chemo-immunotherapy: a multicenter retrospective study","authors":"Shui-Qing He ,&nbsp;Shu-Hui Lv ,&nbsp;Si-Qing Wen ,&nbsp;Lin-Wang ,&nbsp;Ya-Hui Yu ,&nbsp;Guo-Yi Zhang ,&nbsp;Ding-Sheng Peng ,&nbsp;Wei-Xin Bei ,&nbsp;Chun-Lan Chen ,&nbsp;Ze-Yu Zhao ,&nbsp;Ying Huang ,&nbsp;Yan-Qun Xiang ,&nbsp;Guo-Ying Liu","doi":"10.1016/j.radonc.2025.111160","DOIUrl":"10.1016/j.radonc.2025.111160","url":null,"abstract":"<div><h3>Background and purpose</h3><div>De novo metastatic nasopharyngeal carcinoma (dmNPC) exhibits heterogeneous survival outcomes. While combining chemo-immunotherapy with locoregional radiotherapy (LRRT) improves outcomes, the role of metastatic lesion radiotherapy (MLRT) remains controversial, especially in the context of immunotherapy. This study aims to evaluate MLRT’s efficacy in dmNPC patients receiving chemo-immunotherapy and LRRT and establish a prognostic model for identifying MLRT beneficiaries.</div></div><div><h3>Materials and methods</h3><div>The study comprised of 347 dmNPC patients from four different centers. All patients received ≥2 cycles of first-line chemo-immunotherapy and LRRT. MLRT was administered to 77 patients. Prognostic factors were analyzed using Cox regression. A recursive partitioning analysis (RPA) model was employed to construct a prognostic model for risk stratification. Progression-free survival (PFS) differences between MLRT and non-MLRT groups were compared across risk strata.</div></div><div><h3>Results</h3><div>MLRT recipients demonstrated superior median PFS (not reached vs. 34.87 months, p = 0.006). The RPA model classified patients into three risk groups based on the number of metastatic lesions, liver metastasis, and post-treatment Epstein-Barr Virus (EBV) DNA. The 3-year PFS rates for the low-, medium-, and high-risk groups were 71.4 %, 39.2 %, and 12.3 %. MLRT significantly improved 3-year PFS in low-risk patients (82.8 % vs. 69.1 %, p = 0.031), but not in medium or high-risk groups. Independent adverse prognostic factors included detectable post-treatment EBV DNA (HR = 3.36), liver metastasis (HR = 1.5), and &gt;5 metastatic lesions (HR = 1.52).</div></div><div><h3>Conclusion</h3><div>MLRT benefits dmNPC patients with low-risk features (limited metastases, undetectable EBV DNA). Risk stratification using metastatic burden and EBV DNA status may guide personalized MLRT decisions in the immunotherapy era.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111160"},"PeriodicalIF":5.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150614","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 between prostate radiotherapy and survival among patients with metastatic prostate cancer by extent of disease burden","authors":"Peter S. Palencia ,&nbsp;Shayan Smani ,&nbsp;Xiwen Zhao ,&nbsp;Keervani Kandala ,&nbsp;Nethusan Sivanesan ,&nbsp;Jaime A. Cavallo ,&nbsp;Navid Roessler ,&nbsp;Sanjay Aneja ,&nbsp;Yi An ,&nbsp;Marcin Miszczyk ,&nbsp;Michael S. Leapman","doi":"10.1016/j.radonc.2025.111158","DOIUrl":"10.1016/j.radonc.2025.111158","url":null,"abstract":"<div><h3>Background and objective</h3><div>Prostate radiotherapy (RT) is increasingly used in the treatment of hormone-sensitive metastatic prostate cancer (PCa) based on evidence of benefit in subsets with low disease volume. However, survival outcomes of patients with metastatic PCa receiving prostate RT across contemporary distributions of stage are less well understood.</div></div><div><h3>Methods</h3><div>Within the National Cancer Database (2004–2020), we identified individuals with de-novo metastatic PCa treated with hormonal therapy (HT) with or without prostate RT. Kaplan-Meier curves and multivariable proportional hazard regression models were used to compare overall survival (OS) across nodal (M1a), bone (M1b), and visceral (M1c) disease, using propensity score matched (PSM) samples.</div></div><div><h3>Results</h3><div>We identified 48,121 eligible patients, including 42,437 (88.2 %) patients receiving only HT and 5,684 (11.8 %) patients receiving HT + RT. In PSM-adjusted hazard regression models, RT was associated with improved OS (HR: 0.62; 95 % CI: 0.58–0.66; p &lt; 0.001). The association differed by metastatic substage; the risk of death was reduced in patients with M1a (HR: 0.48; 95 % CI: 0.39–0.58; p &lt; 0.001) and M1b disease (HR: 0.60; 95 % CI: 0.56–0.65; p &lt; 0.001). No significant OS benefit was observed in M1c disease (HR: 0.91; 95 % CI: 0.74–1.13; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Prostate RT with HT was associated with improved survival in this observational study of patients with metastatic PCa. However, these associations differed by metastatic substage, with greater benefit in M1a, and no apparent benefit in M1c disease.<!--> <!-->In the era of molecular imaging, further refinement of patient selection for prostate RT may optimize treatment benefit.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111158"},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131833","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":"Radiotherapy quality assurance of the prospective randomised EORTC-1219/DAHANCA-29 trial: an individual case review analysis","authors":"Najlaa Alyamani ,&nbsp;André Abrunhosa-Branquinho ,&nbsp;Coreen Corning ,&nbsp;Marjan Sharabiani ,&nbsp;Pierre Castadot ,&nbsp;Jordi Giralt ,&nbsp;Joanna Kazmierska ,&nbsp;Warren Grant ,&nbsp;Melissa Christiaens ,&nbsp;Milan Tomsej ,&nbsp;Raquel Bar-Deroma ,&nbsp;Angelo F. Monti ,&nbsp;Jean-Jacques Stelmes ,&nbsp;Enrico Clementel ,&nbsp;Catherine Fortpied ,&nbsp;Sandra Collette ,&nbsp;Coen W. Hurkmans ,&nbsp;Vincent Grégoire ,&nbsp;Jens Overgaard ,&nbsp;D.-C. Weber ,&nbsp;Nicolaus Andratschke","doi":"10.1016/j.radonc.2025.111141","DOIUrl":"10.1016/j.radonc.2025.111141","url":null,"abstract":"<div><h3>Background</h3><div>The EORTC-1219/DAHANCA-29 trial investigated whether adding nimorazole to accelerated radiotherapy (RT) and chemotherapy improves locoregional control of locally advanced head and neck cancer. As part of the trial’s RT quality assurance (RTQA) program, individual case review (ICR) of RT plans was performed to assess protocol compliance and treatment planning quality.</div></div><div><h3>Materials and methods</h3><div>Nineteen centers submitted RT plans for central review. The trial mandated prospective ICR (p-ICR) for the first five patients per institution, with subsequent plans reviewed retrospectively or as optional p-ICR. Plans were reviewed by radiation oncologists and medical physicists. Plans deemed unacceptable in p-ICR were resubmitted for review, whereas retrospective ICR (r-ICR) cases were reviewed once. Plans were categorized as “Acceptable as per protocol,” “Acceptable variation,” or “Unacceptable variation.”.</div></div><div><h3>Results</h3><div>RT plans for all 194 randomized patients were reviewed, with 174p-ICRs and 44 r-ICRs. The delineation acceptability rate for p-ICR improved from 69% at the first submission to 93% at final review. p-ICR had an 18% higher acceptance rate (90%) compared to r-ICR (73%). Dose and plan acceptability remained high (97%) at both first and final submission, with minimal differences between p-ICR and r-ICR.</div></div><div><h3>Conclusion</h3><div>P-ICR significantly improved CTV delineation quality, ensuring higher protocol compliance and treatment planning accuracy. p-ICRs are recommended for complex treatments, tailored to the performance of individual sites.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111141"},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131814","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}