Radiotherapy and Oncology最新文献

{"title":"Lymphocyte nadir and recovery dynamics for locally advanced thoracic malignancies undergoing concurrent chemo-irradiation: Establishment of organs-at-risk constraints","authors":"Ben Man Fei Cheung ,&nbsp;Kwok Keung Yuen ,&nbsp;Mai Yee Luk ,&nbsp;Dennis Kwok Chuen Leung ,&nbsp;Feng-Ming Spring Kong ,&nbsp;Victor Ho-Fun Lee","doi":"10.1016/j.radonc.2025.111009","DOIUrl":"10.1016/j.radonc.2025.111009","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiotherapy-induced-lymphopenia (RIL) worsens outcome in thoracic malignancies on radiotherapy (RT). We hypothesised that post-RT absolute lymphocyte count (ALC) nadir and recovery were independently prognostic for overall survival (OS) and progression-free survival (PFS) in thoracic malignancies following radical chemo-irradiation. We also aimed to determine relevant organs-at-risk (OARs) constraints.</div></div><div><h3>Methods and materials</h3><div>Two independent cohorts of stage III non-small-cell lung cancer (NSCLC) and stage II to III oesophageal cancer (EC) patients receiving chemo-irradiation from 2013 to 2022 were analysed. ALC nadir was defined as the lowest ALC on RT. ALC recovery index (ARI) was the ALC at 6 months/Pre-RT ALC. Effect of ALC nadir and ARI on OS and PFS were evaluated.</div><div>RT dose of OARs was correlated with ALC nadir and ARI. OAR thresholds were then determined.</div></div><div><h3>Results</h3><div>High ARI and ALC nadir were independently prognostic of improved OS and PFS for both cohorts. In NSCLC, thoracic spine V35Gy and ribs V35Gy were associated with ARI. Cut-off for thoracic spine V35Gy was 25.5 % while ribs V35Gy cut-off was 6.6 %. Thoracic spine V20Gy and Mean lung dose (MLD) were associated with ALC nadir in NSCLC. MLD cut-off was 16.5 Gy while T spine V20Gy cut off was 25.6 %. For EC, thoracic spine V35Gy was also associated with ARI. Similar to NSCLC, cut-off was 25.7 %. MLD and spleen V5Gy were associated with ALC nadir. MLD and Spleen V5Gy cut-off was 10.6 Gy and 7.2 % respectively.</div></div><div><h3>Conclusion</h3><div>Post-RT lymphocyte nadir and recovery were both important for survival outcomes. Future prospective studies are warranted to validate whether abiding to lymphocyte sparing OARs constraints developed in the current study can improve lymphopenia and outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111009"},"PeriodicalIF":4.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501886","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":"Predicting the impact of target volume contouring variations on the organ at risk dose: results of a qualitative survey","authors":"Jonas Willmann ,&nbsp;Amith Kamath ,&nbsp;Robert Poel ,&nbsp;Elena Riggenbach ,&nbsp;Lucas Mose ,&nbsp;Jenny Bertholet ,&nbsp;Silvan Muller ,&nbsp;Daniel Schmidhalter ,&nbsp;Nicolaus Andratschke ,&nbsp;Ekin Ermiş ,&nbsp;Mauricio Reyes","doi":"10.1016/j.radonc.2025.110999","DOIUrl":"10.1016/j.radonc.2025.110999","url":null,"abstract":"<div><h3>Purpose</h3><div>Integrating auto-contouring in radiotherapy workflows is shifting the role of radiation oncologists from manual delineation to reviewing and correcting automatically generated contours. However, we postulate that this process is hindered by significant inter-evaluator variability in assessing the dosimetric impact of contour variations. This study investigates how radiation oncologists and medical physicists evaluate the impact of glioblastoma target volume (TV) variations on the dose to organs at risk (OARs), focusing on understanding inter-evaluator variability and decision-making patterns.</div></div><div><h3>Methods</h3><div>A qualitative survey was conducted involving four radiation oncologists and three medical physicists. Participants classified 54 glioblastoma TV contour variations using up to four changes each across 14 patients as “better,” “no change,” or “worse” regarding their expected impact on the dose to OARs. The corresponding ground truth labels were derived from standardized treatment plans. Inter-evaluator variability was analyzed using Cohen’s Kappa.</div></div><div><h3>Results</h3><div>Substantial variability was observed, with Cohen’s Kappa values ranging from weak to moderate agreement (0.33–0.74). Evaluators frequently overestimated the negative impact of contour variations, misclassifying 46% of “no change” variations as “Worse.” No evaluator judged contour variations as resulting in “better” doses to OARs, despite this being the case for 4 variations.</div></div><div><h3>Conclusion</h3><div>Significant variability in estimating the dosimetric impact of contour variations underscores the critical need for standardized guidelines to reduce inconsistencies and allow for the assessment of automatically generated contours based on clinically meaningful factors. Evaluators frequently overestimated the negative impact of contour variations, potentially leading to inefficiencies and unnecessary contour corrections in clinical practice.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 110999"},"PeriodicalIF":4.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529442","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":"GEC-ESTRO guidelines for commissioning and quality assurance of TG-43 based brachytherapy treatment planning systems","authors":"Marisol De Brabandere ,&nbsp;Luc Beaulieu ,&nbsp;Catherine Dejean ,&nbsp;Claire Dempsey ,&nbsp;Chris Lee ,&nbsp;Josh Mason ,&nbsp;Mark J. Rivard ,&nbsp;Jose Perez-Calatayud ,&nbsp;Ryan Smith ,&nbsp;Jacco Steenhuijsen ,&nbsp;Renate Walter ,&nbsp;Geraldine Workman ,&nbsp;Anysja Zuchora ,&nbsp;Frank-André Siebert","doi":"10.1016/j.radonc.2025.111008","DOIUrl":"10.1016/j.radonc.2025.111008","url":null,"abstract":"<div><div>This report defines practical guidelines for (a) commissioning a TG-43-based treatment planning system for brachytherapy, and (b) establishing a continuous quality assurance program for the TPS. The main functionalities of the TPS are described, including image import and geometry, source specification, dose calculation, applicator specification and treatment plan data output, and recommended tests are given. For all tests, the frequency and tolerance are summarized in tables. For the different imaging modalities detailed descriptions of the necessary phantoms are provided in the supplementary data. These guidelines aim to help physicists to setup a comprehensive quality management program for BT TPSs.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111008"},"PeriodicalIF":4.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529441","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 prognostic value of the ESTRO/EORTC classification of reirradiation in patients with non-small cell lung cancer","authors":"Katja Dähler,&nbsp;Madalyne Day,&nbsp;Klara Kefer,&nbsp;Nathan Torelli,&nbsp;Jens von der Grün,&nbsp;Anja Joye,&nbsp;Michael C. Mayinger,&nbsp;Stephanie Tanadini-Lang,&nbsp;Panagiotis Balermpas,&nbsp;Matthias Guckenberger,&nbsp;Nicolaus Andratschke,&nbsp;Jonas Willmann","doi":"10.1016/j.radonc.2025.111003","DOIUrl":"10.1016/j.radonc.2025.111003","url":null,"abstract":"<div><h3>Background</h3><div>Retreatment with thoracic radiotherapy for recurrent, metastatic, or new primary non-small cell lung cancer (NSCLC) is increasingly used, yet evidence remains limited. This study evaluated the efficacy and safety of radical thoracic retreatment classified by the ESTRO/EORTC reirradiation definition.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included patients with NSCLC undergoing retreatment with a second course of radical thoracic radiotherapy (≥40 Gy EQD2) between 2015 and 2023. Retreatment was classified according to the ESTRO/EORTC consensus on reirradiation. Survival outcomes were analyzed using Kaplan-Meier estimates and Cox regression.</div></div><div><h3>Results</h3><div>A total of 150 patients were included: 72 (48 %) underwent type 1 reirradiation, 34 (22.7 %) type 2, and 44 (29.3 %) repeat organ irradiation. Patients had non-metastatic vs. metastatic disease in 67.3 % and 31.3 % at the first course, and 36 % vs. 42 % at retreatment, respectively. Median overall survival (OS) and progression-free survival (PFS) was 26.3 and 5.3 months respectively, without significant differences between retreatment subgroups. Local control differed significantly by retreatment type (p = 0.043), with the longest freedom from local failure (FFLF) observed in repeat organ irradiation. Grade ≥ 3 toxicity occurred in 7.3 % of patients, most commonly pneumonitis (2.7 %), which was more frequent in repeat organ irradiation (9.1 %) than in type 1 reirradiation (0 %, p = 0.02).</div></div><div><h3>Conclusions</h3><div>Radical thoracic retreatment in NSCLC is feasible with favorable outcomes and mostly manageable toxicity in selected patients. The ESTRO/EORTC classification captures meaningful differences in toxicity and local control between retreatment types.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111003"},"PeriodicalIF":4.9,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485744","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":"Efficacy and toxicity of hyperfractionated thoracic reirradiation","authors":"Santino S. Butler,&nbsp;Tyler Raclin,&nbsp;Brianna Lau,&nbsp;Neelufar Raja,&nbsp;Lawrie Skinner,&nbsp;Noah Kastelowitz,&nbsp;Alexander L. Chin,&nbsp;Maximilian Diehn,&nbsp;Billy W. Loo,&nbsp;Lucas K. Vitzthum","doi":"10.1016/j.radonc.2025.111001","DOIUrl":"10.1016/j.radonc.2025.111001","url":null,"abstract":"<div><h3>Background</h3><div>Hyperfractionated reirradiation (re-RT) has been shown to mitigate late toxicity for some cancers, but data on safety and efficacy for thoracic tumors are limited.</div></div><div><h3>Methods</h3><div>We evaluated a cohort of 28 consecutive cases among 25 patients treated with re-RT to either primary or metastatic thoracic tumors, using 60 Gy in 50 fractions delivered twice daily. Incidence rates of toxicity, local recurrence (LR), and any disease progression were evaluated using competing risk analysis. Cumulative dose to organs at risk (OARs) was calculated (EQD2 [alpha/beta = 3]), correlated with toxicity outcomes, and compared to published constraints for re-RT.</div></div><div><h3>Results</h3><div>There was direct overlap of 100 % isodose lines between treatment courses in 90.5 % of cases. Most patients had tumors abutting the proximal bronchial tree (PBT, 89 %). The median re-RT PTV volume was 67 cm³. The overall rate of ≥G2 toxicity was 46 % and the rate of ≥ G3 toxicity was 15 %. The rate of local recurrence and overall survival at 12 months was 33 % and 80 %, respectively. The lung volume receiving a cumulative dose of 20 Gy was kept under 40 % (V_{20 Gy} &lt; 40 %) for nearly all patients (91 %). Lung V_5Gy ≥ 60 % was associated with higher rates of ≥ G2 pulmonary toxicity (69 vs. 18 %, p &lt; 0.01). Cumulative D_max exceeded previously published constraints in most cases for the PBT (110 Gy, 57 % of cases) and great vessels (120 Gy, 52 % of cases) without observed cases of ≥G2 pulmonary hemorrhage, stenosis, fistula, or great vessel toxicity.</div></div><div><h3>Conclusions</h3><div>Hyperfractionated re-RT for thoracic tumors resulted in favorable rates of local control and toxicity in a high-risk cohort and is worthy of prospective evaluation. Putative dose constraints were not able to be met for many cases of definitive re-RT, particularly for the great vessels and PBT, without excessive observed toxicity.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 111001"},"PeriodicalIF":4.9,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485743","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":"Deep learning dosiomics in grade 4 radiation-induced lymphopenia prediction in radiotherapy for esophageal cancer: a multi-center study","authors":"Qiao Zheng ,&nbsp;Xianwen Yu ,&nbsp;Wenkai Pan ,&nbsp;Yao Ai ,&nbsp;Ziyang Liu ,&nbsp;Tongbin Zhang ,&nbsp;Ziqing Xiang ,&nbsp;Xiyao Lei ,&nbsp;Mingqi Zhu ,&nbsp;Jianping Wu ,&nbsp;Chengjian Xiao ,&nbsp;Li Shao ,&nbsp;Wenhao Guo ,&nbsp;Sunjun Li ,&nbsp;Junhao Ma ,&nbsp;Yuxin Lou ,&nbsp;Lijing Liu ,&nbsp;Congying Xie ,&nbsp;Xiance Jin","doi":"10.1016/j.radonc.2025.110995","DOIUrl":"10.1016/j.radonc.2025.110995","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the feasibility and accuracy of using deep learning and dosiomics features, as well as their combination with dose-volume histogram (DVH) parameters and clinical factors to predict grade 4 radiation-induced lymphopenia (G4RIL) for patients with esophageal cancer (EC) who undergoing radiotherapy (RT).</div></div><div><h3>Methods</h3><div>This retrospective study enrolled 545 patients with EC who underwent RT between January 2015 and December 2023 from five medical centers, and divided them into a training set, an internal validation set, an external test set 1, and an external test set 2, respectively. Dosiomics (D) and deep learning dosiomics (DLD) models were built to predict the probability of G4RIL based on radiation dose distributions using five-fold cross-validation. DVH parameters were extracted from organs-at-risk to build a G4RIL prediction model after dimensionality reduction using principal component analysis. A combination model integrating dosiomics, DLD features, DVH parameters and clinical factors (C) was investigated.</div></div><div><h3>Results</h3><div>The D + DLD model and D + DLD + DVH model achieved mean area under curves (AUCs) of 0.78 ± 0.02 vs. 0.83 ± 0.02, 0.75 ± 0.04 vs. 0.80 ± 0.02, 0.77 ± 0.04 vs. 0.79 ± 0.03, and 0.70 ± 0.02 vs. 0.76 ± 0.03 in the training set, internal validation set, external test set 1, external test set 2, respectively. The combination model of D + DLD + DVH + C achieved the best predictive performance in the prediction of G4RIL with a mean AUC of 0.86 ± 0.03, 0.83 ± 0.03, 0.82 ± 0.04 and 0.78 ± 0.04 in the training set, internal validation set, external test set 1 and 2, respectively.</div></div><div><h3>Conclusions</h3><div>The combination model demonstrated the ability to effectively predict G4RIL in patients with EC undergoing RT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110995"},"PeriodicalIF":4.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476548","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":"Non-linear early rapid hippocampal atrophy and associated microstructural injury in patients with nasopharyngeal carcinoma after radiotherapy: Implications for hippocampal protection","authors":"Yunpeng Li ,&nbsp;Jiahui Liang ,&nbsp;Gui Fu ,&nbsp;Jie Pan ,&nbsp;Haoqiang He ,&nbsp;Jing Li ,&nbsp;Shishi Chen ,&nbsp;Aner Deng ,&nbsp;Linquan Tang ,&nbsp;Haiqiang Mai ,&nbsp;Xiaofei Lv","doi":"10.1016/j.radonc.2025.110997","DOIUrl":"10.1016/j.radonc.2025.110997","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-induced hippocampal atrophy is a key contributor to neurological dysfunction in patients with nasopharyngeal carcinoma (NPCs) after radiotherapy (RT); however, its dynamic pattern and underlying microstructural injury characteristics are unclear.</div></div><div><h3>Methods</h3><div>In this prospective study, we longitudinally analyzed 193 NPCs (158 in the discovery cohort and 35 in the validation cohort) and 20 healthy controls. Based on structural and multi-shell diffusion magnetic resonance imaging, repeated-measures analysis of covariance, generalized additive mixed model, and partial correlation analysis were used to study the longitudinal evolution of hippocampal volume, microstructural metrics, and their relationships. Bootstrap-enhanced least absolute shrinkage and selection operator and multivariate logistic regression were employed to select key risk factors of hippocampal atrophy 1 year after RT. The normal tissue complication probability model and dose–response analysis were used to further investigate the effect of RT on hippocampal atrophy.</div></div><div><h3>Results</h3><div>The bilateral hippocampus of NPCs underwent rapid atrophy in the acute phase after RT, and the volumes remained stable during the subsequent phases, which differed from those of the temporal lobe. Hippocampal microstructural injury primarily manifests in the acute phase and is associated with hippocampal atrophy post-RT. D_max was the strongest predictive dosimetric factor for hippocampal atrophy 1 year after RT. For NPCs who had received neoadjuvant chemotherapy (NCT), the tolerance dose for a 50 % probability of developing hippocampal atrophy was 44.26 Gy, which was lower than the 55.06 Gy for NPCs who had not received NCT.</div></div><div><h3>Conclusions</h3><div>Nonlinear early rapid hippocampal atrophy was observed within 1 year post-RT in NPCs, which was associated with microstructural injuries. Understanding the hippocampus tolerance dose and rational use of chemotherapy drugs may help to optimize RT planning and preserve hippocampal volume.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110997"},"PeriodicalIF":4.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471380","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":"Dynamic joint prediction model of severe radiation-induced oral mucositis among nasopharyngeal carcinoma: a prospective longitudinal study","authors":"Juejin Li ,&nbsp;Hong-Gu He ,&nbsp;Chang Guan ,&nbsp;Yuxin Ding ,&nbsp;Xiaolin Hu","doi":"10.1016/j.radonc.2025.110993","DOIUrl":"10.1016/j.radonc.2025.110993","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-induced oral mucositis is one of the most common and debilitating side effects in nasopharyngeal carcinoma patients, which can cause decreased quality of life and treatment adherence. But the effective and tailored strategies for preventing radiation-induced oral mucositis are limited due to unclear risk factors and the lack of prediction models for identifying and stratifying high-risk patients.</div></div><div><h3>Purpose</h3><div>To develop a dynamic joint prediction model for severe radiation-induced oral mucositis among nasopharyngeal carcinoma patients.</div></div><div><h3>Methods</h3><div>A prospective longitudinal study was conducted. Multidimensional variables were longitudinally evaluated till 3 months after the completion of radiotherapy. The outcome was the occurrence of severe radiation-induced oral mucositis during follow-up. Dynamic joint prediction model was based on the COX regression analysis and linear mixed effects model. Bootstrap resampling method was used to calculate the area under curve (AUC) and plot receiver operator characteristics (ROC) curve for model internal validation. All statistical analyses were performed in RStudio 4.3.1.</div></div><div><h3>Results</h3><div>A total of 294 participants were included. Risk factors include oral pH &gt; 6.5 (HR = 0.61 [0.37–0.99]), sequential radiotherapy (HR = 1.80 [1.01–3.13]), dose-volume parameter D50 (HR = 1.04 [1.01–1.08]), increased white blood cell count (HR = 4.47 [1.53–14.60]), increased neutrophilic granulocyte percentage (HR = 1.52 [0.97–2.38]), log(anxiety) (HR = 612.78 [7.66–2.71*10^4]), log(depression) (HR = 0.01 [0.0001–0.20]), and log(nutritional status) (HR = 0.12 [0.01–0.82]). The ROC curves and AUC values revealed that the model has acceptable predictive performance.</div></div><div><h3>Conclusions</h3><div>This study established a dynamic joint prediction model for severe radiation-induced oral mucositis based on multidisciplinary risk factors, which could provide guidance for developing targeted multidisciplinary interventions to improve severe radiation-induced oral mucositis.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110993"},"PeriodicalIF":4.9,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369159","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":"Local control assessment following SABR for lung metastases of colorectal cancer: A multicenter retrospective analysis","authors":"Robin Morcet-Delattre ,&nbsp;Loïg Duvergé ,&nbsp;Vincent Bourbonne ,&nbsp;Romuald Le Scodan ,&nbsp;Ariane Lapierre ,&nbsp;Yoann Pointreau ,&nbsp;Delphine Argo-Leignel ,&nbsp;Rémy Kinj ,&nbsp;Julien Bellec ,&nbsp;Loïg Vaugier ,&nbsp;Joël Castelli","doi":"10.1016/j.radonc.2025.110992","DOIUrl":"10.1016/j.radonc.2025.110992","url":null,"abstract":"<div><h3>Objectives</h3><div>Stereotactic ablative radiotherapy (SABR) is a relevant option for the radical treatment of lung metastases from colorectal cancer with insufficient local control in some cases. The aim of this study is to determine the dosimetric and clinical predictive factors affecting the efficacy of SABR in treating lung metastases from colorectal cancer.</div></div><div><h3>Materials and methods</h3><div>Patients with lung metastases from colorectal cancer treated with SABR in 8 centers between August 2016 and January 2023 were consecutively reviewed. Clinical and dosimetric parameters were evaluated as predictive factors for freedom from local relapse (FFLR), overall survival (OS), and time to polymetastatic conversion (tTPC).</div></div><div><h3>Results</h3><div>A total of 309 lesions from 201 patients were analyzed. With a median follow-up time of 31 months, the 2-year FFLR and OS were 69.5 % and 80.8 % respectively. Treated Tumor Volume (TTV, corresponding to either GTV or ITV) biological effective dose (BED) near to the minimum (TTV BEDmin) ≥ 110 Gy (HR 0.48, 95 % CI 0.3–0.79, p = 0.003), number of previous metastatic systemic treatment before SABR (NPT) ≥ 2 (HR 2.08, 95 % CI 1.25–3.45, p = 0.004) and the left side origin (HR 0.55, 95 % CI 0.33–0.91, p = 0.02) were significantly associated with FFLR in multivariate analysis. The 2-year FFLR rates were 56.2 % (95 % CI 43.9 %-72.1 %) and 73.1 % (95 % CI 66.8 %-80 %) for lesions treated with TTV BEDmin &lt; 110 Gy and ≥ 110 Gy respectively (p = 0.007). For lesions with a NPT before SABR of 0–1 and NPT ≥ 2, the two-year FFLR rate was 73.2 % (95 % CI 67.1 %-79.9 %) and 51.8 % (95 % CI 37.9 %-70.8 %) respectively (p = 0.02). For lesions from the left and the right side, the two-year FFLR rate was 72.9 % (95 % CI 66.6 %-79.7 %) and 53.4 % (95 % CI 40.3 %-70.8 %) respectively (p = 0.02). For OS, age (HR 1.03, 95 % CI 1.01–1.06, p = 0.007) and the presence of ≥ 4 total lung metastases (4.44, 95 % CI 1.3–15.2, p = 0.017) were independent prognostic factors for OS in multivariate analysis. For tTPC, synchronous metastasis (HR 1.93, 95 % CI 1.08–3.44, p = 0.025) and the number of total lung metastases ≥ 4 (HR 7.3 95 % CI 2.2–23.7, p &lt; 0.001) were significantly associated with tTPC in multivariate analysis.</div></div><div><h3>Conclusion</h3><div>This study highlights the prognostic significance of the TTV BEDmin dose delivered to the tumor and identifies prior treatment as a risk factor for local relapse, while a left-sided primary tumor origin is associated with improved local control.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110992"},"PeriodicalIF":4.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330698","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":"Neoadjuvant radiotherapy and immediate breast reconstruction: A systematic review of literature of the last decade","authors":"S.H. Nelissen ,&nbsp;D.A. Young-Afat ,&nbsp;H.J.G.D. van den Bongard ,&nbsp;J.H. Coert ,&nbsp;L.J. Boersma ,&nbsp;W. Maarse","doi":"10.1016/j.radonc.2025.110991","DOIUrl":"10.1016/j.radonc.2025.110991","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Adjuvant radiotherapy (RT) of the chestwall in breast cancer treatment negatively influences complication rates and cosmetic outcomes of breast reconstructions (BR). Neoadjuvant radiotherapy (NART) offers potential advantages, theoretically enabling immediate BR (IBR) with less complications. This comprehensive systematic review provides an overview of patient-reported, complications, and oncological outcomes of NART followed by IBR in breast cancer treatment.</div></div><div><h3>Materials and methods</h3><div>A systematic literature search was conducted on PubMed, Ovid EMBASE and Cochrane library including studies published between 2014–2024. Risk of bias and methodological quality were appraised.</div></div><div><h3>Results</h3><div>Twenty-one articles (16 journal articles, 5 abstracts) involving 1.199 patients (mean follow-up 35 months) were included. Six studies compared NART to adjuvant RT, with majority of patients (98 %) receiving neoadjuvant chemoradiotherapy. Patient-reported outcomes, assessed in three studies, reported excellent-to-good cosmetic outcomes, with one reporting significantly better on cosmetic outcomes for NART compared to adjuvant RT. Complications were reported in eighteen studies. There were no complete flap failures, loss of implant rates were low. Mean incidence of unplanned surgical intervention was 11 % (range: 2–21 %). Grade 3 skin toxicity ranged from 1–17 %, with no Grade 4–5 events. Mastectomy skin necrosis varied from 3-17 %. Pathological complete response after NARCT was achieved in 12–53 % of patients, and locoregional recurrences ranged between 3 %–10 %.</div></div><div><h3>Conclusion</h3><div>This review indicates that NART followed by IBR may result in higher patient satisfaction, lower complication rates and shorter total treatment time compared to adjuvant RT. Randomized trials with head-on comparison between NART and adjuvant RT are needed to confirm this.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110991"},"PeriodicalIF":4.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144294850","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}