Radiotherapy and Oncology最新文献

{"title":"Climate impact of early-stage NSCLC treatment: A comparison between radiotherapy and surgery using Life Cycle Assessment","authors":"Jochem Kaas ,&nbsp;Marit Verbeek ,&nbsp;Wilson W.L. Li ,&nbsp;Stefan M. van der Heide ,&nbsp;Ad F.T.M. Verhagen ,&nbsp;René Monshouwer ,&nbsp;Hugo R.W. Touw ,&nbsp;Johan Bussink ,&nbsp;Erik van der Bijl ,&nbsp;Tim Stobernack","doi":"10.1016/j.radonc.2024.110601","DOIUrl":"10.1016/j.radonc.2024.110601","url":null,"abstract":"<div><h3>Introduction</h3><div>Healthcare systems contribute significantly to CO₂ emissions, accounting for 7 % of emissions in the Netherlands. Understanding the environmental footprint of medical treatments can help identify opportunities for reducing climate impact. We evaluated the climate impact of stereotactic body radiotherapy (SBRT) and Video-Assisted Thoracic Surgery (VATS) when treating T1-2N0M0 Non-Small Cell Lung Cancer (NSCLC).</div></div><div><h3>Materials and methods</h3><div>We used life cycle assessment (LCA) to evaluate climate impact in emissions of kilograms of CO₂ equivalent. Care trajectories were inventoried for both VATS and SBRT with the same entry and end point of the paths. We analyzed a range of factors contributing to climate impact, such as patient and staff travel, energy consumption, disposables and medication using direct measurements: questionnaires and waste audits, or retrospective record analysis. As is common in LCA, existing infrastructure was excluded from the analysis. Reductions that can be influenced by individual departments were also modeled.</div></div><div><h3>Results</h3><div>Using LCA we calculated the impact of all categorized contributions for two treatments for NSCLC. In total, VATS generates approximately 547 kg CO₂ equivalent (CO₂e), whereas SBRT generates 172 kg CO₂e per treatment. For SBRT, the largest contributors were energy use in the hospital (52 % of total), of which 22 % is from the linac, and patient travel (23 %). For VATS, major contributions were hospital energy use (52 %) and disposables (23 %). Climate impact could be reduced by 20 % (SBRT) by hypofractionation, reduced linac idle time and patient travel impact, and 13 % (VATS) with fast track recovery and a reduction of disposables.</div></div><div><h3>Conclusion</h3><div>When treating T1-2N0M0 NSCLC, surgery has a larger climate impact than SBRT. For both modalities reductions are possible.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110601"},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558629","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":"Locoregional control in high-risk neuroblastoma using highly-conformal image-guided radiotherapy, with reduced margins and a boost dose for residual lesions","authors":"Atia Samim ,&nbsp;Annemieke S. Littooij ,&nbsp;Max Peters ,&nbsp;Bart de Keizer ,&nbsp;Alida F.W. van der Steeg ,&nbsp;Raquel Dávila Fajardo ,&nbsp;Kathelijne C.J.M. Kraal ,&nbsp;Miranda P. Dierselhuis ,&nbsp;Natasha K.A. van Eijkelenburg ,&nbsp;Martine van Grotel ,&nbsp;Roel Polak ,&nbsp;Cornelis P. van de Ven ,&nbsp;Marc H.W.A. Wijnen ,&nbsp;Enrica Seravalli ,&nbsp;Mirjam E. Willemsen-Bosman ,&nbsp;Max M. van Noesel ,&nbsp;Godelieve A.M. Tytgat ,&nbsp;Geert O. Janssens","doi":"10.1016/j.radonc.2024.110604","DOIUrl":"10.1016/j.radonc.2024.110604","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiotherapy protocols for high-risk neuroblastoma (HR-NBL) vary across international studies. The purpose of this study was to evaluate the locoregional control in a national HR-NBL cohort treated with highly-conformal image-guided radiotherapy (IGRT), using reduced margins, and a boost dose for residual lesions.</div></div><div><h3>Materials and methods</h3><div>Patients treated with radiotherapy as part of first-line HR-NBL treatment between 2015 and 2022 were eligible. To obtain clinical, internal, and planning target volumes, +0.5 cm, 4DCT-based, and + 0.3/0.5 cm margins, respectively, were added to the edited gross tumour volumes. Prescription dose was 21.6/1.8 Gy, followed by 14.4/1.8 Gy for any residual lesions measuring ≥ 1 cm³ at the time of radiotherapy planning. Intensity-modulated arc therapy was combined with daily cone beam CT-based online patient position verification. Locoregional failure (LRF) rates were compared for the presence of residual lesions &lt; 1 cm³ vs. ≥ 1 cm³ (with/without locoregional activity on nuclear- and MRI[diffusion-weighted imaging]-scans) pre-radiotherapy, age at diagnosis, MYCN-status, [¹³¹I]mIBG therapy, response to induction chemotherapy, interval to radiotherapy onset, and metastatic site irradiation.</div></div><div><h3>Results</h3><div>Among the 77 included patients, 34 had residual lesions (median volume: 10.0 cm³, IQR 4.8–29.9) with activity visible on 17 nuclear- and 10 MRI-scans. Five-year LRF rate was 7.8 % (95 % confidence interval 1.8–13.8), and not significantly different between those with residual lesions &lt; 1 cm³ vs. ≥ 1 cm³ (6.4 % vs. 14.3 %, respectively, p = 0.27), or any of the other variables. All 6 LRFs (2 isolated, 4 combined) occurred &lt; 1.5 years post-radiotherapy.</div></div><div><h3>Conclusion</h3><div>In HR-NBL, IGRT with reduced margins and a boost dose for residual lesions ≥ 1 cm³ demonstrated excellent locoregional control, comparable to modern literature.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110604"},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxicity in patients receiving radiotherapy for ultracentral stage I non-small cell lung cancer: A secondary analysis of the LUSTRE randomized trial","authors":"Che Hsuan David Wu ,&nbsp;Marcin Wierzbicki ,&nbsp;Sameer Parpia ,&nbsp;Vijayananda Kundapur ,&nbsp;Alexis Bujold ,&nbsp;Edith Filion ,&nbsp;Harold Lau ,&nbsp;Sergio Faria ,&nbsp;Naseer Ahmed ,&nbsp;Nelson Leong ,&nbsp;Gordon Okawara ,&nbsp;Khalid Hirmiz ,&nbsp;Timothy Owen ,&nbsp;Alexander V Louie ,&nbsp;James R Wright ,&nbsp;Timothy J Whelan ,&nbsp;Anand Swaminath","doi":"10.1016/j.radonc.2024.110605","DOIUrl":"10.1016/j.radonc.2024.110605","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Stereotactic body radiotherapy (SBRT) carries potentially higher risks for ultracentral (UC) NSCLC with limited prospective data to guide decision making. We conducted a secondary analysis from a randomized trial of SBRT and conventionally hypofractionated radiation (CRT) to assess these risks.</div></div><div><h3>Materials and Methods</h3><div>Patients (n = 233) with medically inoperable stage I NSCLC were recruited from 2014 to 2020. Patients with UC targets directly overlapping the proximal bronchial tree (PBT) were identified. The primary objective was the occurrence of related grade 3–5 toxicity &gt; 3 months following radiation. Secondary endpoints included local control, survival, and evaluation of PBT dose and its association with late toxicity.</div></div><div><h3>Results</h3><div>Thirty UC tumors were identified (23 − SBRT 60 Gy/8 fractions, 7 − CRT 60 Gy/15 fractions). Median age was 72 years, and median tumor size was 2.8 cm. Most patients (67 %) had histologically confirmed NSCLC. At a median follow-up of 2.9 years, 3 and 1 patients developed grade 3 and 5 toxicity respectively (all SBRT). 3-year local control was 85 %. Mean PBT dose (converted to 2 Gy dose equivalents) was higher in patients with grade ≥ 3 toxicity, particularly for 4 cc (105.5 vs 51.8 Gy, p = 0.0004), 5 cc (84 vs 46.1 Gy, p = 0.003), and volumetric doses (V65 – V100Gy). The patient with grade 5 toxicity had the highest 5 cc dose (117 Gy), V90Gy (8.2 cc), and V100Gy (7 cc).</div></div><div><h3>Conclusions</h3><div>SBRT for UC NSCLC provides good local control but carries a high rate of late grade 3–5 toxicity. An apparent association between toxicity and PBT volumetric dose was observed, which should be considered if SBRT is offered.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110605"},"PeriodicalIF":4.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the impact of treatment on memory functions in pediatric posterior fossa tumor survivors using diffusion tensor imaging","authors":"Fatima Tensaouti ,&nbsp;Germain Arribarat ,&nbsp;Bastien Cabarrou ,&nbsp;Lisa Pollidoro ,&nbsp;Nicolas Courbière ,&nbsp;Annick Sévely ,&nbsp;Margaux Roques ,&nbsp;Yves Chaix ,&nbsp;Patrice Péran ,&nbsp;Eloïse Baudou ,&nbsp;Anne Laprie","doi":"10.1016/j.radonc.2024.110599","DOIUrl":"10.1016/j.radonc.2024.110599","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The aim of the present prospective exploratory study was to investigate the long-term impact of treatment on brain structure integrity and memory functions in pediatric posterior fossa tumor (PFT) survivors using diffusion tensor imaging (DTI), to determine whether the latter could provide useful biomarkers of memory impairment.</div></div><div><h3>Material and Methods</h3><div>Sixty participants were included in this study, divided into three groups: 22 irradiated PFT, 17 non-irradiated PFT, and 21 healthy controls. All underwent memory tests and multimodal MRI, including a DTI sequence. Mean diffusivity and fractional anisotropy values were extracted for bilateral brain structures involved in memory, in order to carry out between-group comparisons and calculate correlations with memory test scores and radiotherapy doses. Statistical tests were two-sided, and <em>p</em> values &lt; 0.05 were considered statistically significant.</div></div><div><h3>Results</h3><div>DTI metrics were significantly higher for irradiated PFT survivors than in non-irradiated PFT survivors and controls (<em>p</em> &lt; 0.05). Memory test scores were significantly lower for PFT survivors, particularly irradiated patients (<em>p</em> &lt; 0.02), and were correlated with DTI metrics.</div><div>(−0.27 &lt; <em>r</em> &lt; -0.62, <em>p</em> &lt; 0.04). DTI metrics were correlated with either total or maximum dose for some structures.</div></div><div><h3>Conclusion</h3><div>Preliminary results of this study point to microstructural damage in memory-related brain areas in PFT survivors, particularly in irradiated patients, and identify DTI metrics as potential biomarkers of memory deficit.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110599"},"PeriodicalIF":4.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569416","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":"Knowledge-based planning, multicriteria optimization, and plan scorecards: A winning combination","authors":"Carlos E. Cardenas,&nbsp;Rex A. Cardan,&nbsp;Joseph Harms,&nbsp;Eric Simiele,&nbsp;Richard A. Popple","doi":"10.1016/j.radonc.2024.110598","DOIUrl":"10.1016/j.radonc.2024.110598","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The ESTRO 2023 Physics Workshop hosted the Fully-Automated Radiotherapy Treatment Planning (Auto-RTP) Challenge, where participants were provided with CT images from 16 prostate cancer patients (6 prostate only, 6 prostate + nodes, and 4 prostate bed + nodes) across 3 challenge phases with the goal of automatically generating treatment plans with minimal user intervention. Here, we present our team’s winning approach developed to swiftly adapt to both different contouring guidelines and treatment prescriptions than those used in our clinic.</div></div><div><h3>Materials and methods</h3><div>Our planning pipeline comprises two main components: 1) auto-contouring and 2) auto-planning engines, both internally developed and activated via DICOM operations. The auto-contouring engine employs 3D U-Net models trained on a dataset of 600 prostate cancer patients for normal tissues, 253 cases for pelvic lymph node, and 32 cases for prostate bed. The auto-planning engine, utilizing the Eclipse Scripting Application Programming Interface, automates target volume definition, field geometry, planning parameters, optimization, and dose calculation. RapidPlan models, combined with multicriteria optimization and scorecards defined on challenge scoring criteria, were employed to ensure plans met challenge objectives. We report leaderboard scores (0–100, where 100 is a perfect score) which combine organ-at-risk and target dose-metrics on the provided cases.</div></div><div><h3>Results</h3><div>Our team secured 1st place across all three challenge phases, achieving leaderboard scores of 79.9, 77.3, and 78.5 outperforming 2nd place scores by margins of 6.4, 0.4, and 2.9 points for each phase, respectively. Highest plan scores were for prostate only cases, with an average score exceeding 90. Upon challenge completion, a “Plan Only” phase was opened where organizers provided contours for planning. Our current score of 90.0 places us at the top of the “Plan Only” leaderboard.</div></div><div><h3>Conclusions</h3><div>Our automated pipeline demonstrates adaptability to diverse guidelines, indicating progress towards fully automated radiotherapy planning. Future studies are needed to assess the clinical acceptability and integration of automatically generated plans.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110598"},"PeriodicalIF":4.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying paediatric patients at risk of severe hearing impairment after treatment for malignancies of the H&N/CNS with proton therapy","authors":"Simona Gaito ,&nbsp;Eunji Hwang ,&nbsp;David Thwaites ,&nbsp;Verity Ahern ,&nbsp;Ed Smith ,&nbsp;Gillian A. Whitfield ,&nbsp;Peter Sitch ,&nbsp;Anna France ,&nbsp;Marianne Aznar","doi":"10.1016/j.radonc.2024.110597","DOIUrl":"10.1016/j.radonc.2024.110597","url":null,"abstract":"<div><h3>Background and purpose</h3><div>A risk calculation model was presented in 2021 by Keilty et al. for determining the likelihood of severe hearing impairment (HI) for paediatric patients treated with photon radiation therapy. This study aimed to validate their risk-prediction model for our cohort of paediatric patients treated with proton therapy (PT) for malignancies of the head and neck (H&amp;N) or central nervous system (CNS).</div></div><div><h3>Materials and methods</h3><div>This was a single-institution study which extracted data on all patients aged ≤ 18 years treated with PT between Feb 2010 – Feb 2022 for malignancies of the H&amp;N/CNS. The factors required for input into the Keilty model were extracted: age at PT, time since end of PT, mean cochlea dose, and platinum chemotherapy doses. Validation was performed using the statistical software R v 4.3.1, which analysed event discrimination and model calibration.</div></div><div><h3>Results</h3><div>587 patients met the criteria. Validation of the model demonstrated excellent discriminative ability, with an “optimal” cut-off value of 16% at a specificity and sensitivity of 82%. However, model calibration was less satisfactory, indicating an overestimation of risk of severe hearing loss (HI) by the model as compared to clinically observed events in our cohort, possibly linked to differences in event scoring between the model developers and this study, and short follow-up time in this study.</div></div><div><h3>Conclusion</h3><div>The published (photon-based) model of Keilty et al. was validated in a PT context, demonstrating a high discriminative ability to determine patients at high risk versus low risk for severe HI. However the overall observed risk was lower than model predictions.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110597"},"PeriodicalIF":4.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569395","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":"ESTRO-EANO guideline on target delineation and radiotherapy for IDH-mutant WHO CNS grade 2 and 3 diffuse glioma","authors":"Brigitta G. Baumert ,&nbsp;Jaap P. M. Jaspers ,&nbsp;Vera C. Keil ,&nbsp;Norbert Galldiks ,&nbsp;Ewa Izycka-Swieszewska ,&nbsp;Beate Timmermann ,&nbsp;Anca L. Grosu ,&nbsp;Giuseppe Minniti ,&nbsp;Umberto Ricardi ,&nbsp;Frédéric Dhermain ,&nbsp;Damien C. Weber ,&nbsp;Martin van den Bent ,&nbsp;Roberta Rudà ,&nbsp;Maximilian Niyazi ,&nbsp;Sara Erridge","doi":"10.1016/j.radonc.2024.110594","DOIUrl":"10.1016/j.radonc.2024.110594","url":null,"abstract":"<div><h3>Purpose</h3><div>This guideline will discuss radiotherapeutic management of IDH-mutant grade 2 and grade 3 diffuse glioma, using the latest 2021 WHO (5th) classification of brain tumours focusing on: imaging modalities, tumour volume delineation, irradiation dose and fractionation.</div></div><div><h3>Methods</h3><div>The ESTRO Guidelines Committee, CNS subgroup, nominated 15 European experts who identified questions for this guideline. Four working groups were established addressing specific questions concerning imaging, target volume delineation, radiation techniques and fractionation. A literature search was performed, and available literature was discussed. A modified two-step Delphi process was used with majority voting resulted in a decision or highlighting areas of uncertainty.</div></div><div><h3>Results</h3><div>Key issues identified and discussed included imaging needed to define target definition, target delineation and the size of margins, and technical aspects of treatment including different planning techniques such as proton therapy.</div></div><div><h3>Conclusions</h3><div>The GTV should include any residual tumour volume after surgery, as well as the resection cavity. Enhancing lesions on T1 imaging should be included if they are indicative of residual tumour. In grade 2 tumours, T2/FLAIR abnormalities should be included in the GTV. In grade 3 tumours, T2/FLAIR abnormalities should also be included, except areas that are considered to be oedema which should be omitted from the GTV. A GTV to CTV expansion of 10 mm is recommended in grade 2 tumours and 15 mm in grade 3 tumours. A treatment dose of 50.4 Gy in 28 fractions is recommended in grade 2 tumours and 59.4 Gy in 33 fractions in grade 3 tumours. Radiation techniques with IMRT are the preferred approach.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110594"},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose calculation accuracy of a new high-performance ring-gantry CBCT imaging system for prostate and lung cancer patients","authors":"Nienke D. Sijtsema,&nbsp;Joan J. Penninkhof,&nbsp;Agustinus J.A.J. van de Schoot,&nbsp;Britt Kunnen,&nbsp;Judith H. Sluijter,&nbsp;Marjan van de Pol,&nbsp;Femke E. Froklage,&nbsp;Maarten L.P. Dirkx,&nbsp;Steven F. Petit","doi":"10.1016/j.radonc.2024.110596","DOIUrl":"10.1016/j.radonc.2024.110596","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The recently introduced high-performance CBCT imaging system called HyperSight offers improved Hounsfield units (HU) accuracy, a larger CBCT field-of-view and improved image quality compared to conventional ring gantry CBCT, possibly enabling treatment planning on CBCT imaging directly. In this study, we evaluated whether the dose calculation accuracy on HyperSight CBCT was sufficient for treatment planning in prostate and lung cancer patients.</div></div><div><h3>Materials and methods</h3><div>HyperSight CBCT was compared to planning CT (pCT) in terms of HU-to-mass density (MD) calibration curves. For twenty prostate patients and twenty lung patients, differences in DVH parameters, and 3D global gamma between dose distributions calculated on pCT and free breathing HyperSight CBCT were evaluated. For this purpose, HyperSight CBCT acquired at the first fraction was rigidly registered to the pCT, delineations from the CT were propagated and the dose was recalculated on the HyperSight CBCT.</div></div><div><h3>Results</h3><div>For each insert of the HU-to-MD calibration phantom, the HU values of HyperSight CBCT and pCT agreed within 35 HU. For prostate maximum deviations in PTV D_mean, V_95% and V_107% were 1.8 %, −1.1 % and &lt; 0.1 % respectively. For lung PTV V_95% was generally lower (median −1.1 %) and PTV V_107% was generally higher (median 1.1 %) on HyperSight CBCT due to breathing motion artifacts. The average (±SD) 2 %/2mm gamma pass rate was 98.7 %±1.2 % for prostate cancer patients and 96.2 %±2.1 % for lung cancer patients.</div></div><div><h3>Conclusion</h3><div>HyperSight CBCT enabled accurate dose calculation for prostate cancer patients, without implementation of a specific HyperSight CBCT-to-MD curve. For lung cancer patients, breathing motion hampered accurate dose calculations.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110596"},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose constraints in breast cancer radiotherapy. A critical review","authors":"Fiorenza De Rose ,&nbsp;Maria Carmen De Santis ,&nbsp;Sara Lucidi ,&nbsp;Riccardo Ray Colciago ,&nbsp;Lorenza Marino ,&nbsp;Francesca Cucciarelli ,&nbsp;Eliana La Rocca ,&nbsp;Francesca Di Pressa ,&nbsp;Frank Lohr ,&nbsp;Valentina Vanoni ,&nbsp;Bruno Meduri","doi":"10.1016/j.radonc.2024.110591","DOIUrl":"10.1016/j.radonc.2024.110591","url":null,"abstract":"<div><div>Radiotherapy plays an essential role in the treatment of breast cancer (BC). Recent advances in treatment technology and radiobiological knowledge have a major impact in BC patients with locoregional disease as the majority are now long-term survivors.</div><div>Over the last three decades, intensity-modulated radiotherapy (IMRT), volumetric-modulated arc therapy (VMAT) and deep inspiration breath-hold (DIBH) techniques, together with the increasing adoption of moderately hypofractionated and ultra-hypofractionated treatment schedules as well as the possibility to offer partial breast radiotherapy to a well-defined patient subset have significantly changed radiotherapy for BC patients.</div><div>As dose-volume constraints (DVCs) have to be adapted to these new treatment paradigms we have reviewed available evidence-based data concerning dose-constraints for the main organs at risk (OARs) that apply to the treatment of whole breast/chest wall radiotherapy, whole breast/chest wall radiotherapy including regional nodal irradiation (RNI) and partial breast irradiation (PBI), for the most relevant fractionation schedules that have been introduced recently. This narrative review provides a comprehensive summary that may help to harmonize treatment planning strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110591"},"PeriodicalIF":4.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473420","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":"Variable-RBE-induced NTCP predictions for various side-effects following proton therapy for brain tumors – Identification of high-risk patients and risk mitigation","authors":"Martina Palkowitsch ,&nbsp;Lisa-Marie Kaufmann ,&nbsp;Fabian Hennings ,&nbsp;Stefan Menkel ,&nbsp;Christian Hahn ,&nbsp;Jona Bensberg ,&nbsp;Armin Lühr ,&nbsp;Annekatrin Seidlitz ,&nbsp;Esther G.C. Troost ,&nbsp;Mechthild Krause ,&nbsp;Steffen Löck","doi":"10.1016/j.radonc.2024.110590","DOIUrl":"10.1016/j.radonc.2024.110590","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Disregarding the increase of relative biological effectiveness (RBE) may raise the risk of acute and late adverse events after proton beam therapy (PBT). This study aims to explore the relationship between variable RBE (above 1.1)-induced normal tissue complication probabilities (NTCP) and patient-specific factors, identify patients at high risk of RBE-induced NTCP increase, and assess risk mitigation by incorporating RBE variability into treatment planning.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 105 primary brain tumor patients treated with PBT (RBE = 1.1). We calculated differences in estimated NTCP (ΔNTCP) using a variable RBE-weighted dose (D_RBE, Wedenberg model) and a constant RBE-weighted dose (D_RBE=1.1), across 16 NTCP models. These differences were correlated with patient-specific characteristics. Based on ΔNTCP, patients were classified as high risk (32 %) or low risk (68 %) for adverse events due to RBE-induced NTCP. This classification was compared with alternative classifications based on (a) relevant patient-specific characteristics, (b) D_RBE=1.1, and (c) the difference between D_RBE and D_RBE=1.1 (ΔD), assessing the balanced accuracy. The potential to reduce RBE-induced NTCP through track-end and linear energy transfer (LET) optimization was evaluated in six example patients.</div></div><div><h3>Results</h3><div>Using a variable RBE instead of a constant one resulted in NTCP increases (up to 32 percentage points). Variable-RBE-induced NTCP increases were strongly negatively correlated with the distance between the clinical target volume (CTV) and the organ at risk (OAR) for most side-effects, and positively correlated with CTV volume for certain side-effects. High increases were associated with (a) specific patient factors, particularly the proximity of the CTV to OARs, (b) D_RBE=1.1, and (c) ΔD, with a balanced accuracy of 0.88, 0.94, and 0.86, respectively. Optimization of track-ends and LET considerably reduced NTCP values, achieving a mean reduction of 31 % for optimized OARs.</div></div><div><h3>Conclusion</h3><div>The risk of variable-RBE-induced NTCP strongly depends on patient-specific factors and the considered side-effect. A small distance between the tumor and OARs notably increases the risk. Integrating biologically-guided objectives into treatment planning can effectively mitigate the risk.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110590"},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}