Radiotherapy and Oncology最新文献

{"title":"Delineation of the post-operative primary tumour and nodal clinical target volumes in oral cavity squamous cell carcinoma: European Society for Radiotherapy and Oncology (ESTRO) clinical guidelines","authors":"Mererid Evans ,&nbsp;Pierluigi Bonomo ,&nbsp;Po Chung Chan ,&nbsp;Melvin L.K. Chua ,&nbsp;Jesper Grau Eriksen ,&nbsp;Keith Hunter ,&nbsp;Kenneth Jensen ,&nbsp;T.M. Jones ,&nbsp;Sarbani Ghosh Laskar ,&nbsp;Roberto Maroldi ,&nbsp;Brian O’Sullivan ,&nbsp;Claire Paterson ,&nbsp;Luca Tagliaferri ,&nbsp;Silke Tribius ,&nbsp;Sue S. Yom ,&nbsp;Vincent Gregoire","doi":"10.1016/j.radonc.2025.111135","DOIUrl":"10.1016/j.radonc.2025.111135","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To date, no consensus guidelines have been published that systematically guide delineation of primary and nodal Clinical Target Volumes (CTVs) in patients who require post-operative radiotherapy (PORT) for mucosal Head and Neck squamous cell carcinoma (HNSCC). As a result, significant individual, institutional and national variation exists in the way that CTVs are delineated in the post-operative setting, leading to considerable heterogeneity in radiotherapy treatment.</div></div><div><h3>Methods</h3><div>A multi-disciplinary group of experts convened by the European Society for Radiotherapy and Oncology (ESTRO) set-out principles for the multi-disciplinary management of oral cavity squamous cell carcinoma (OCSCC). Building on these, and adapting the geometric expansion approach described in previous primary CTV delineation guidelines, new consensus guidelines for the delineation of post-operative CTVs, both for the primary tumour and nodal regions, were proposed by the expert group, before being shared with a second tier of international experts to ensure their worldwide acceptability and applicability.</div></div><div><h3>Results</h3><div>These guidelines propose that surrogate volumes representing the resected primary and nodal Gross Tumour Volumes (GTV-P and GTV-N respectively) are re-created on the radiotherapy planning scan, either by registration with diagnostic imaging or via reference to anatomical landmarks. A post-operative CTV for the primary tumour (CTV-P) is created as a composite volume that includes: i) geometric expansion around the surrogate GTV-P, and ii) geometric expansion around the surgical defect and/or reconstruction flap. A post-operative CTV for the nodal region (CTV-N) is created as a composite volume that includes: i) geometric expansion around the surrogate GTV-N, and ii) the involved nodal level (CTV-N1). Guidelines for delineating at-risk nodal levels in a prophylactic dose CTV (CTV-N2) are included, and for making decisions regarding the need for unilateral and/or bilateral neck treatment.</div></div><div><h3>Conclusions</h3><div>Implementation of these guidelines into clinical practice should reduce variation, and by promoting consistency of approach, facilitate multi-institutional audits and clinical trials including Radiation Therapy Quality Assurance (RTQA) in patients with OCSCC. It is anticipated that they will form the basis for future guidelines aiming to standardise post-operative CTV delineation in other head and neck subsites.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111135"},"PeriodicalIF":5.3,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030579","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":"Sparing effects of FLASH irradiation in patient-derived lung tissue","authors":"Maxime Dubail ,&nbsp;Chloé Lafouasse ,&nbsp;Sophie Heinrich ,&nbsp;Vincent Favaudon ,&nbsp;Arturo Londoño-Vallejo ,&nbsp;Marie Dutreix ,&nbsp;Delphine Colin ,&nbsp;Jean-François Côté ,&nbsp;Jérôme Didier ,&nbsp;Christelle Pouliquen ,&nbsp;Abdelali Benali ,&nbsp;Pierre Verrelle ,&nbsp;Marine Lefèvre ,&nbsp;Nicolas Girard ,&nbsp;Agathe Seguin-Givelet ,&nbsp;Gilles Créhange ,&nbsp;Charles Fouillade","doi":"10.1016/j.radonc.2025.111126","DOIUrl":"10.1016/j.radonc.2025.111126","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiation toxicities, such as pneumonitis and fibrosis, are major limitations affecting patients’ quality of life. Developed a decade ago, FLASH radiotherapy is an innovative method that, by delivering radiation at ultrafast dose rate, reduces radiation toxicities on healthy tissue while preserving the anti-tumoral effect of radiotherapy. This so-called FLASH effect has been described in different preclinical models but has not been observed in human tissue. This study aims to determine if FLASH irradiation can induce a sparing effect on human healthy lung tissue.</div></div><div><h3>Materials and methods</h3><div>To address this question, precision-cut lung slices (Hu-PCLS) were prepared from healthy lung samples collected from 19 lung cancer patients undergoing lobectomy. These Hu-PCLS were irradiated <em>ex vivo</em> at a dose of 9 Gy using the ElectronFLASH (SIT) device operated either in conventional or FLASH mode. We monitored cell division for each patient and performed RNAseq analysis to uncover some mechanistic insights.</div></div><div><h3>Results</h3><div>Analysis of cell division 24 h after treatment with conventional or ultra-high dose rate showed a higher proportion of dividing cells in Hu-PCLS after FLASH irradiation. Consistently, RNAseq analysis from irradiated lung samples confirmed an attenuated cell cycle checkpoint inhibition, p53 pro-apoptotic genes, DNA damage, and antioxidant pathways after ultra-high dose rate compared to conventional treatment.</div></div><div><h3>Conclusion</h3><div>Altogether, this study shows that, using freshly isolated patient-derived lung samples, cell proliferation can serve as an early marker of the normal lung response to FLASH irradiation. These findings hold great promises for future applications of FLASH radiotherapy in the clinic.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111126"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024122","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":"Dose, dose rate and split dose impacts murine skin responses following photon FLASH irradiation","authors":"Kathryn H. Brown ,&nbsp;Mihaela Ghita-Pettigrew ,&nbsp;Malachy P. McIvor ,&nbsp;Mark P. McDowell ,&nbsp;Owen McLaughlin ,&nbsp;Kevin M. Prise ,&nbsp;Daniel Sforza ,&nbsp;John W. Wong ,&nbsp;Mohammad Rezaee ,&nbsp;Stephen J. McMahon ,&nbsp;Karl T. Butterworth","doi":"10.1016/j.radonc.2025.111125","DOIUrl":"10.1016/j.radonc.2025.111125","url":null,"abstract":"<div><h3>Introduction</h3><div>Preclinical evidence has demonstrated the potential of FLASH radiotherapy (FLASH-RT) to spare normal tissues compared to conventional (CONV) exposures. Most FLASH studies have used ultra-high dose rate (&gt;40 Gy/sec) electrons and protons whilst comparatively few studies have reported photon FLASH responses. Given the widespread use of photons clinically, there is a need to characterise the FLASH effect using photons. In this study, we applied a novel photon FLASH system (FLASH-SARRP, Xstrahl) to investigate the effects of dose, dose rate and split dose on murine skin toxicity.</div></div><div><h3>Methods</h3><div>Skin toxicity was assessed at CONV (3.2 Gy/min) and FLASH (72 Gy/s) dose rates using the SARRP or FLASH-SARRP. CONV responses were investigated at a dose of 20.2 Gy and FLASH responses at doses of 18.1, 21.3 &amp; 25.8 Gy. Comparative studies were conducted using a split dose exposure with an average dose rate of 2.8 Gy/s. Skin toxicity on the hind leg of C57BL/6 mice was visually scored and histopathological analysis performed at 8–12 weeks. Tumour growth delay was also assessed using a melanoma (B16-F10) xenograft model irradiated at FLASH and CONV dose rates.</div></div><div><h3>Results</h3><div>Skin toxicity was delayed for FLASH exposures and tissue analysis showed hyperplasia and significant fibrosis deposition (p &lt; 0.01) in CONV mice compared to FLASH. Tissue recovery was observed for both dose rates from 8 weeks post RT. A dose dependent relationship for FLASH sparing was observed, while a split dose exposure resulted in loss of sparing. FLASH was equally effective for tumour control in comparison to CONV exposures (p = 0.99).</div></div><div><h3>Conclusions</h3><div>These results demonstrate it is feasible to deliver photon FLASH exposures with sparing consistent with observations from previous studies using proton and electron beams. Dose, average dose rate and beam structure are key parameters that modulate radiobiological responses to photon FLASH.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111125"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018445","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":"Prospective cohort study to validate esophageal dose constraints and predictive models for esophagitis in patients with breast cancer undergoing hypofractionated regional nodal radiotherapy","authors":"Dan-Qiong Wang ,&nbsp;Lei Yan ,&nbsp;Hong-Fen Wu ,&nbsp;Ya-Hua Zhong ,&nbsp;Xiao-Bo Huang ,&nbsp;Jing Jin ,&nbsp;Qiu-Zi Zhong ,&nbsp;Li-Na Zhao ,&nbsp;Xiao-Hong Wang ,&nbsp;Hao Jing ,&nbsp;Yu Tang ,&nbsp;Yong-Wen Song ,&nbsp;Ning-Ning Lu ,&nbsp;Bo Chen ,&nbsp;Yue-Ping Liu ,&nbsp;Shu-Nan Qi ,&nbsp;Yuan Tang ,&nbsp;Yi-Rui Zhai ,&nbsp;Wen-Wen Zhang ,&nbsp;Ning Li ,&nbsp;Shu-Lian Wang","doi":"10.1016/j.radonc.2025.111120","DOIUrl":"10.1016/j.radonc.2025.111120","url":null,"abstract":"<div><h3>Purpose</h3><div>Esophageal RV25 &lt; 20 % and AV35 &lt; 0.27 mL were reported as dose constraints predictive of grade ≥ 2 radiation esophagitis (RE) for breast cancer in our previous study. This prospective study aimed to validate the effectiveness of esophageal dose constraints and develop RE prediction models.</div></div><div><h3>Methods</h3><div>We enrolled 465 patients with breast cancer receiving 43.5 Gy in 15 fractions to the chest wall and nodal regions using IMRT/VMAT between January 2022 and February 2024. The esophagus was contoured from the cricoid cartilage level to the aortic arch’s lower margin. RE was assessed weekly during radiotherapy and at weeks 1 and 2 and months 3 and 6 post-RT using CTCAE v3.0. Analyzed esophageal dosimetric parameters: total volume, mean/max dose, the relative and absolute volumes receiving at least 5–45 Gy by 5 Gy increments (RV5–RV45 and AV5–AV45). Predictive models incorporating tumor laterality, internal mammary nodal irradiation (IMNI), and RV25 or AV35 thresholds were developed. Discrimination (AUC) and calibration [Hosmer-Lemeshow (H-L) test] were evaluated, and risk stratification was performed using decision tree analysis.</div></div><div><h3>Results</h3><div>The grade 2 RE incidence (23.7 %) was considerably lower than in a previous report (40.9 %), and no grade ≥ 3 RE was observed. Both models performed well (RV25 model: AUC, 0.688, H-L, <em>p</em> = 0.974; AV35 model: AUC, 0.651, H-L, <em>p</em> = 0.776). Risk factors for RE included left-side tumor, IMNI, and RV25 ≥ 20 % or AV35 ≥ 0.27 mL. Patients with no risk factors were classified as low risk, those with one risk factor as intermediate risk, and those with ≥ 2 risk factors as high risk. The grade ≥ 2 RE incidence differed significantly across groups (RV25: 14.8 % vs. 24.7 % vs. 48.3 %; AV35: 14.7 % vs. 23.7 % vs. 45.4 %).</div></div><div><h3>Conclusion</h3><div>Clinical validation confirmed the effectiveness of esophageal dose constraints and the predictive accuracy of the RV25 and AV35 models. Avoiding unnecessary IMNI and maintaining RV25 &lt; 20 % and AV35 &lt; 0.27 mL could reduce the risk for RE.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111120"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024204","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":"Dosiomics-guided deep learning for radiation esophagitis prediction in lung cancer: optimal region of interest definition via multi-branch fusion auxiliary learning","authors":"Xianwen Yu ,&nbsp;Yao Ai ,&nbsp;Wanyu Su ,&nbsp;Ziqing Xiang ,&nbsp;Jianping Wu ,&nbsp;Yiran Mu ,&nbsp;Yifan Yang ,&nbsp;Long Zhang ,&nbsp;Wenliang Yu ,&nbsp;Weihua Ni ,&nbsp;Juebin Jin ,&nbsp;Congying Xie ,&nbsp;Xiance Jin","doi":"10.1016/j.radonc.2025.111121","DOIUrl":"10.1016/j.radonc.2025.111121","url":null,"abstract":"<div><h3>Background</h3><div>Accurate delineation of regions of interest (ROIs) is critical for feature extraction and selection in radiomics-based prediction models.</div></div><div><h3>Purpose</h3><div>To develop a combined dosiomics and deep learning (DL) model for predicting grade ≥ 2 radiation esophagitis (RE) in lung cancer patients undergoing radiotherapy, we propose a multi-task auxiliary learning approach to define accurate and objective ROIs based on radiation dose distribution (RDD) images.</div></div><div><h3>Materials and Methods</h3><div>Lung cancer patients who underwent radiotherapy were gathered retrospectively from hospital 1 (January 2020 and December 2022) for model development. Two external validation sets were obtained retrospectively from hospital 2 (January 2021 and December 2022) and hospital 3 (January 2022 and December 2023), respectively. A dosiomics-guided deep learning (DGD) network using multi-task auxiliary learning to define accurate and objective ROIs was introduced by integrating dosiomic features with high-dimensional DL features for RE prediction.</div></div><div><h3>Results</h3><div>This study enrolled 488 patients from three hospitals: 235 in the training set, 101 in the internal validation set, 57 in the external validation set 1 and 95 in the external validation set 2, respectively. The dosiomics −guided ResNet34 combined with contrastive learning and auxiliary segmentation module achieved the best AUCs of 0.88 [95% CI: 0.76–0.95], 0.82 [95% CI: 0.65–0.96], 0.83 [95% CI: 0.74–0.92] in the internal validation set, external validation set 1, and external validation set 2, respectively.</div></div><div><h3>Conclusion</h3><div>The proposed DGD model leverages multi-task auxiliary learning to automatically define ROIs and effectively predict RE in lung cancer patients undergoing radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111121"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024135","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 significance of estimated radiation dose to immune cells in cancer patients undergoing thoracic irradiation: A meta-analysis","authors":"Chih-Wei Luan ,&nbsp;Yao-Te Tsai ,&nbsp;Kuan-Yin Chen ,&nbsp;Wing-Keen Yap","doi":"10.1016/j.radonc.2025.111123","DOIUrl":"10.1016/j.radonc.2025.111123","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Emerging evidence suggests that excessive radiation dose to immune cells may impair host immunity and negatively affect cancer prognosis. However, the prognostic impact of the estimated radiation dose to immune cells across different cancer types and treatment modalities remains inconclusive. This <em>meta</em>-analysis aimed to systematically evaluate the association between estimated radiation dose to immune cells and survival outcomes in patients with lung and esophageal cancers undergoing radiotherapy.</div></div><div><h3>Materials and methods</h3><div>We systematically searched PubMed, EMBASE, and Cochrane Library up to April 2025 following PRISMA guidelines. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model for overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), locoregional progression-free survival (LPFS), and distant metastasis-free survival (DMFS).</div></div><div><h3>Results</h3><div>Sixteen studies comprising 4511 patients were included, with 1073 patients diagnosed with esophageal cancer and 3438 with lung cancer. The pooled analysis demonstrated that higher estimated radiation dose to immune cells was significantly associated with inferior OS (HR = 1.228; 95 % CI, 1.135–1.329; p &lt; 0.001) and PFS (HR = 1.265; 95 % CI, 1.134–1.412; p &lt; 0.001). Similar associations were observed for DFS (HR = 1.227; 95 % CI, 1.009–1.492), LPFS (HR = 1.091; 95 % CI, 1.042–1.141), and DMFS (HR = 1.172; 95 % CI, 1.066–1.290). Subgroup analyses revealed consistent findings across tumor types, geographic regions, age groups, sample sizes, and the estimated radiation dose to immune cells cutoff values. Funnel plot asymmetry and statistical tests suggested potential publication bias; however, trim-and-fill analyses confirmed the robustness of the results. Sensitivity analyses further supported the stability of pooled estimates.</div></div><div><h3>Conclusions</h3><div>Higher estimated radiation dose to immune cells is linked to adverse survival outcomes. Immune-sparing radiotherapy strategies may improve prognosis and warrant further investigation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111123"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024120","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":"Impact of radiation dose on immune cells (EDIC) on oncologic outcome in small cell lung cancer (SCLC)","authors":"Hannah Sophie Penzl ,&nbsp;David Alexander Ziegler ,&nbsp;Markus Anton Schirmer ,&nbsp;Jona Bensberg ,&nbsp;Sonia Ziegler ,&nbsp;Benedikt Kieslich ,&nbsp;Carla Marie Zwerenz ,&nbsp;Andrea Hille ,&nbsp;Leif Hendrik Dröge ,&nbsp;Martin Leu ,&nbsp;Manuel Guhlich ,&nbsp;Lisa von Diest ,&nbsp;Laura Anna Fischer ,&nbsp;Mahalia Zoe Anczykowski ,&nbsp;Tobias Overbeck ,&nbsp;Alexander von Hammerstein-Equord ,&nbsp;Friederike Braulke ,&nbsp;Stefan Rieken ,&nbsp;Rami El Shafie","doi":"10.1016/j.radonc.2025.111122","DOIUrl":"10.1016/j.radonc.2025.111122","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy (RT) is an essential part of small-cell lung cancer (SCLC) treatment. It can however deplete circulating lymphocytes, impairing systemic immune surveillance and potentially reducing the efficacy of immune checkpoint inhibitors (ICIs). The Effective Dose to Immune Cells (EDIC) quantifies RT-induced immune suppression and has been linked to survival in non-small cell lung cancer (NSCLC), but its prognostic significance in SCLC remains unclear.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 220 patients with SCLC who received thoracic RT at a German tertiary cancer center between 2006 and 2020. EDIC was calculated from treatment plans using the model developed by Jin et al., which approximates the dose to circulating immune cells based on the dose to circulating blood. The primary endpoint was overall survival (OS), secondary endpoints were progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LPFS). Multivariable Cox regression identified independent prognostic factors.</div></div><div><h3>Results</h3><div>The median OS was 17.7 months (Q1–Q3: 11.6–38.8, 95 % CI: 16.0–19.3). In LD-SCLC, higher EDIC (&gt; 4.9 Gy) was independently associated with shorter OS (HR 1.62, p = 0.011), PFS (HR 1.57, p = 0.037), and DMFS (HR 1.72, p = 0.017), but not LPFS (p = 0.308). In contrast, EDIC showed no prognostic impact in ED-SCLC. Other independent prognostic factors in LD-SCLC included prophylactic cranial irradiation (HR 0.43, p &lt; 0.001) and bi-daily fractionation (HR 0.41, p = 0.002).</div></div><div><h3>Conclusion</h3><div>Higher EDIC is an independent negative prognostic factor in LD-SCLC, correlating with shorter OS, PFS, and DMFS, but had no prognostic relevance in ED-SCLC in this analysis. As immunotherapy becomes part of LD-SCLC treatment, immune-preserving RT strategies should be developed to optimize patient outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111122"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024210","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":"Prediction of metastasis-free survival in patients with localized prostate adenocarcinoma using primary tumor and lymph node radiomics from pre-treatment PSMA-PET/CT scans","authors":"Apurva Singh ,&nbsp;William Silva Mendes ,&nbsp;Sang-Bo Oh ,&nbsp;Ozan Cem Guler ,&nbsp;Aysenur Elmali ,&nbsp;Birhan Demirhan ,&nbsp;Amit Sawant ,&nbsp;Phuoc Tran ,&nbsp;Cem Onal ,&nbsp;Lei Ren","doi":"10.1016/j.radonc.2025.111119","DOIUrl":"10.1016/j.radonc.2025.111119","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;To predict metastasis-free survival (MFS) for patients with prostate adenocarcinoma (PCa) treated with androgen deprivation therapy (ADT) and external radiotherapy using clinical factors and radiomics extracted from primary tumor and node volumes in pre-treatment PSMA PET/CT scans.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials/Methods&lt;/h3&gt;&lt;div&gt;Our cohort includes 134 PCa patients (nodal involvement in 28 patients). Gross tumor volumes of primary tumor (GTVp) and nodes (GTVn) on CT and PET scans were segmented. A 5 mm expansion ring area outside primary tumor was defined. Z-score normalization was applied to radiomics features extracted from tumor and ring; dimension reduction was performed using Principal Components Analysis (PCA). For patients with only primary tumor, we took 3 principal components (PCs) from GTVp and one ring PC as representative radiomics components from CT and PET scans. For patients with nodes, we calculated weighted average (by volume) of radiomics from primary tumor and nodes, computed first 3 PCs and combined it with 1st PC from the ring. Radiomics PCs and clinical variables (age, Gleason score, initial prostate specific antigen value (i PSA), PSA_relapse) formed the predictors. Due to MFS data imbalance (metastasis-24, no metastasis-110), we performed 70:30 train-test split and applied imbalance correction to training data. Univariate Cox-regression was used to select top predictors (logistic regression p &lt; 0.05). Multivariate Cox-regression was performed on imbalance-corrected training data and fit on testing data (using predictors selected from training). Model 2 was built using clinical variables and radiomic PCs from primary tumors (GTVp, ring). Model 3 was built using clinical variables only. Binary classification analysis for prediction of five-year MFS was also performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Results of time-to-event analysis (MFS) were: Cox-regression c-scores: model1: train- 0.77 [0.72, 0.78]; test- 0.69 [0.64, 0.70]; model2: train- 0.72 [0.66, 0.73]; test- 0.63 [0.58, 0.64]; model3: train- 0.62 [0.57, 0.63]; test- 0.54 [0.51, 0.56]. The results of 5 year MFS classification analysis were [sensitivity, specificity, AUC]: model 1: train- [83.6 %, 91.3 %, 0.88]; test- [76.3 %, 82.5 %, 0.81]; model 2: train- [77.4 %, 85.1 %, 0.84]; test- [71.5 %, 78.2 %, 0.76]; model 3: train- [69.3 %, 78.2 %, 0.76]; test- [64.7 %, 72.6 %, 0.68]. The two cohorts of patients classified by model 1 showed statistically significant differences in their actual survival curves, demonstrating the efficacy of the classification. Integration of node with primary tumor-radiomics provides the best prognostic performance in MFS prediction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This is one of the first studies to explore the prognostic value of pre-treatment PSMA-PET, a relatively recent advancement in the care of prostate adenocarcinoma patients. Results demonstrated the potential of using imaging biomarkers from ","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"212 ","pages":"Article 111119"},"PeriodicalIF":5.3,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024163","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":"GEOGRAPHIC PATTERNS OF BREAST CANCER CLINICAL TRIAL ENROLLMENT IN CANADA: AN ANALYSIS OF CCTG-REGISTERED TRIALS","authors":"Curtis Leclerc ,&nbsp;Alan Nichol ,&nbsp;Robert Olson","doi":"10.1016/S0167-8140(25)04726-7","DOIUrl":"10.1016/S0167-8140(25)04726-7","url":null,"abstract":"<div><h3>Purpose:</h3><div>Breast cancer clinical trials, with their large patient pool and widespread use of standard treatments like surgery, radiation, and chemotherapy, provide a valuable model for understanding the geographic patterns of clinical trials in Canada. Therefore, the purpose of this analysis was to explore the state of CCTG registered breast cancer clinical trials within Canada.</div></div><div><h3>Materials and Methods:</h3><div>We conducted a retrospective observational analysis of 7,005 participants enrolled in 16 CCTG-registered breast cancer clinical trials between 2000 and 2017. Participant accrual was assessed by province, city, and major cancer centre. Census Metropolitan Areas (CMAs), as defined by Statistics Canada, were used to identify urban recruitment patterns. Data were visualized using geographic information systems and analyzed descriptively to assess regional differences.</div></div><div><h3>Results:</h3><div>Clinical trial recruitment was highly centralized. 99.9% of participants were enrolled from CMA-designated urban centres, with only three patients recruited from non-CMA regions. Ontario, Quebec, and British Columbia accounted for over 80% of national accrual, with Ontario alone contributing 52.6%. The majority of trial enrollments originated from a small number of large urban academic centres, with minimal participation from rural or remote regions and none from the territories.</div></div><div><h3>Conclusions :</h3><div>Breast cancer clinical trial enrollment in Canada is highly concentrated in urban academic centres, leaving rural, remote, and northern populations significantly underrepresented. These findings underscore the urgent need for decentralized trial models, regional recruitment networks, and targeted investments in rural research infrastructure to ensure equitable access to clinical research across Canada.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S30"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099950","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 AND TOXICITIES FOLLOWING CONVENTIONAL RADIATION THERAPY FOR PITUITARY NEUROENDOCRINE TUMOURS (PITNETS)","authors":"Brandon Craig ,&nbsp;Inhwa Kim ,&nbsp;Anthony Lausch ,&nbsp;Aruz Mesci ,&nbsp;Jelena Lukovic ,&nbsp;Dana Keilty ,&nbsp;Richard Tsang ,&nbsp;Derek Tsang ,&nbsp;Michael Yan","doi":"10.1016/S0167-8140(25)04760-7","DOIUrl":"10.1016/S0167-8140(25)04760-7","url":null,"abstract":"<div><h3>Purpose:</h3><div>Radiation is an effective treatment modality for recurrent pituitary neuroendocrine tumours (PitNETs). Both stereotactic radiosurgery (SRS) and conventional radiation are the two main treatment paradigms for these tumours depending on the distance to the optic apparatus. The aim of the current study was to retrospectively assess outcomes and toxicities following conventional radiation in patients with PitNETs and eventually compare these findings to SRS cohorts.</div></div><div><h3>Materials and Methods:</h3><div>A single-centre, retrospective, population-based analysis was performed. Patients with functional and non-functional PitNETS treated with conventionally fractionated radiation (50 Gy in 25 fractions) between 2000-2023 were included. The primary outcome was local tumour control and secondary outcomes included various toxicities (hormonal, optic, vascular, edema, and second tumours).</div></div><div><h3>Results:</h3><div>194 patients met criteria and were included in the final analysis (100 females [52%] and 94 males [48%]). The median age at initial diagnosis was 47.2 years (range=13.9-92.yrs) and 134 (69%) tumours were non-functional. Most patients had 1-4 surgeries prior to radiation (98.5%). The median duration of follow-up after completion of radiation was 6.8 years (range=0.4-23.1yrs). Local recurrence was seen in 8 patients (4.1%), where 5 were functional (2.6%) and 3 were non-functional (1.5%). The median time to local recurrence following radiotherapy was 6.1 years (range=0.5-14.8yrs) and these patients were subsequently treated with gamma-knife radiotherapy (n=4), surgery (n=3), or convention radiation (n=1). Pituitary dysfunction requiring pituitary hormone replacement following radiation was seen in 42 patients (21.6%), and 76 patients (39.2%) were on pituitary replacement following surgery but prior to radiation. Of those requiring pituitary replacement, 30 (71.4%) were for hypothyroidism, 29 (69.0%) were for adrenal insufficiency, 10 (23.8%) were for hypogonadism, and 1 (2.5%) was for diabetes insipidus. The median time to initiating pituitary replacement was 5.6 years (range=0.2-19.8yrs). A secondary tumour (vestibular schwannoma) was seen in 1 patient (0.52%) twelve years following radiation. There was no optic, vascular or edematous toxicities.</div></div><div><h3>Conclusions:</h3><div>Here, we provide an updated, large population-based study to investigate conventionally fractionated radiotherapy for PitNETs, which confirms this technique is a safe and effective treatment. The main toxicity of this treatment is pituitary dysfunction that requires hormone replacement. Further analysis comparing conventional radiation to SRS is forthcoming.</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":"145099951","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}