Radiotherapy and Oncology最新文献

{"title":"Towards reliable feature interpretation in machine learning-based acute diarrhoea toxicity assessment.","authors":"Souichi Oka, Yoshiki Takahashi, Yoshiyasu Takefuji","doi":"10.1016/j.radonc.2025.111140","DOIUrl":"10.1016/j.radonc.2025.111140","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111140"},"PeriodicalIF":5.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131819","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":"The climate and health impact of U.S. radiation therapy: estimating greenhouse gas emissions, DALYs, and potential of hypofractionation.","authors":"Katie E Lichter, Alyssa Asaro, Muhammad Mustafa Qureshi, Minh Tam Truong, Akash Parekh, Alon Witztum, Chirjiv Anand, Genevieve S Silva, Trevor Royce, Nicholas G Zaorsky, Surbhi Grover, May Abdel-Wahab, Cassandra Thiel, Matthew J Eckelman, Nicolas Prionas, Sue S Yom, Osama Mohamad","doi":"10.1016/j.radonc.2025.111161","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111161","url":null,"abstract":"<p><strong>Background/purpose: </strong>Climate change is a global crisis, with the healthcare sector contributing 8.5-10% of greenhouse gas (GHG) emissions in the United States (U.S.). Radiation oncology, particularly through patient transportation for external beam radiation therapy (EBRT), is known to contribute to these emissions. In this study, we aim to quantify the annual GHG emissions in carbon dioxide equivalents (CO₂e) from EBRT in the U.S., estimate their down-stream impact on human health in terms of disability-adjusted life-years (DALYs) lost, and evaluate the potential reduction in emissions through increased adoption of hypofractionation, using early-stage breast cancer as a model.</p><p><strong>Materials/methods: </strong>This is a retrospective analysis using life cycle assessment (LCA) methodologies, integrating real-world data on patient transportation and energy use, and simulations of alternative fractionation schedules following previously established breast treatment guidelines. The study included 556,426 patients who received EBRT for nine cancer types (breast, central nervous system, gastrointestinal, genitourinary, gynecological, head and neck, musculoskeletal, skin, and thoracic), as recorded in the National Cancer Database (NCDB) in 2019 and 2020. Of these, 49,909 patients with early-stage breast cancer (stages I-II, node-negative) were modeled for hypofractionation scenarios.</p><p><strong>Results: </strong>In 2019 and 2020, EBRT treatments in the U.S. resulted in 3.3 and 2.7 million metric tonnes of CO₂e, respectively. Corresponding DALYs lost were 1,040 in 2019 and 863 in 2020. Simulations showed that increasing use of hypofractionation for eligible breast cancer treatments could reduce GHG emissions by up to 64%.</p><p><strong>Conclusions: </strong>Establishing baseline U.S. GHG emissions from EBRT offers a foundation for identifying opportunities to mitigate emissions. Investigating clinical practices from an environmental perspective can yield dual benefits: improved quality of care and significant emissions reductions.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111161"},"PeriodicalIF":5.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125883","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":"Evaluation of the association between sex-linked genes and treatment response in lung cancer","authors":"A Kinsella ,&nbsp;A Prina-Mello ,&nbsp;L Marignol","doi":"10.1016/j.radonc.2025.111159","DOIUrl":"10.1016/j.radonc.2025.111159","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The impact of biological sex on treatment response and prognosis in lung cancer remains poorly understood. This study investigates the relationship between sex-linked genes, DNA repair, senescence, and survival in male and female patients with lung cancer.</div></div><div><h3>Materials and Methods</h3><div>Whole-genome mRNA expression data from The Cancer Genome Atlas (TCGA) PanCancer Atlas for lung adenocarcinoma (LUAD) were analyzed (N = 275 female, N = 239 male). Curated lists of 874 X-linked, 57 Y-linked, and 314 DNA damage response (DDR) genes were obtained from UniProt and HUGO. Additionally, 279 senescence genes were sourced from <span><span>Senescence.info</span><svg><path></path></svg></span>. Overall survival (OS) was assessed using Kaplan-Meier analysis. Correlation analyses between sex-linked and DDR/senescence genes used Spearman’s rank correlation. Based on their strong association with DDR genes and OS in patient tumours, two top-ranked X-linked genes, <em>CENPI</em> and <em>ERCC6L</em>, were further evaluated <em>in vitro</em> in male (A549) and female (H1975) lung adenocarcinoma cells after radiation or fisetin treatment.</div></div><div><h3>Results</h3><div>Of 44 Y-linked genes evaluated, 11 were differentially expressed; <em>PRKY</em> was significantly associated with OS. In tumours, 287 (male) and 314 (female) X-linked genes were altered, with strong correlations to DDR genes. Low <em>ERCC6L</em> expression was linked to increased OS in males treated with radiation (p = 0.036, HR = 3.1). Radiation and fisetin treatment modified <em>CENPI</em> and <em>ERCC6L</em> expression in a sex-specific manner.</div></div><div><h3>Conclusion</h3><div>Sex-linked gene expression in lung tumours influences DDR and senescence pathways, correlating with survival outcomes. These findings highlight the importance of sex-specific analysis in lung cancer research and treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111159"},"PeriodicalIF":5.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125943","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":"Quality assessment of 2705 treatment plans in the randomised Danish Breast Cancer Group Skagen trial 1","authors":"M.S. Thomsen ,&nbsp;E.L. Lorenzen ,&nbsp;J. Alsner ,&nbsp;S.L. Krogh ,&nbsp;E.S. Yates ,&nbsp;M. Berg ,&nbsp;K.I. Dybvik ,&nbsp;K. Boye ,&nbsp;C. Kirkove ,&nbsp;I. Jensen ,&nbsp;M.M.B. Nielsen ,&nbsp;V. Tømmerås ,&nbsp;P. Schilling ,&nbsp;S. Makocki ,&nbsp;M.P. Hasler ,&nbsp;K. Andersen ,&nbsp;L. Stick ,&nbsp;M.-B. Jensen ,&nbsp;B.V. Offersen ,&nbsp;on behalf of the DBCG RT Committee","doi":"10.1016/j.radonc.2025.111142","DOIUrl":"10.1016/j.radonc.2025.111142","url":null,"abstract":"<div><h3>Purpose</h3><div>Based on prospectively uploaded treatment plans, a comprehensive analysis of the radiation therapy (RT) in the DBCG Skagen trial 1 is presented.</div></div><div><h3>Methods</h3><div>From 2015 to 2021, 2963 breast cancer patients referred to adjuvant locoregional breast cancer RT after breast conserving surgery (BCS) or mastectomy were randomised to 50 Gy/25 fractions versus 40 Gy/15 fractions. Tumour-bed boost was simultaneous integrated boost (SIB). Delineated structure volumes were per ESTRO guidelines. Dosimetric data were obtained from the individual treatment plans.</div></div><div><h3>Results</h3><div>RT treatment plans from 2705 patients treated at 14 centres in 4 countries were analysed corresponding to 94 % of the per protocol patients. Overall, 1407 had BCS, 1298 had mastectomy, and 437 had SIB. The randomisation was balanced: 1329 (50 Gy) versus 1376 (40 Gy). All plans had target volume delineations per ESTRO guidelines. No significant differences were observed regarding delineated volumes nor regarding inter-centre variations per randomisation arm. Compliance to protocol constraints was generally high, however, the “hot-spot” dose compliance was higher in 50 Gy plans compared to 40 Gy plans due to stricter high dose constraints for the 40 Gy arm. The minimum coverage of target volumes was similar per randomisation arms. Respiratory gating technique was used in 83 % of the patients. When divided into subgroups per laterality and breathing technique, significantly higher lung and heart doses were detected in non-gated compared to gated plans.</div></div><div><h3>Conclusion</h3><div>A high degree of protocol compliance was documented in the DBCG Skagen trial 1. No differences were observed among the treatment plans in the two randomisation arms.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111142"},"PeriodicalIF":5.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081403","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 factors and clinical outcomes in a large cohort of head and neck adenoid cystic carcinoma patients treated with proton beam therapy: Insights from an Italian referral center","authors":"Barbara Vischioni ,&nbsp;Maria Bonora ,&nbsp;Giulia Fontana ,&nbsp;Sara Scardo ,&nbsp;Laura Brighenti ,&nbsp;Luca D’Ambrosio ,&nbsp;Sara Ronchi ,&nbsp;Rossana Ingargiola ,&nbsp;Anna Maria Camarda ,&nbsp;Sara Imparato ,&nbsp;Nadia Facchinetti ,&nbsp;Alessandro Vai ,&nbsp;Mario Ciocca ,&nbsp;Silvia Molinelli ,&nbsp;Ester Orlandi","doi":"10.1016/j.radonc.2025.111143","DOIUrl":"10.1016/j.radonc.2025.111143","url":null,"abstract":"<div><h3>Purpose</h3><div>Head<!--> <!-->and<!--> <!-->neck<!--> <!-->adenoid<!--> <!-->cystic<!--> <!-->carcinoma<!--> <!-->(ACC) is a rare tumor, challenging to be cured for the tendency to perineural invasion and local recurrence. Our study aimed to report clinical outcomes and prognostic factors in a large cohort of ACC<!--> <!-->patients<!--> <!-->treated with curative proton<!--> <!-->therapy<!--> <!-->(PT) at our center.</div></div><div><h3>Methods and materials</h3><div>Between 2017 and 2022, 129 ACC patients were treated with curative PT, both in postoperative (n = 104: R0/R1 = 74, R2 = 30) and radical settings (n = 25), with 59.4–74.2 Gy Relative Biological Effectiveness dose, in 28–37 fractions. Survival outcomes, toxicities, and the impact of key cohort characteristics on outcomes and toxicities were evaluated (α = 0.05).</div></div><div><h3>Results</h3><div>With 34 months of median follow-up, the Overall Survival (OS), Disease-Free Survival (DFS), Local Control (LC), and Distant Metastasis-Free Survival (DMFS) at 2-, 3-, and 5-years were 94.2 %, 89.4 %, and 86.7 %, 77.5 %, 76.4 % and 64 %, 92.4 %, 90.8 % and 84 %, 77.4 %, 76.3 % and 66.6 %, respectively. Advanced T stage (HR = 4.99, p = 0.002 and HR = 4.76, p = 0.022), and solid histologic subtype (HR = 3.27, p = 0.004 and HR = 3.76, p = 0.002) negatively impacted DFS and DMFS after confounders adjustment at multivariable analysis. As for DFS, at univariable analysis, surgical margins R0/R1 positively influenced the LC in comparison to the unresected patients (p = 0.042), while HR was similar for R2 and unresected patients (p = 0.8). The maximum toxicity grade recorded was G3, 11 acute and 9 late. No G3 brain radionecrosis were registered.</div></div><div><h3>Conclusions</h3><div>PT was effective for ACC in our hands, with a limited toxicity burden. Identification of<!--> <!-->prognostic<!--> <!-->factors<!--> <!-->is essential to address proper treatment. In unresectable cases, PT can be offered as alternative to debulking surgery.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111143"},"PeriodicalIF":5.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076034","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":"Response to \"Towards reliable feature interpretation in machine learning-based acute diarrhoea toxicity assessment\".","authors":"Ying Zhang, Charles-Antoine Collins Fekete, Maria A Hawkins","doi":"10.1016/j.radonc.2025.111139","DOIUrl":"10.1016/j.radonc.2025.111139","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111139"},"PeriodicalIF":5.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076046","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":"Re-irradiation in patients affected by prostate cancer and relapsing after previous definitive or postoperative radiotherapy. An international registry based study on behalf of Italian association of radiotherapy and clinical oncology (AIRO). (RE-START)","authors":"Giulio Francolini ,&nbsp;Vanessa Di Cataldo ,&nbsp;Saverio Caini ,&nbsp;Barbara A Jereczek-Fossa ,&nbsp;Giulia Marvaso ,&nbsp;Federico Mastroleo ,&nbsp;Eugenio Cammareri ,&nbsp;Daniela Alterio ,&nbsp;Marcin Miszczyk ,&nbsp;Wojciech Majewski ,&nbsp;Maja Hasterok ,&nbsp;Fabio Matrone ,&nbsp;Alessandra Donofrio ,&nbsp;Luca Triggiani ,&nbsp;Vittorio Morelli ,&nbsp;Liliana Belgioia ,&nbsp;Elisa D’angelo ,&nbsp;Rosario Mazzola ,&nbsp;Rossana Ingargiola ,&nbsp;Antonella Fontana ,&nbsp;Lorenzo Livi","doi":"10.1016/j.radonc.2025.111138","DOIUrl":"10.1016/j.radonc.2025.111138","url":null,"abstract":"<div><h3>Background</h3><div>Aiming to evaluate the long-term safety of re-irradiation approaches, the Italian Association for Radiotherapy and Clinical Oncology Oncology (AIRO) re-irradiation study group proposed the institution of a multicentric registry including prostate cancer patients undergoing re-irradiation for local relapse after postoperative or definitive RT.</div></div><div><h3>Materials and methods</h3><div>RESTART is an observational longitudinal study including patients with biochemical relapse according to EAU criteria after a previous course of definitive or postoperative RT, and treated for a macroscopic recurrence within the prostate or prostate bed visualized on PET-CT or magnetic resonance imaging (MRI). Patients were treated with stereotactic body radiotherapy (SBRT) or brachytherapy (BT), with fraction doses of at least 5 Gy for EBRT, and no other restrictions regarding fractionation schedule or total dose. Exclusion criteria consisted of the presence of regional nodal disease or distant metastases, persisting severe toxicities from previous RT or follow-up shorter than 6 months.</div></div><div><h3>Results</h3><div>Four hundred and thirty-three patients from 5 centers were included in the current analysis. Overall, 64.2 % and 90.3 % of patients did not report any acuteGU or GI toxicity. No treatment-related deaths were registered. LateG2 or G3 GU toxicity was reported in 16.2 and 4.8 % of patients, respectively. After a median follow-up of 54 months (95 % CI 26–78), 239 biochemical recurrences (55.2 %), 119 radiologically-confirmed regional or distant relapses (27.2 %), and 95 deaths (21.9 %) were recorded, respectively.</div></div><div><h3>Conclusion</h3><div>Results confirm the safety, feasibility, and efficacy of re-irradiation for prostate cancer, and provide insights about features associated with improved oncological outcomes after treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111138"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070401","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 of artificial intelligence-screened interstitial lung disease with radiation pneumonitis in locally advanced non-small cell lung cancer","authors":"Hannah Bacon ,&nbsp;Nicholas McNeil ,&nbsp;Tirth Patel ,&nbsp;Mattea Welch ,&nbsp;Xiang Y. Ye ,&nbsp;Andrea Bezjak ,&nbsp;Benjamin H. Lok ,&nbsp;Srinivas Raman ,&nbsp;Meredith Giuliani ,&nbsp;B.C. John Cho ,&nbsp;Alexander Sun ,&nbsp;Patricia Lindsay ,&nbsp;Geoffrey Liu ,&nbsp;Sonja Kandel ,&nbsp;Chris McIntosh ,&nbsp;Tony Tadic ,&nbsp;Andrew Hope","doi":"10.1016/j.radonc.2025.111144","DOIUrl":"10.1016/j.radonc.2025.111144","url":null,"abstract":"<div><h3>Purpose</h3><div>Interstitial lung disease (ILD) has been correlated with an increased risk for radiation pneumonitis (RP) following lung SBRT, but the degree to which locally advanced NSCLC (LA-NSCLC) patients are affected has yet to be quantified. An algorithm to identify patients at high risk for RP may help clinicians mitigate risk.</div></div><div><h3>Methods</h3><div>All LA-NSCLC patients treated with definitive radiotherapy at our institution from 2006 to 2021 were retrospectively assessed. A convolutional neural network was previously developed to identify patients with radiographic ILD using planning computed tomography (CT) images<em>.</em> All screen-positive (AI-ILD + ) patients were reviewed by a thoracic radiologist to identify true radiographic ILD (r-ILD). The association between the algorithm output, clinical and dosimetric variables, and the outcomes of grade ≥3 RP and mortality were assessed using univariate (UVA) and multivariable (MVA) logistic regression, and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>698 patients were included in the analysis. Grade (G) 0–5 RP was reported in 51 %, 27 %, 17 %, 4.4 %, 0.14 % and 0.57 % of patients, respectively. Overall, 23 % of patients were classified as AI-ILD+. On MVA, only AI-ILD status (OR 2.15, p = 0.03) and AI-ILD score (OR 35.27, p &lt; 0.01) were significant predictors of G3+RP. Median OS was 3.6 years in AI-ILD- patients and 2.3 years in AI-ILD+patients (NS). Patients with r-ILD had significantly higher rates of severe toxicities, with G3+RP 25 % and G5 RP 7 %. R-ILD was associated with an increased risk for G3+RP on MVA (OR 5.42, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Our AI-ILD algorithm detects patients with significantly increased risk for G3+RP.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111144"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070439","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":"High-Dose-Rate brachytherapy for salvage treatment of prostate cancer recurrence post-prostatectomy and radiotherapy: A multicenter retrospective analysis (HDR-REPOPRA) by UroGEC","authors":"Adam Kluska ,&nbsp;Artur J. Chyrek ,&nbsp;Benjamin Guix ,&nbsp;Patricia Willisch ,&nbsp;Tamer Soror ,&nbsp;Mateusz Bilski ,&nbsp;Ivan Garcia ,&nbsp;Teresa Guix ,&nbsp;Beatriz Vázquez ,&nbsp;Wojciech Burchardt ,&nbsp;Piotr Lelek ,&nbsp;Ricarda Merten ,&nbsp;Vratislav Strnad ,&nbsp;Iosif Strouthos ,&nbsp;Mario Terlizzi ,&nbsp;David Büchser ,&nbsp;Pierre Blanchard ,&nbsp;Alfonso Gomez- Iturriaga ,&nbsp;Piotr Wojcieszek","doi":"10.1016/j.radonc.2025.111145","DOIUrl":"10.1016/j.radonc.2025.111145","url":null,"abstract":"<div><h3>Background</h3><div>Local recurrence of prostate cancer following radical prostatectomy (RP) and adjuvant or salvage external beam radiotherapy (a/sEBRT) presents a therapeutic challenge. Salvage high-dose-rate brachytherapy (HDR-BT) is a promising modality, though evidence remains limited.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively analyzed 90 patients treated with salvage HDR-BT after RP and a/sEBRT across 10 UroGEC-ESTRO-affiliated European centers. Eligible patients had biopsy- or imaging-confirmed local recurrence and ECOG performance status 0–2. Primary endpoints were local recurrence-free survival (LRFS) and toxicity; secondary endpoints included biochemical failure-free survival (BFFS), metastasis-free survival (MFS), progression-free survival (PFS), and overall survival (OS).</div></div><div><h3>Results</h3><div>The median follow-up was 47 months. The 5-year LRFS was 81.1 %, BFFS 62 %, MFS 77.5 %, PFS 58.0 %, and OS 95.9 %. Biopsy-confirmed recurrence and use of androgen deprivation therapy (ADT) were associated with improved LRFS and PFS. Grade ≥3 genitourinary toxicity occurred in 5.5 % (acute) and 8.9 % (late) of patients; gastrointestinal grade 3 toxicity was observed in 1.1 %.</div></div><div><h3>Conclusion</h3><div>HDR-BT is a safe and effective salvage option for well-selected patients with local recurrence after RP and a/sEBRT. Our data support its feasibility, acceptable toxicity, and favorable oncologic outcomes. Biopsy confirmation and ADT use may improve results and should be considered in treatment planning. These findings warrant further prospective evaluation to optimize patient selection and refine salvage strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111145"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070422","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":"Dual benefits of new radiotherapy units: Improved access and reduced emissions","authors":"David Ali ,&nbsp;Max Piffoux","doi":"10.1016/j.radonc.2025.111137","DOIUrl":"10.1016/j.radonc.2025.111137","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiotherapy accessibility varies significantly within countries. Radiotherapy has a significant carbon footprint, primarily driven by patient transportation emissions in Europe.</div></div><div><h3>Objective</h3><div>This study aimed to determine if strategically located new Radiotherapy Units (RUs) and Linear Accelerator (LINAC) reallocation could simultaneously improve accessibility and reduce the carbon footprint of External Beam Radiotherapy (EBRT) in France.</div></div><div><h3>Methodology</h3><div>A national-scale Location-Allocation (LA) model, incorporating accessibility efficiency and equity, resource density, and greenhouse gas emissions, was used. Sensitivity analysis was used to assess the robustness of the results.</div></div><div><h3>Results</h3><div>We identified 27 potential locations for new RUs across 13 geographically independent clusters. Increase in emissions for the creation and maintenance is compensated with a mean carbon Return on Investment (ROI) of 4.6 years. Implementing the optimal RU within each cluster and reallocating LINACs would save an estimated 26,050 tons of CO2eq over a 10-year period, corresponding to ≈326 years in good health (DALYs) saved in the future. Public transport accessibility to an RU within 45 min would be gained for 405,487 individuals (0.6 %), and driving duration would improve for 3,301,705 (4.8 %). An additional 912 patients annually who currently do not receive radiotherapy due to excessive travel times (decay effect) would be treated.</div></div><div><h3>Conclusion</h3><div>Strategically located new Radiotherapy Units and LINAC reallocation can improve both accessibility and reduce the carbon footprint of EBRT. However, this latter benefit is limited and other more effective mitigation strategies should be considered concurrently.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111137"},"PeriodicalIF":5.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070445","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}