Radiotherapy and Oncology最新文献

{"title":"Optimizing fractionation schedules for de-escalation radiotherapy in head and neck cancers using deep reinforcement learning","authors":"Yongheng Yan ,&nbsp;Xin Sun ,&nbsp;Yuanhua Chen ,&nbsp;Zihan Sun ,&nbsp;SenXiang Yan ,&nbsp;Zhongjie Lu ,&nbsp;Feng Zhao","doi":"10.1016/j.radonc.2025.110833","DOIUrl":"10.1016/j.radonc.2025.110833","url":null,"abstract":"<div><h3>Purpose</h3><div>: Patients with locally-advanced head and neck squamous cell carcinomas (HNSCCs), particularly those related to human papillomavirus (HPV), often achieve good locoregional control (LRC), yet they suffer significant toxicities from standard chemoradiotherapy. This study aims to optimize the daily dose fractionation based on individual responses to radiotherapy (RT), minimizing toxicity while maintaining a low risk of LRC failure.</div></div><div><h3>Method:</h3><div>A virtual environment was developed to simulate tumor dynamics under RT for optimizing dose schedules. Patients predicted to maintain LRC were selected for de-escalation experiments. The proliferation saturation index (PSI) and linear-quadratic model were used to predict responses. A deep reinforcement learning (DRL) agent optimized fractionation schemes by interacting with the simulation environment, aiming to reduce the OAR’s biologically effective dose (BED) while preserving LRC. The impact of model uncertainty was analyzed and a support vector machine (SVM) model was used to segment parameter space and identify patients more robust to noise.</div></div><div><h3>Results:</h3><div>Personalized de-escalation plans were compared to conventional RT in a cohort of 5000 virtual patients. Personalized fractionation reduced the tumor dose and OAR’s BED by 29%, with an average OAR BED reduction of 5.61 ± 2.96 Gy. Prognostic outcomes were nearly identical, with 99.80% of patients in the low-risk LRC failure group. Model uncertainty impacted dosimetric indicators and prognosis, but the high-BED benefit group showed greater robustness to noise. SVM decision boundaries defined parameters range for patient selection.</div></div><div><h3>Conclusion:</h3><div>Optimizing fractionated doses based on patient responses minimizes toxicity while maintaining LRC in HNSCCs. Stratifying patients can mitigate model uncertainty and reduce treatment risks.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110833"},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639517","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":"Longitudinal analysis of cognitive function in patients treated with postoperative radiotherapy for grade 2 and 3 IDH mutant diffuse glioma","authors":"J.P.M. Jaspers ,&nbsp;A. Méndez Romero ,&nbsp;A. El Yaakoubi ,&nbsp;E. van Werkhoven ,&nbsp;R.A. Nout ,&nbsp;M.J. van den Bent ,&nbsp;D. Satoer","doi":"10.1016/j.radonc.2025.110847","DOIUrl":"10.1016/j.radonc.2025.110847","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative radiotherapy and chemotherapy improve survival in <em>IDH</em> mutant diffuse glioma. We investigated whether neurocognitive function declines over time, and whether mean dose to the brain outside of CTV (mean brain dose) is related to neurocognitive function.</div></div><div><h3>Patients and methods</h3><div>Patients that underwent resection and postoperative radiotherapy for grade 2 or 3 <em>IDH</em> mutant diffuse glioma were tested using the Hopkins Verbal Learning Test, Letter Fluency and Trail Making Test before surgery and afterwards up until disease progression. Mixed effects models were fitted for each of three cognitive test scores, using time from surgery, mean brain dose, CTV volume, and tumor grade as fixed effects.</div></div><div><h3>Results</h3><div>Between 1–10-2013 and 31–12-2022, 49 patients underwent longitudinal neurocognitive testing. Average mean dose to brain minus CTV was 17.8 Gy (95 % CI 16.1 – 19.4). At the time of analysis, median follow-up in patients free from disease progression was 5.8 years (range 1.1 – 20.8). Attrition rate during the first five years of follow up was 14.1 %. There was no decline of test performance over time (<em>p</em> ≥ 0.526). However, there was a negative effect of increasing mean brain dose on TMT score A (−0.11, <em>p</em> = 0.008) and TMT score B (−0.13, <em>p</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>In this study, no effect of time after resection on test scores was found. Multivariable modelling indicates an negative relationship between mean brain dose and specific neurocognitive test scores, accounting for effects of tumor grade and CTV volume.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110847"},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639509","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":"A comprehensive mechanistic study on the proton FLASH sparing effect in zebrafish embryos: From DNA damage to developmental abnormalities","authors":"Eva Bogaerts ,&nbsp;Gaëlle Saade ,&nbsp;Ellina Macaeva ,&nbsp;Sophie Chiavassa ,&nbsp;Manon Evin ,&nbsp;Ferid Haddad ,&nbsp;Sofie Isebaert ,&nbsp;Charbel Koumeir ,&nbsp;Quentin Mouchard ,&nbsp;Vincent Potiron ,&nbsp;Noël Servagent ,&nbsp;Stéphane Supiot ,&nbsp;Edmond Sterpin ,&nbsp;Karin Haustermans","doi":"10.1016/j.radonc.2025.110848","DOIUrl":"10.1016/j.radonc.2025.110848","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Ultra-high dose rate (UHDR) irradiation induces less normal tissues toxicities compared to conventional dose rate (CONV) irradiation. We aimed to assess whether UHDR and CONV proton irradiation result in different levels of DNA damage in zebrafish embryos. Moreover, we studied the downstream transcriptional activation and functional changes following both modalities.</div></div><div><h3>Materials and methods</h3><div>Zebrafish embryos received 30 Gy UHDR (&gt;5100 Gy/s) or CONV (0.18 Gy/s) proton irradiation at 28 h post-fertilization on a 68 MeV cyclotron. DNA damage was assessed at 4 h post-irradiation. Gene expression changes were assessed at 6 and 24 h post-irradiation. Apoptosis, proliferation and neutrophil migration were investigated at 6 h and 20 h post-irradiation. Survival and morphological abnormalities were assessed at 4 days post-irradiation.</div></div><div><h3>Results</h3><div>No significant differences in morphological abnormalities were found between treatment groups. Conversely, significantly higher levels of DNA damage were observed in CONV- versus UHDR-irradiated embryos. CONV irradiation resulted in higher expression levels of genes involved in cell cycle arrest (<em>cdkn1a</em>) and p53 regulation (<em>mdm2</em>). Lastly, CONV irradiation resulted in higher levels of apoptosis in the embryonic tail compared to UHDR irradiation. Comparable cell proliferation and neutrophil migration to the sites of injury was found between treatments.</div></div><div><h3>Conclusion</h3><div>UHDR proton irradiation induces less DNA damage and less downstream transcriptional activation of DNA damage response pathways in zebrafish embryos compared to CONV irradiation, resulting in reduced embryonic cell death. However, the magnitude of observed differences might not always be high enough to translate into significant differences in developmental abnormalities.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110848"},"PeriodicalIF":4.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630735","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 systematic review and proportional meta-analysis of image-based pattern of loco-regional failure analyses outcomes in head and neck squamous cell carcinoma","authors":"Morten Horsholt Kristensen ,&nbsp;Signe Bergliot Nielsen ,&nbsp;Jan Alsner ,&nbsp;Anne Ivalu Sander Holm ,&nbsp;Christian Rønn Hansen ,&nbsp;Jens Overgaard ,&nbsp;Jesper Grau Eriksen","doi":"10.1016/j.radonc.2025.110838","DOIUrl":"10.1016/j.radonc.2025.110838","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The prognosis following loco-regional failure after primary radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC) is poor. The hypothesis that most failures occur as a consequence of tumor radioresistance, can be evaluated by proxy as the proportion of failures that occur in the high-dose region. Several studies have investigated possible reasons for treatment failure by an image-based pattern of failure analyses (POF), comparing the initial planning CT scan with a scan conducted upon failure. The aim of the present systematic review and <em>meta</em>-analysis was to evaluate the proportion of failures that occurred in the high-dose region of all analyzed failures.</div></div><div><h3>Materials and Methods</h3><div>A systematic database search from 2000 to 2023, was performed for studies including results from image-based loco-regional POF, regardless of the method, after primary RT for HNSCC. Proportions of volumetrically in-field (opposed to marginal or outfield) failures, point of origin-based inside high-dose targets, or covered by curative doses for both the number of patients and the number of failure sites were analyzed in proportional <em>meta</em>-analyses.</div><div>The review was registered at Prospero (CRD42023412545).</div></div><div><h3>Results</h3><div>Out of 56 included studies, accumulated image-based POF results were available from 1,161 patients and 658 individual failure sites. The majority of patients had in-field failures in volumetric-based studies (84 % (95 % CI: 77;90)), inside failures in point of origin-based studies (82 % (95% CI:61;85)) or failures covered by 95 % of dose prescribed to CTV1 (84 % (95% CI:69;95)). A trend toward increasing proportions of non-high-dose failures in more recently treated patients was observed.</div></div><div><h3>Conclusion</h3><div>Most loco-regional failures for patients treated with primary RT for HNSCC are related to the high-dose volume. Therefore, a focus on biomarkers predicting individual tumor radiosensitivity is warranted to enable individualized treatment intensification to increase loco-regional control.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110838"},"PeriodicalIF":4.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634433","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":"Delphi consensus-based recommendations of tools and outcomes for the assessment of radiation dermatitis severity","authors":"S. Minhaj Rahman ,&nbsp;Partha Patel ,&nbsp;Samuel Finkelstein ,&nbsp;Shing Fung Lee ,&nbsp;Henry Wong ,&nbsp;Adrian Wai Chan ,&nbsp;Elwyn Zhang ,&nbsp;Jennifer Yin Yee Kwan ,&nbsp;Pierluigi Bonomo ,&nbsp;Raymond J. Chan ,&nbsp;Corina van den Hurk ,&nbsp;Edward Chow ,&nbsp;Suvam Banerjee ,&nbsp;Michele Aquilano ,&nbsp;Mark Trombetta ,&nbsp;Tara Behroozian ,&nbsp;Julie Ryan Wolf ,&nbsp;on behalf of the Multinational Association of Supportive Care in Cancer MASCC Oncodermatology Study Group Radiation Dermatitis Guidelines Working Group","doi":"10.1016/j.radonc.2025.110846","DOIUrl":"10.1016/j.radonc.2025.110846","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute radiation dermatitis (ARD) is a common side effect experienced during radiation therapy (RT) for cancer. Published clinical trials for ARD use a myriad of assessment tools and outcomes to measure ARD severity, which limits the comparability of clinical trial results. Our study utilized a modified Delphi consensus survey to gather expert opinions on commonly used tools for ARD severity.</div></div><div><h3>Materials and methods</h3><div>Thirty experts were invited to participate in a two-round Delphi consensus survey. Of these, 80 % (24/30) completed the first round; and 92 % (22/24) completed the second round. The Delphi process was conducted using the REDCap platform to systematically collect expert opinions on 32 assessment tools and 11 key outcomes pertinent to the severity of ARD. Assessment tools and outcomes that achieved a consensus of ≥ 70 % among the experts were subsequently recommended.</div></div><div><h3>Results</h3><div>Expert recommendations included four tools (RTOG, CTCAE, RISRAS, and Skindex-16) and eight relevant outcomes (moist desquamation, pain, QoL, erythema, dry desquamation, pruritus/itching, necrosis/ulceration, and burning) for ARD severity assessment. Due to limited evidence, no biophysical parameters reached consensus. Further, experts suggested modifications to existing tools to improve measurement of ARD severity across all skin types.</div></div><div><h3>Conclusion</h3><div>Our study was the first step in standardizing ARD severity assessment with expert consensus recommendation for four tools and eight relevant outcomes. However, modifications to existing tools are necessary to promote validation and accuracy across all skin types. Future efforts should create a new comprehensive ARD severity assessment tool to address deficiencies in existing tools.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110846"},"PeriodicalIF":4.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630771","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":"Acute toxicity and quality of life after margin reduction using a sub-fractionation workflow for stereotactic radiotherapy of localized prostate cancer on a 1.5 Tesla MR-linac","authors":"T.A. Lalmahomed ,&nbsp;T. Willigenburg ,&nbsp;S.M.G. van de Pol ,&nbsp;E.N. de Groot-van Breugel ,&nbsp;L.M.W. Snoeren ,&nbsp;J. Hes ,&nbsp;H.H.E. van Melick ,&nbsp;H.M. Verkooijen ,&nbsp;J.C.J. de Boer ,&nbsp;J.R.N. van der Voort van Zyp","doi":"10.1016/j.radonc.2025.110845","DOIUrl":"10.1016/j.radonc.2025.110845","url":null,"abstract":"<div><h3>Background and purpose</h3><div>A sub-fractionation workflow to correct for intrafraction motion in localized prostate cancer radiotherapy was implemented at our center, allowing for PTV margin reduction from isotropic 5 mm to 2 mm in cranio-caudal and left-right directions and 3 mm in the anterior-posterior direction. The purpose of this study was to assess differences in acute toxicity before and after margin reduction.</div></div><div><h3>Materials and methods</h3><div>Included patients were treated with 36.25 Gy in five fractions on a 1.5 T MR-linac, with PTV margins of 5 mm (standard margins) or 2-3 mm (tight margins). The primary endpoint was acute (90 days post-RT) toxicity. Physician-reported toxicity was measured by maximum CTCAE version 5.0 genitourinary (GU) and gastrointestinal (GI) scores. Patient reported toxicity was a secondary endpoint, assessed through EPIC-26 urinary and bowel domain scores. Groups were balanced through propensity score matching after multiple imputation using chained equations. Pearson’s Chi-squared tests were used to analyze CTCAE scores and Wilcoxon rank sum tests to analyze EPIC-26 scores.</div></div><div><h3>Results</h3><div>299 eligible patients were identified (193 and 106 in the tight and standard margin groups, respectively). After matching, 212 patients (106 per treatment group) were available for assessment. No statistically significant between-group differences in physician-reported toxicity were observed at any follow-up point. Patient-reported urinary irritative/obstructive quality of life was statistically, but not clinically, significantly higher after one month. Overall, scores declined during treatment and one month post-RT, but returned to baseline levels three months post-RT.</div></div><div><h3>Conclusion</h3><div>Margin reduction below 5 mm did not seem to reduce acute toxicity after radiotherapy with a stereotactic body radiotherapy (SBRT) treatment schedule in localized prostate cancer. The introduction of real-time comprehensive motion management with prostate gating could further lower GU and GI toxicity and ameliorate treatment related quality of life.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110845"},"PeriodicalIF":4.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634434","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":"Effect of glioblastoma and brain radiotherapy on T-lymphocyte subpopulations in rodents","authors":"Thao-Nguyen Pham ,&nbsp;Julie Coupey ,&nbsp;Florian Yger ,&nbsp;Serge M. Candéias ,&nbsp;Juliette Thariat ,&nbsp;Samuel Valable","doi":"10.1016/j.radonc.2025.110801","DOIUrl":"10.1016/j.radonc.2025.110801","url":null,"abstract":"<div><h3>Introduction</h3><div>Although lymphopenia is linked to immune suppression favoring tumor growth, the effect of different radiation types on specific T-lymphocyte subsets remains unclear. Among the T-lymphocyte subpopulations, CD8⁺-lymphocytes serve as key effectors in cancer immunity. This study aimed to examine the changes in T-lymphocyte subpopulations in both tumor-free and glioblastoma-bearing mice following brain-irradiation.</div></div><div><h3>Methods</h3><div>The study was divided into two main phases. First, C57BL/6 mice, with or without glioblastoma (GL261 cells), received hemispheric brain-irradiation or no-treatment. T-lymphocyte subpopulations were analyzed using flow cytometry at various timepoint. The effect of tumor size and brain-irradiation on these cells was assessed using correlation analysis. Next, C57BL/6 mice were subjected to different brain-irradiation conditions. Blood samples were collected during and post-irradiation to analyze T-lymphocyte subpopulations, and tree-based modeling was used to determine radiation parameters impact on naïve CD8⁺-lymphocyte levels.</div></div><div><h3>Results</h3><div>Glioblastoma reduced all T-lymphocyte subpopulations by day 15 post-inoculation. Radiotherapy decreased regulatory and effector CD4⁺-lymphocytes in both tumor-free and glioblastoma-bearing mice, but not naïve or memory CD4⁺-lymphocytes, in both tumor-free and glioblastoma-bearing mice. In tumor-free mice, radiotherapy had no effect on CD8⁺-lymphocytes, but reduced all CD8⁺-lymphocyte types in glioblastoma-bearing mice. Glioblastoma size negatively affected CD8⁺-lymphocytes. Brain-irradiation persistently reduced naïve and memory CD8⁺-lymphocytes, but effector and regulatory T-lymphocytes recovered. Exposure of lymph nodes to radiation worsened CD8⁺-lymphocyte reduction.</div></div><div><h3>Conclusion</h3><div>These findings confirm that the presence of glioblastoma and brain-irradiation affect T-lymphocyte subpopulations in mice. The inclusion of lymph nodes in the irradiated area led to a long-term decrease in naïve CD8⁺-lymphocytes. Further mechanistic studies are needed to understand the molecular basis of radiation impact on T-lymphocyte subpopulations.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110801"},"PeriodicalIF":4.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625626","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":"Multi-contrast 4DMR via MR multitasking: Early clinical experience and implication for liver stereotactic body radiation therapy","authors":"Oi Wai April Chau ,&nbsp;Theodore Geoghegan ,&nbsp;Joshua Everts ,&nbsp;Junzhou Chen ,&nbsp;Mary Feng ,&nbsp;William C. Chen ,&nbsp;Jessica E. Scholey ,&nbsp;Yang Yang ,&nbsp;Michael A. Ohliger ,&nbsp;Ke Sheng ,&nbsp;Xin Miao ,&nbsp;Zhaoyang Fan ,&nbsp;Wensha Yang","doi":"10.1016/j.radonc.2025.110839","DOIUrl":"10.1016/j.radonc.2025.110839","url":null,"abstract":"<div><h3>Background</h3><div>Liver tumors have low contrast on 4DCT. A novel Multitasking (MT)MR imaging technique has been implemented on the MR simulator, providing both T1 and T2-weighted 4DMR images in a single 8-min free-breathing scan for better tumor delineation and motion evaluation. This study reports our early clinical experience of MTMR regarding tumor visibility, motion characteristics, and resultant dosimetry compared to post-contrast 4DCT for liver SBRT.</div></div><div><h3>Methods</h3><div>Phantom motion validation was performed. Tumor contrast-to-noise ratio (CNR) and motion were analyzed in 54 patients. Replanning for 17 patients (21 tumor volumes) was performed, and planning target volume receiving greater than 90% of the prescription (PTV_V90) was compared based on optimized dose distributions for each 4D dataset-derived PTV.</div></div><div><h3>Results</h3><div>Phantom motions in both 4DCT and MTMR datasets were within &lt;1.8 mm of the programmed ground truth. The absolute CNR of MTMR-T1w and MTMR-T2w were significantly greater than post-contrast 4DCT. Tumor superior-inferior motions were significantly greater in MTMR than in 4DCT, while PTV volumes were not significantly different between the two 4D datasets. The PTV_V90 calculated from individual MTMR-T1w and 4DCT optimized plans were similar. However, a statistically significant 5 % reduction of PTV_V90 was observed when the optimized PTV_MTMR dose was superimposed on the respective PTV_4DCT, or vice versa for the re-planning patient cohort.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that the MTMR sequence offers superior tumor visualization and detects greater superior-inferior motion compared to 4DCT, enhancing the precision of radiotherapy planning for liver SBRT. While both imaging methods achieve comparable target volume coverage with individually optimized plans, discrepancies in tumor positioning lead to reduced coverage when plans are cross-applied, highlighting the importance of motion assessment accuracy. MTMR’s ability to provide multiple contrast-weighted images in a single scan addresses limitations of traditional 4DCT and multi-sequence MR protocols, particularly for patients unable to receive contrast.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110839"},"PeriodicalIF":4.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625630","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":"Adaptable framework for cost-analyses in radiotherapy: Application to the cost of proton versus photon therapy for lung cancer in The Netherlands","authors":"Bradley M. Sugden ,&nbsp;Willem J.A. Witlox ,&nbsp;Bram L.T. Ramaekers ,&nbsp;Djoya Hattu ,&nbsp;Boy Vluggen ,&nbsp;Judith van Loon ,&nbsp;Maria Jacobs ,&nbsp;Manuela A. Joore ,&nbsp;Dirk K.M. De Ruysscher","doi":"10.1016/j.radonc.2025.110832","DOIUrl":"10.1016/j.radonc.2025.110832","url":null,"abstract":"<div><h3>Background/purpose</h3><div>Proton radiation-therapy (PrT) may provide clinical benefit for lung cancer compared to photon radiation-therapy (PhT), however is more costly. Literature reporting costs for PrT, PhT, and comparisons thereof, particularly from a societal perspective, are scarce. This study aims to provide an adaptable framework to estimate PrT/PhT costs, demonstrated through application to lung cancer, from societal and healthcare perspectives.</div></div><div><h3>Methods</h3><div>Dutch Costing Guidelines were followed to estimate costs from first referral to end of treatment. A parallel base-case was conducted whereby centre-specific inputs replaced general input parameters. Costs were calculated probabilistically using Monte Carlo simulations (10,000 iterations) and separated into three categories: healthcare (subdivided: personnel, non-personnel), patient/family, and costs in other sectors. Direct healthcare personnel costs were estimated using time-driven activity-based costing, allowing separation of non-fraction-dependant costs. Further sensitivity/scenario analyses were explored.</div></div><div><h3>Results</h3><div>Fixed costs (guideline[centre-specific] analyses mean) from a societal perspective were €11,208[€12,299] for PrT and €9,651[€10,977] for PhT. Variable costs per fraction were €932[€798] for PrT and €265[€265] for PhT. Total cost ratio for PrT to PhT was 2.00[1.74] for 20 fraction schedules and 2.23[1.91] for 30 fractions. The greatest incremental cost driver category for PrT versus PhT was non–(direct)personnel healthcare costs (overheads, capital outlays).</div></div><div><h3>Conclusion</h3><div>An adaptable framework for probabilistic cost-analyses was developed. Results highlight cost disparities between PrT and PhT and serves to inform future cost-effectiveness analyses. Scenarios reveal potential for clinical experience and increased capacity to narrow differences. Parallel base-case analyses highlight cost disparities arising when utilising generic vs centre-specific inputs, and potential outcome differences between centres.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110832"},"PeriodicalIF":4.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586721","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":"Response to “When predictions don’t match reality: Revisiting sample size and PFS in the OpRAH Study”","authors":"Supriya Mallick","doi":"10.1016/j.radonc.2025.110829","DOIUrl":"10.1016/j.radonc.2025.110829","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110829"},"PeriodicalIF":4.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586736","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}