Radiotherapy and Oncology最新文献

{"title":"THE PREVENTION OF RADIATION-INDUCED MALIGNANCIES IN LI-FRAUMENI SYNDROME","authors":"Pamela Psarianos , Nicholas Fischer , David Malkin","doi":"10.1016/S0167-8140(25)04693-6","DOIUrl":"10.1016/S0167-8140(25)04693-6","url":null,"abstract":"<div><h3>Purpose:</h3><div>Li-Fraumeni Syndrome (LFS) is a genetic disorder associated with a significant risk of early-onset cancer. This condition is driven by germline mutations in the <em>TP53</em> gene which plays a primary role in the regulation of the radiation response. Aberrant TP53 function contributes to radiation vulnerability and a greater risk of secondary, radiation-induced malignancies. As a result, therapeutic options for LFS patients are often limited to exclude radiotherapy (RT), which may otherwise be beneficial for the treatment of primary tumours. Data from our lab demonstrate an aberrant transcriptomic response to irradiation (IR) in mutant p53 patient skin fibroblasts compared to wildtype; however, it is unknown whether reprogramming this radiation response can decrease the risk of radiation-induced malignancy in LFS. Metformin, a commonly prescribed anti-diabetic drug, is associated with lower cancer incidence and may decrease cancer-related mortality in murine LFS models. In addition to its potential anti-tumourigenicity, recent studies have shed light on the ability of metformin to prevent IR-induced damage in normal tissue; hence, we hypothesize that metformin can reprogram the radiation response to protect against radiation injury and delay the onset of radiation-induced tumours in LFS.</div></div><div><h3>Materials and Methods:</h3><div>To establish a murine model of radiation-induced tumours in LFS, and to investigate whether metformin can delay tumour onset in this model, whole-body or localized IR were administered to mice harboring a hotspot TP53<sup>R172H/+</sup>mutation in the presence and absence of metformin. Serial MRI was conducted to monitor for tumour development. To understand the effect of metformin on the mutant p53 radiation response <em>in vivo</em>, a similar murine workflow was established and irradiated skin was collected longitudinally from untreated and metformin-treated cohorts for whole transcriptome sequencing. Sequencing data were functionally validated in a separate cohort of mice using flow cytometry. In parallel, we performed RNA sequencing on LFS patient fibroblasts to characterize the effect of metformin on the human radiation response.</div></div><div><h3>Results:</h3><div>We demonstrate that IR accelerates tumour onset in TP53<sup>R172H/+</sup> mice, and that metformin significantly delays the development of tumours within the radiation field. Moreover, transcriptomic analyses of both patient and murine samples revealed that metformin upregulates apoptosis following IR. Flow cytometry analysis of murine tumours and irradiated skin tissue validated these findings, demonstrating that metformin promotes the apoptosis-driven clearance of damaged, potentially tumourigenic cells following IR.</div></div><div><h3>Conclusions:</h3><div>Overall, we show that metformin delays radiation-induced tumour onset in LFS mice, and have begun to characterize the biology underpinning this reprogrammed re","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S16"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100249","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":"AUTOMATED LYMPH NODE SEGMENTATION AND IENE CLASSIFICATION MODEL FOR HPV-ASSOCIATED OROPHARYNGEAL CANCER","authors":"Gabriel Dayan , Gautier Henqiue , Houda Bahig , Kristoff Nelson , Coralie Brodeur , Apostolos Christopoulos , Edith Filion , Phuc-Felix Nguyen-Tan , Brian O’Sullivan , Tareck Ayad , Eric Bissada , Paul Tabet , Louis Guertin , Samuel Kadoury , Laurent Letourneau-Guillon","doi":"10.1016/S0167-8140(25)04695-X","DOIUrl":"10.1016/S0167-8140(25)04695-X","url":null,"abstract":"<div><h3>Purpose:</h3><div>Though not included in the 8<sup>th</sup> edition of the AJCC staging system, there is growing evidence suggesting that imaging-based extranodal extension (iENE) is associated with worse outcomes for HPV-associated oropharyngeal cancer (OPC). The aim was to develop an automated pipeline for lymph node segmentation, classification of iENE status and outcome prediction using pre-radiation therapy planning CT scans.</div></div><div><h3>Materials and Methods:</h3><div>From a prospectively maintained OPC database, we analyzed HPV-associated N+ OPC patients treated with (chemo)radiation between 2009-2020. We extracted pretreatment planning CT scans along with lymph node gross tumour volume (GTV-LN) segmentations performed by expert radiation oncologists. Two neuroradiologists consensually assessed iENE (Grade 0 to 3) as the primary outcome. We evaluated multiple artificial intelligence (AI) architectures for node segmentation, including CNNs, Vision Transformers, and hybrid models, using Dice and IoU metrics. For iENE classification (dichotomized as Grade 0 versus 1, 2 or 3), we compared radiomics and deep learning feature extraction methods, using PCA/LASSO feature selection, followed by Random Forest or MLP classification, with five-fold cross validation and SMOTE addressing class imbalance. The prognostic value of predicted iENE was assessed through Kaplan-Meier and multivariable Cox regression analyses.</div></div><div><h3>Results:</h3><div>Among 397 included cases, 126 (31.7%) exhibited iENE based on expert radiological evaluation. The nnUNET segmentation model demonstrated the highest performance for GTV-LN segmentation, achieving a mean Dice Similarity Coefficient (DSC) of 81.0%. The most effective model for classifying iENE used radiomic-based feature extraction with LASSO and MLP, yielding an AUROC of 78.0 ±3.5. In Kaplan-Meier analysis, predicted iENE was associated with significantly worse oncologic outcomes, including 3-year locoregional recurrence-free survival (89.9% versus 94.8%, P=0.016), distant recurrence-free survival (85.4% versus 96.0%, P<0.001), disease-free survival (78.6% versus 89.6%, P<0.001), and overall survival (86.3% versus 94.1%, P=0.026). On multivariate analysis, predicted iENE remained an independent predictor of disease-free survival (HR 2.16, 95% CI 1.27-3.67, P=0.005), adjusting for age, ECOG performance status, T stage, and N stage.</div></div><div><h3>Conclusions:</h3><div>This study demonstrates that an AI-driven pipeline can successfully automate lymph node segmentation and iENE classification from pretreatment CT scans in HPV-associated OPC. The model achieved segmentation and classification performance that meet clinical requirements. Predicted iENE was independently associated with worse oncologic outcomes. Multi-centre external validation will be needed to assess generalizability and the potential for implementing this tool to institutions without specialized imaging expertis","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S17"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100251","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":"ASSESSING DOSIMETRIC IMPACT OF GYNECOLOGICAL BRACHYTHERAPY APPLICATOR RECONSTRUCTION ON T1- WEIGHTED AND T2-WEIGHTED MR IMAGES VERSUS CT IMAGES","authors":"Clara Fallone , Matthew Frick","doi":"10.1016/S0167-8140(25)04752-8","DOIUrl":"10.1016/S0167-8140(25)04752-8","url":null,"abstract":"<div><h3>Purpose:</h3><div>Gynecological brachytherapy (BT) treatment planning traditionally uses CT images for applicator and catheter reconstruction, and MRI imaging for contouring. Some centres now employ MRI-only BT planning. Constructing on MRI images poses challenges; inherent MRI distortions can lead to dosimetric effects of 2-7% per mm of displacement (Tanderup, Hellebust and Lang 2008) (Richart, et al. 2018) (Schindel, et al. 2013) (Oonsiri, et al. 2017). This research retrospectively quantified dosimetric differences for gynecological brachytherapy treatment plans using applicators reconstructed on CT versus MRI images acquired with a T<sub>2</sub>-PROPELLER or a T<sub>1</sub>-3D-LAVA-FLEX sequence.</div></div><div><h3>Materials and Methods:</h3><div>MRI and CT images were obtained for 10 cervical cancer patients undergoing brachytherapy with a Venezia (Elekta) applicator. The patients were scanned on a 1.5 Tesla Avanto fit GE scanner and a Philips Big Bore Radiation Therapy CT scanner. The MRI images acquired included a T<sub>2</sub>-weighted PROPELLER sequence and a T<sub>1</sub>-weighted 3D-LAVA-FLEX sequence. Images were oriented in the plane of the tandem to minimize distortions. MRI images were imported into MIM (Medical Image Merge, version 7.2.8) for reorientation. Applicator reconstruction was completed for each CT or MRI image using the Oncentra Treatment Planning System (Elekta, version 4.6.2). The clinical treatment dwell positions and dwell times were copied to each image with its corresponding reconstruction. A three-dimensional dose grid was calculated in Oncentra for each independent MRI or CT reconstruction. The dose calculated using each MRI reconstruction was then compared to that calculated using the CT reconstruction via a gamma index analysis (Das, et al. 2022) in MIM. A passing rate of 90% using a 3%/2mm dose difference/ distance to agreement, with 10 % maximum dose thresholding, was considered acceptable (Miften, et al. 2018). The gamma results were averaged for the T<sub>2</sub>-weighted images and T<sub>1</sub>-weighted images. A student t-test was completed (p<0.05) to determine if there were significant differences in gamma index results obtained with the T<sub>2</sub> reconstruction versus the T<sub>1</sub> reconstructions.</div></div><div><h3>Results:</h3><div>Each of the 10 patients underwent 3 fractions of brachytherapy. In some cases, one or both of the MRI images were not acquired due to hospital resource constraints. Thus, a total of 22 T<sub>1</sub> images and 23 T<sub>2</sub> images were assessed. The average and minimum gamma result over all T<sub>1</sub>-weighted image reconstructions were 96.6% and 90.5%, respectively. For T<sub>2</sub>-weighted images, average gamma results were 96.0 % and the minimum result was 90.2%. The student t-test yielded a p-value of 0.52, indicating there is no significant difference between reconstructions performed on the T<sub>2</sub>-weighed versus the T<sub>1</su","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S39-S40"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100297","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":"DEFINITIVE RADIOTHERAPY FOR SQUAMOUS CELL CARCINOMAS OF THE ORAL CAVITY: A SYSTEMATIC REVIEW AND POOLED ANALYSIS","authors":"Emmanuel Akingbade ,&nbsp;Aquila Akingbade ,&nbsp;Andrea Vucetic ,&nbsp;Anthony Luginaah ,&nbsp;Matthew Van Oirschot ,&nbsp;Lydia Abraha ,&nbsp;Ella Rival ,&nbsp;Andrew Youssef ,&nbsp;Christopher Goodman ,&nbsp;Adam Mutsaers","doi":"10.1016/S0167-8140(25)04761-9","DOIUrl":"10.1016/S0167-8140(25)04761-9","url":null,"abstract":"<div><h3>Purpose:</h3><div>Surgery is the standard of care for oral cavity (OC) squamous cell carcinoma (OC-SCC). Some patients are unfit for or refuse standard therapy. Definitive radiotherapy (dRT) is an alternative option, but techniques and outcomes are heterogeneous. Systematic review and pooled analyses were undertaken to synthesize available evidence.</div></div><div><h3>Materials and Methods:</h3><div>PubMed, EMBASE, and Cochrane databases were queried from inception to October 2023 for studies evaluating dRT for OC-SCC. Studies which specified definitive intent treatment or treated with EQD2 ≥60 Gy were included. Studies without quantitative endpoints or data specific to OC subgroups were excluded. Brachytherapy studies were excluded in present analysis. Data on 1 and 5-year local control (LC1,5), overall survival (OS1,5) and graded toxicities were extracted. Weighted means and standard deviations (wSD) were calculated.</div></div><div><h3>Results:</h3><div>Of 5584 studies, 86 studies met inclusion criteria. Studies included patients from 1962 to 2020, with 19 papers including patients treated exclusively after 2005. Ten studies used 3D-conformal RT, 16 used intensity modulated RT, and the remainder utilized 2D or mixed techniques. Most studies were retrospective (n=55) and single centre (n=66). Induction or concurrent chemotherapy was delivered in 18.6% (n=16) and 65.1% (n=56) of studies, respectively. Median EQD2 was 68.5 Gy (range 50-74 Gy). LC1 was 66.4% (wSD: 20.1%, reported in 16 studies), and LC5 was 61.6% (wSD: 18.1%, 23 studies). OS1 was 70.1% (wSD: 12.1%, 55 studies), and OS5 was 34.5% (wSD: 15.9%%, 60 studies). Toxicity was reported in 52 studies. Pooled rates of acute Grade 3+ toxicity for dermatitis, dysphagia, and mucositis were 14.6%, 23.6%, and 43.8%, respectively. Rate of late Grade 3+ dysphagia was 11.4%. Grade 2+ osteoradionecrosis was identified in 7.8% of patients (range: 0-28%). There were no Grade 5 toxicities reported.</div></div><div><h3>Conclusions:</h3><div>In this large, heterogeneous cohort, durable local control was attainable with acceptable toxicity. This analysis supports dRT as a useful alternative in OC-SCC patients who refuse or are not candidates for resection. Future analyses will include quantitative outcomes by subgroups (OC subsite, radiation technique, tumour T-stage, overall stage, systemic therapy, etc.) and understanding patterns of failure.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S43"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099952","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":"DOSIMETRIC OUTCOMES FOR STEREOTACTIC RADIOTHERAPY IN EARLY-STAGE NON-SMALL CELL LUNG CANCER AND INTERSTITIAL LUNG DISEASE: A SECONDARY ANALYSIS OF THE ASPIRE-ILD TRIAL","authors":"Alexa Dang ,&nbsp;David A. Palma ,&nbsp;Edward Wang ,&nbsp;Pencilla Lang ,&nbsp;Andrew Warner ,&nbsp;Houda Bahig ,&nbsp;Alexander V. Louie ,&nbsp;Stephen Harrow ,&nbsp;Meredith E. Giuliani ,&nbsp;Brock J. Debenham ,&nbsp;Christopher J. Ryerson ,&nbsp;Stewart Gaede","doi":"10.1016/S0167-8140(25)04719-X","DOIUrl":"10.1016/S0167-8140(25)04719-X","url":null,"abstract":"<div><h3>Purpose:</h3><div>The use of stereotactic ablative radiotherapy (SABR) in the setting of interstitial lung disease (ILD) is associated with higher toxicity risks. This dosimetric analysis of the ASPIRE-ILD trial evaluates doses delivered to targets and organs at risk (OARs), and correlations between baseline factors and outcomes, to better inform patient selection and treatment planning.</div></div><div><h3>Materials and Methods:</h3><div>Radiation plans were centrally collected and reviewed, and descriptive statistics were used to assess doses to targets and OARs. Unadjusted Cox proportional hazards and logistic regression were performed, respectively, to identify predictors of overall survival (OS), local control (LC) and related adverse events Grade ≥2 based on the Common Terminology Criteria for Adverse Events (CTCAE) version 4. Linear regression was performed to identify significant predictors of the Functional Assessment of Cancer Therapy: Lung (FACT-L), Cough Severity Scale, and pulmonary function testing (PFT) at 6 months.</div></div><div><h3>Results:</h3><div>The cohort included 39 patients treated with SABR (50 Gy in 5 fractions every other day). Thirty-five patients were treated with a volumetric modulated arc therapy (VMAT) technique, while the remaining four patients were treated using Cyberknife®. The mean internal gross tumour volume (iGTV) and planning target volume (PTV) for the entire cohort were 12.0 ± 11.2 cc and 33.9 ± 22.0 cc, respectively. The mean ± SD Dmax was 64.2 ± 6.3 Gy (128% of prescription). On unadjusted analyses, LC decreased with increasing tumour size (measured as either iGTV size [p=0.038] or PTV size [p=0.033]). The risk of Grade ≥2 adverse events increased with higher heart Dmax (p=0.020) and heart D15cc (p=0.025), and with increasing fibrosis surrounding the primary tumour (measured as the Hounsfield unit density of lung immediately surrounding the PTV [p=0.006]). Worse OS was associated with ILD sub-type (specifically connective tissue disease-associated ILD [CT-ILD] and idiopathic pulmonary fibrosis [IPF]), previous ILD treatment, current ILD treatment, home oxygen use, and larger iGTV and PTV sizes. Smoking cessation, a diagnosis of IPF, and higher baseline forced vital capacity (FVC) were associated with improved FACT-L scores at 6 months. None of the examined OAR dosimetry and planning metrics were predictive of PFT values.</div></div><div><h3>Conclusions:</h3><div>Several factors were associated with clinically relevant outcomes after SABR in patients with ILD, including some that are modifiable (e.g. radiation dose to the heart and smoking cessation). SABR delivered to highly fibrotic areas of lung was associated with higher toxicity. Smoking cessation may be important in preserving quality of life after treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S26-S27"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100001","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":"LONG-TERM PATIENT REPORTED OUTCOMES IN A RANDOMIZED CONTROLLED TRIAL OF MEPITEL FILM VERSUS STANDARD OF CARE IN BREAST RADIATION THERAPY","authors":"Caroline Hircock ,&nbsp;Sarah Bayrakdarian ,&nbsp;Henry Wong ,&nbsp;Liying Zhang ,&nbsp;Keyue Ding ,&nbsp;Irene Karam ,&nbsp;Francois Gallant ,&nbsp;Eileen Rakovitch ,&nbsp;William Tran ,&nbsp;Hany Soliman ,&nbsp;Eric Leung ,&nbsp;Danny Vesprini ,&nbsp;Ewa Szumacher ,&nbsp;Hanbo Chen ,&nbsp;Elysia Donovan ,&nbsp;Jacqueline Lam ,&nbsp;Silvana Spadafora ,&nbsp;Katherine Carothers ,&nbsp;Edward Chow","doi":"10.1016/S0167-8140(25)04740-1","DOIUrl":"10.1016/S0167-8140(25)04740-1","url":null,"abstract":"<div><h3>Purpose:</h3><div>This study aims to evaluate the long-term skin-related patient-reported outcomes (PROs) of a randomized controlled trial (RCT) comparing Mepitel Film (MF) to standard of care (SOC) for the prevention of acute radiation dermatitis (ARD) in breast cancer patients undergoing radiation therapy (RT).</div></div><div><h3>Materials and Methods:</h3><div>Patients were contacted via telephone at 6-, 12-, and 24-months post-RT to complete the Skin Symptom Assessment (SSA) and Radiation-induced Skin Reaction Assessment Scale (RISRAS). SSA and RISRAS scores at follow-up visits were compared to baseline using generalized estimation equation with Poisson distribution and log link function. To account for multiple testing, the Bonferroni-adjusted p-value of &lt;0.001 was considered statistically significant.</div></div><div><h3>Results:</h3><div>From April 2020 to August 2024, 376 patients were included in the modified intention-to-treat analysis and followed at the pre-specified time points. When comparing MF and SOC, no significant differences were captured longitudinally regardless of the severity of ARD (Common Terminology Criteria for Adverse Events Grade [G] 0-1 versus G2-3). Comparing to the baseline scores, patients reported worse pruritus at 6 months and pigmentation at 6, 12, and 24 months (p&lt;0.0001) for the SSA. For the RISRAS, tenderness/ discomfort/ pain, itchiness and burning sensation were worse at 6 months (p&lt;0.0001), but only itchiness was worse at 12 and 24 months (p=0.0007, p&lt;0.0001 respectively) compared to baseline. In the subgroup analysis of patients based on severity of ARD, pigmentation was worse at all follow-up visits (p&lt;0.0001) in both G0-1 and G2-3 cohorts.</div></div><div><h3>Conclusions:</h3><div>PROs returned to baseline at 6 months to 2 years after RT, except pigmentation and pruritus that persist regardless of the severity of ARD, necessitating confirmation with physical signs and further research to understand the pathophysiology of these chronic symptoms to guide preventative strategies. No long-term issues were identified in patients treated with MF, confirming it as a safe and effective strategy for the prevention of ARD.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S35"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100104","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 ABLATIVE RADIOTHERAPY USE AND DURATION OF SYSTEMIC THERAPY IN PATIENTS WITH METASTATIC EGFR-MUTATED NON-SMALL CELL LUNG CANCER: A POPULATION-BASED ANALYSIS","authors":"Michael Yan ,&nbsp;Ambika Parmar ,&nbsp;Natalie Coburn ,&nbsp;Lena Nguyen ,&nbsp;Alexander Louie","doi":"10.1016/S0167-8140(25)04676-6","DOIUrl":"10.1016/S0167-8140(25)04676-6","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose:&lt;/h3&gt;&lt;div&gt;Advances in systemic therapy have improved survival for patients with EGFR-mutated non-small cell lung cancer (NSCLC). Randomized trials have shown that adding stereotactic body radiation therapy (SBRT) to EGFR-targeted tyrosine kinase inhibitors (TKIs) may improve progression-free survival (PFS) and overall survival (OS). Prospective studies also suggest that SBRT to oligoprogressive sites may prolong the duration of the same line of systemic therapy. This study evaluates these outcomes in a real-world setting using a population-based healthcare administrative database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods:&lt;/h3&gt;&lt;div&gt;We analyzed data from the provincial Institute for Clinical Evaluative Sciences (ICES), a repository of linked health administrative databases, identifying all patients diagnosed with non-squamous NSCLC between 2002 and 2022, in Ontario, Canada. Eligible patients received EGFR-targeted therapy with Gefitinib or Osimertinib, with treatment start/stop dates and radiotherapy (RT) data recorded. Patients younger than 18 or those with a prior cancer diagnosis within five years of NSCLC diagnosis were excluded. SBRT was defined as any radiotherapy course delivering ≥5 Gy per fraction in ≤8 fractions, except for single-fraction treatments ≤8 Gy. Patients who received SBRT during EGFR-targeted therapy were classified in the SBRT cohort, while all others comprised the palliative RT cohort. The primary outcome was the duration of first-line systemic therapy. Baseline and treatment characteristics were summarized descriptively, and OS was estimated via the Kaplan-Meier method from the date of drug start. Propensity score matching using logistic regression adjusted for baseline factors influencing systemic therapy duration, including age, sex, rurality index, Charlson and Elixhauser comorbidity indices, income quintile, and treatment year. A sensitivity analysis excluded patients treated before 2013 (~10% of the cohort).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;A total of 898 patients met inclusion criteria, with 185 receiving SBRT and 713 receiving palliative RT. SBRT use increased in later years (2019-2022). The median duration of first-line systemic therapy was 683 days in the SBRT cohort versus 400 days in the palliative RT cohort (p&lt;0.01). Median OS was 35.3 months (95% CI 27.2-77.5) for SBRT and 23.1 months (25.4-32.4) for palliative RT (p&lt;0.01 log rank test). After excluding patients treated before 2013, 797 patients remained (SBRT: 171, palliative RT: 626). Median first-line systemic therapy duration was 692 versus 393 days, respectively (p&lt;0.01), and median OS was 35.6 (95% CI 31.4-41.2) versus 23.1 months (95%CI 21.2-24.5) (p&lt;0.01 log rank test). After propensity score matching (n=364, 184 per cohort), standardized mean differences were balanced (&lt;0.1). The SBRT cohort maintained a longer median first-line therapy duration (683 versus 431 days, p&lt;0.01) and improved median OS (35.3 versus 2","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S9-S10"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OUTCOMES OF BRAIN METASTASIS FROM NON-SEMINOMATOUS GERM CELL TUMOUR: A POPULATION-BASED REVIEW","authors":"Linden Lechner ,&nbsp;Scott Tyldesley ,&nbsp;Christian Kollmannsberger ,&nbsp;Tom Zwimpfer ,&nbsp;Roy Ma ,&nbsp;Alan Nichol ,&nbsp;Justin Oh","doi":"10.1016/S0167-8140(25)04679-1","DOIUrl":"10.1016/S0167-8140(25)04679-1","url":null,"abstract":"<div><h3>Purpose:</h3><div>To characterize the patients with brain metastases (BM) from non-seminomatous germ cell tumours (NSGCT) and describe their treatments and outcomes.</div></div><div><h3>Materials and Methods:</h3><div>A retrospective review of patients diagnosed with BM from NSGCT in British Columbia over 30 years was conducted using the provincial cancer registry. Demographic, clinical, disease characteristics, and treatment history were analyzed. Overall survival (OS) was assessed using the Kaplan-Meier method.</div></div><div><h3>Results:</h3><div>Preliminary registry review identified 260 NSGCT patients: eight (3%) had BM confirmed by imaging. The median follow-up was 10 months, with six deaths. The median OS from BM diagnosis was 2 months, and the 3-year OS was 25%. One patient had BM at presentation, while the rest had relapsed BM. All patients had symptomatic BM, with extremity weakness (6) being the most common. Four had a single BM, and four had multiple metastases. Two underwent surgical resection for mass effect. Seven received radiation therapy: four had whole brain radiation therapy (WBRT), two had volumetric modulated arc therapy (VMAT), and one had stereotactic radiotherapy (SRT). The most common chemotherapy regimen was ifosfamide, cisplatin, and etoposide. Three intracranial events occurred post-treatment and led to death: one intracranial failure after WBRT (41 Gy/24#), one leptomeningeal disease after SRT (35 Gy/5#), and one fatal intracranial hemorrhage after VMAT (50 Gy/25#). The remaining deaths were due to extracranial disease. Two long-term survivors (17 and 3 years) were less than 25 years old, had a single BM, excellent functional status, and received focused VMAT (54 Gy/30#) or WBRT (24 Gy/12#).</div></div><div><h3>Conclusions:</h3><div>BM from NSGCT is rare and associated with poor outcomes, though long-term survival is possible. Surgery, radiotherapy, and chemotherapy remain critical in management. Further registry review to identify potentially missing cases is planned.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S10-S11"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100137","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":"FIVE-FRACTION SBRT TO PROSTATE AND PELVIC NODES IN HIGH-RISK PROSTATE CANCER. A SINGLE INSTITUTION EXPERIENCE","authors":"Constanza Martinez ,&nbsp;Fabio Cury ,&nbsp;Marie Duclos ,&nbsp;James Tsui ,&nbsp;Horacio Patrocinio ,&nbsp;Luis Souhami ,&nbsp;Sergio Faria","doi":"10.1016/S0167-8140(25)04673-0","DOIUrl":"10.1016/S0167-8140(25)04673-0","url":null,"abstract":"<div><h3>Purpose:</h3><div>Stereotactic body radiation therapy (SBRT) is an attractive treatment alternative for high-risk prostate cancer. However, most prior studies have focused solely on SBRT targeting the prostate. This study aims to report on outcomes for patients with high-risk prostate cancer treated with SBRT to the prostate and pelvic lymph nodes in combination with androgen deprivation therapy (ADT).</div></div><div><h3>Materials and Methods:</h3><div>Patients with localized high-risk prostate cancer that received SBRT at a dose of 36.25 Gy in 5 fractions targeting the prostate, while the pelvic nodal regions received 25 Gy over the same 5 fractions, delivered, on alternate days, via a simultaneous integrated boost technique with intensity-modulated radiation therapy (<em>Figure 1)</em>. We performed same-day MRI and CT simulations with urethrograms in all patients. Cone-beam CT was performed prior to each treatment session. The primary tumour clinical target volume (CTV) prostate included the entire prostate and the proximal 1cm of seminal vesicles. The primary tumour planning target volume (PTV) was CTV with a 5mm isotropic margin. The PTV for pelvic nodes included the pelvic nodes CTV with a 6-7mm margin. The bladder constraint was V38Gy[cc]&lt;0.03; V18Gy&lt;50%, and the rectum constraint was V36Gy[cc]&lt;3; V18Gy&lt;50%. ADT was initiated 2-3 months before SBRT and continued for 6-24 months at the treating physician’s discretion. Follow-ups were conducted every 3-6 months annually. Outcomes were calculated using Kaplan-Meier analysis, from the end of radiation treatment date to the event date.</div></div><div><h3>Results:</h3><div>The data analyzed were collected from the first 102 patients treated between August 2019 and December 2022. The median age at diagnosis was 73 years; median PSA=11.9ng/ mL. T-Stage and Gleason scores are summarized in Table 1. The median follow-up was 33.8 months (range: 15-55 months), and 43% of patients had follow-up beyond 36 months. The 3- and 4-year actuarial biochemical recurrence-free survival were 92.8% and 77.7%, respectively; the distant metastasis-free survival was 96.3% and 82%; and the overall survival were 95.5% and 89.9%. Acute gastrointestinal and genitourinary Grade 2 toxicity were 4% and 25% respectively. No Grade 3 or 4 acute toxicity were observed.</div></div><div><h3>Conclusions:</h3><div>Five-fraction SBRT for high-risk prostate cancer, at dose of 36.25 Gy to prostate and 25 Gy to pelvic nodes, appears both feasible, safe and convenient for patients and the healthcare system. This regimen is associated with promising early outcomes and appears safe. Continued longer follow-up with late-toxicity report. Randomized trials employing similar approaches are needed.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S8"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100187","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 MULTIDISCIPLINARY QUALITY INITIATIVE TO ADDRESS DELAYS IN INITIATING POST-OPERATIVE RADIOTHERAPY IN HEAD AND NECK CANCER PATIENTS","authors":"Madette Galapin ,&nbsp;Antoine Eskander ,&nbsp;Danny Enepekides ,&nbsp;Kevin Higgins ,&nbsp;Irene Karam ,&nbsp;Ian Poon ,&nbsp;Andrew Bayley","doi":"10.1016/S0167-8140(25)04746-2","DOIUrl":"10.1016/S0167-8140(25)04746-2","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose:&lt;/h3&gt;&lt;div&gt;The American College of Surgeons Commission on Cancer’s (ACS/CoC) head and neck (HN) quality metric requires post-operative radiotherapy (PORT) initiation within 42 days from surgery. A 2021/2022 quality improvement (QI) audit revealed only 43% of our patients met this metric. Root cause analysis suggested radiation oncologist (RO) assessment ≤21 days post-op supports timely PORT. This QI initiative aimed to increase adherence from 43% to 70% by the end of 2024.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods:&lt;/h3&gt;&lt;div&gt;This multidisciplinary QI initiative (registered with our institution, REB not required) implemented a new standard operating procedure. Included were patients with mucosal and skin squamous cell carcinomas (SCC), melanomas, salivary gland and other high-risk skin carcinomas undergoing surgery &amp; PORT (January - December 2024), excluding those with prior HN radiotherapy. The intervention involved: 1) HN clinical specialist radiation therapist (CSRT) identifying relevant patients and informing RO of PORT goal dates, and 2) an order for a 3-week post-op RO follow-up (FU) booked via the computerized provider order entry system. Measures included: percentage of patients initiating PORT ≤ 42 days (outcome), seeing RO ≤21 days post-op (process), and initiating PORT ≤42 days with rushed planning process (&lt;14 days) from simulation to treatment (balancing). Quarterly updates maintained project momentum through team feedback and addressing concerns.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;Of the 135 patients included, 62 (46%) began PORT ≤42. Among those with SCC, timely PORT was seen in 50/92 (54%) compared to 12/43 (28%) with non-SCC histology. Timely PORT in 2024 was variable with an improvement of 12/26 (46%) in Q1 to 21/39 (54%) in Q4, but 13/33 (39%) in Q2 and 16/37 (43%) in Q3. RO assessment ≤ 21 days post-op occurred in 54/135 (40%) patients. This improved from 10/26 (38%) in Q1 to 17/39 (44%) in Q4 but varied with 14/33 (47%) in Q2 and 13/37 (35%) in Q3. Among patients with timely RO assessment, 38/54 (70%) achieved timely PORT, increasing from 7/10 (70%) in Q1 to 14/17 (82%) in Q4, but varied with 10/14 (71%) in Q2 and 7/13 (54%) in Q3. Rushed planning increased from 4/12 (33%) in Q1 to 5/13 (38%) in Q2 and 10/16 (63%) in Q3 but decreased to 8/21 (38%) in Q4. For the 73 patients with delayed PORT, main causes were: care coordination issues (56%), post-op complications (32%), and other (12%). Analysis revealed 70% of delays were unavoidable, including post-op complications, wound healing issues, delayed referrals from non-cancer centre surgeons, and patient-requested delays.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions:&lt;/h3&gt;&lt;div&gt;The QI intervention improved adherence to the ACS/ CoC metric from 43% to 46%. This fell short of the 70% goal which can be attributed to 70% of delays deemed as unavoidable. Future sustainable interventions include dedicated patient navigation, automated FU booking, and enhanced care pathway vis","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S37-S38"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100205","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}