Radiotherapy and Oncology最新文献

{"title":"EVALUATING THE TIME SAVINGS OF TARGET VOLUME AUTO-CONTOURING ASSISTANCE IN CERVICAL CANCER HDR BRACHYTHERAPY","authors":"Fletcher Barrett ,&nbsp;Philip McGeachy ,&nbsp;Tyler Meyer ,&nbsp;Ruth Fullerton ,&nbsp;Corrine Doll ,&nbsp;Nina Samson ,&nbsp;Tien Phan","doi":"10.1016/S0167-8140(25)04717-6","DOIUrl":"10.1016/S0167-8140(25)04717-6","url":null,"abstract":"<div><h3>Purpose:</h3><div>To assess the impact on contouring efficiency when an in-house machine learning (ML) model provides a starting point for the high-risk clinical target volume (HR-CTV) definition in high-dose-rate (HDR) cervical brachytherapy.</div></div><div><h3>Materials and Methods:</h3><div>T2-weighted MRIs with HR-CTV contours from patients receiving HDR cervical brachytherapy between 2016 and 2024 were used to develop and test an ML model. The model was built using PyTorch and architectures from the Medical Open Network for AI (MONAI). The final model was used to generate an HR-CTV contour on previously unseen MRIs, serving as a starting point for the radiation oncologist to edit until a clinically acceptable contour was achieved. Efficiency was assessed by having four radiation oncologists individually contour the HR-CTV offline, with and without model support, two months apart. Contouring time for both scenarios was compared to quantify the model’s impact on efficiency. The quality of the contour made with model support was assessed using the Sorensen-Dice similarity coefficient (DSC) against the same radiation oncologist’s contour without model support.</div></div><div><h3>Results:</h3><div>The retrospective dataset for model development included 103 patients (151 MRIs) and the testing dataset consisted of 5 patients (11 MRIs). During development and testing, the model achieved an average DSC of 0.75 and 0.70, respectively, when compared to the clinical contours used for brachytherapy. Contouring time with and without model support in the testing set was 5.1±2.7 and 8.7±4.5 minutes, respectively (p&lt;0.01), corresponding to a 3.6-minute absolute reduction, or a 38% decrease in contouring time with model support. The average DSC between the final contours made with and without support was 0.77±0.07.</div></div><div><h3>Conclusions:</h3><div>Target volume auto-contouring assistance with an ML model reduced the average time spent contouring the HR-CTV by 38% while maintaining contour quality. Future work will include a prospective study to validate the efficiency of this ML model in a real-time clinical setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S26"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099999","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":"ESTABLISHING A COLLABORATIVE AND EFFECTIVE IMAGE-GUIDED HEPATOBILIARY BRACHYTHERAPY PROGRAM: A MODEL FOR BROADER IMPLEMENTATION","authors":"Amandeep Taggar ,&nbsp;Moti Paudel ,&nbsp;Mackenzie Smith ,&nbsp;John Hudson ,&nbsp;Yee Ung ,&nbsp;Robyn Pugash ,&nbsp;Elizabeth David ,&nbsp;Chris Dey","doi":"10.1016/S0167-8140(25)04758-9","DOIUrl":"10.1016/S0167-8140(25)04758-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose:&lt;/h3&gt;&lt;div&gt;Cholangiocarcinoma is a rare malignancy and the leading cause of malignant biliary tract obstruction (MBTO), a condition associated with significant morbidity, including abdominal pain, jaundice, and eventual liver failure. Surgical resection is only feasible for a limited subset of patients, and elevated bilirubin levels often preclude systemic therapy. This study outlines the logistics and workflow of a successful image-guided bile duct intraluminal brachytherapy (ILBT) program designed to improve the quality of life (QOL) and clinical outcomes for patients with MBTO.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods:&lt;/h3&gt;&lt;div&gt;We describe the essential steps for implementing a successful image-guided ILBT program. Additionally, we retrospectively reviewed the first 40 patients enrolled in a prospective registry who underwent ILBT treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;The successful establishment of a brachytherapy program relies on three key components: (1) a dedicated team with brachytherapy expertise, (2) appropriate infrastructure and resources, and (3) strong multidisciplinary collaboration. Cancer centres with existing high-dose-rate (HDR) brachytherapy programs for prostate and gynecological malignancies already possess the necessary major equipment, including HDR afterloaders, treatment planning systems, shielded treatment room, and imaging modalities (CT/MRI/C-arm) for treatment planning and delivery. Therefore, the primary requirement for developing an ILBT program is fostering collaboration between hepatobiliary surgeons, medical oncologists, and interventional radiologists (IRs) to identify suitable patients. Given that most cancer centres are affiliated with hospitals that offer IR services, routine procedures such as stent placement and percutaneous drain insertion can facilitate ILBT delivery. Once a patient is deemed eligible, Interventional Radiology can place hilar biliary stents or a common bile duct stent, with preservation of percutaneous catheter access, enabling safe and effective brachytherapy administration (Figure 1). At our institution, the first two key components for establishing an ILBT program were already in place. A gastrointestinal radiation oncologist with expertise in brachytherapy played a pivotal role in fostering interdisciplinary collaboration among hepatobiliary surgeons, interventional radiologists, medical oncologists, and radiation oncology teams. The ILBT program was successfully implemented in March 2021, with an initial goal of treating one patient per month. As of December 2024, 42 patients have undergone image-guided ILBT. The median age was 77 years (range: 45–89). Tumour locations included the hilar region (n=21), common hepatic duct (n=5), mid bile duct (n=7), and distal common bile duct (n=5). The prescribed dose was 25 Gy, delivered in five daily fractions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions:&lt;/h3&gt;&lt;div&gt;Image-guided ILBT is a feasible and effective treatment modality ","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S42"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100007","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":"RANDOMIZATION IN OLIGOPROGRESSIVE DISEASE: CAN WE STILL RUN TRIALS, OR HAVE WE LOST EQUIPOISE?","authors":"Emily Boyer ,&nbsp;Marie-Pierre Campeau ,&nbsp;Edith Filion ,&nbsp;Toni Vu ,&nbsp;David Roberge ,&nbsp;Guila Delouya ,&nbsp;Cynthia Ménard ,&nbsp;Bertrand Routy ,&nbsp;Daniel Taussky ,&nbsp;Félix Nguyen ,&nbsp;Jean-Marc Bourque ,&nbsp;Nancy El-Bared ,&nbsp;Lara Hathout ,&nbsp;David Donath ,&nbsp;Maroie Barkati ,&nbsp;Normand Blais ,&nbsp;Houda Bahig","doi":"10.1016/S0167-8140(25)04756-5","DOIUrl":"10.1016/S0167-8140(25)04756-5","url":null,"abstract":"<div><h3>Purpose:</h3><div>Oligoprogressive disease presents a therapeutic challenge, with ongoing debate on whether patients should receive stereotactic ablative radiotherapy (SABR) or continue systemic treatment. This study evaluates the feasibility of ongoing randomized controlled trials (RCTs) by assessing randomization patterns and comparing baseline clinical characteristics of patients treated within a trial versus those receiving SABR off-trial.</div></div><div><h3>Materials and Methods:</h3><div>Two ongoing prospective trials investigate treatment strategies: SUPPRESS-Lung (NCT04405401), focusing on SABR for oligoprogressive lung cancer, and SUPPRESS-General (NCT04989725), including other histologies. A registry was simultaneously established for patients receiving SABR off-trial. This study compares randomization patterns and clinical characteristics between the two cohorts. Baseline characteristics were analyzed descriptively, with paired t-tests for continuous variables, considering p&lt;0.05 statistically significant.</div></div><div><h3>Results:</h3><div>Between June 2021 and January 2025, 72 patients were randomized in the trials, and 88 received treatment off-trial, totaling 160 patients. RCT patients represented 40% of the cohort, while 60% were treated off-trial. The distribution of randomized patients by disease site varied: 45% in lung cancer, 56% in breast cancer, 49% in gastrointestinal cancer, 75% in genitourinary cancer, and 50% in head and neck cancer. Randomized patients had a higher metastatic burden, with a mean of 2.4 progressive lesions (range: 1–5) compared to 1.1 (range: 1–3) in registry patients. The total metastatic lesions were 6.4 (range: 1–20) in RCT patients versus 2.4 (range: 0–20) in registry patients. Systemic treatment history was similar, with both groups averaging 1.4 prior treatment lines.</div></div><div><h3>Conclusions:</h3><div>RCT patients had greater disease burden. A significant portion of patients were treated off-trial, especially those with a single oligoprogressive lesion, raising concerns about the feasibility of randomized trials in this setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S41"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100204","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":"UNDERSTANDING AND OVERCOMING INNATE AND ACQUIRED MAPK-INHIBITION RESISTANCE IN ANAPLASTIC THYROID CANCER","authors":"Peter (Yu Fan) Zeng ,&nbsp;Jalna Meens ,&nbsp;Harrison Pan ,&nbsp;Matthew Cecchini ,&nbsp;Amir Karimi ,&nbsp;David Palma ,&nbsp;Eric Winquist ,&nbsp;John Barrett ,&nbsp;Laurie Ailles ,&nbsp;Anthony Nichols","doi":"10.1016/S0167-8140(25)04690-0","DOIUrl":"10.1016/S0167-8140(25)04690-0","url":null,"abstract":"<div><h3>Purpose:</h3><div>Anaplastic thyroid cancer (ATC) is one of the most lethal human cancers, with some patients succumbing to the disease within weeks of diagnosis. Although a subset of patients with ATC with BRAFV600E mutation respond to the monomeric type I RAF inhibitor (RAFi) dabrafenib in combination with MEK inhibitor (MEKi) trametinib, most rapidly develop adaptive or acquired resistance. These patients, along with those who do not harbor the BRAFV600E alteration, have limited treatment options.</div></div><div><h3>Materials and Methods:</h3><div>To understand the mechanism of resistance to dabrafenib and trametinib, we utilized multi-region whole genome, high-coverage whole exome and single nuclei RNA-sequencing of ATC patient tumours to unravel genomic, transcriptomic, and microenvironmental evolution during type I RAFi and MEKi therapy. Cell-line and patient-derived xenograft ATC models were used to identify and understand the efficacy and mechanisms of treatment response and resistance.</div></div><div><h3>Results:</h3><div>Single-cell nuclei RNA sequencing of matched primary and resistant ATC patient tumours identified reactivation of the MAPK-pathway, along with immunosuppressive macrophage proliferation, underlying the development of acquired resistance. Our translational genomics led us that hypothesize that type II RAFi, which inhibit both RAF monomers and dimers, can be efficacious in overcoming treatment resistance. Screening of a panel of type II RAFi revealed that ATC cell lines are exquisitely sensitive to the type II RAFi, naporafenib, by inhibiting EphA2-mediated MAPK-signaling. We further demonstrated that naporafenib, in combination with the MEKi trametinib, can durably and robustly overcome both innate and acquired treatment resistance to dabrafenib and trametinib using ATC cell lines and patient-derived xenograft models. Finally, we describe a novel mechanism of acquired resistance to type II RAFi and MEKi through compensatory mutations in MAST1.</div></div><div><h3>Conclusions:</h3><div>Taken together, our work using translational and functional genomics has unraveled the differential mechanisms of treatment resistance to type I and type II RAFi in combination with trametinib and rationalizes the clinical investigation of type II RAFi in the setting of thyroid cancer.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S15"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100234","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":"SPECIALIZED TEAM MANAGEMENT IMPROVES PERSON-CENTRED CARE FOR PATIENTS UNDERGOING PALLIATIVE RADIOTHERAPY","authors":"Pamela Paterson ,&nbsp;Samir Patel ,&nbsp;Ben Burke ,&nbsp;Melanie Clarkson ,&nbsp;Alysa Fairchild","doi":"10.1016/S0167-8140(25)04697-3","DOIUrl":"10.1016/S0167-8140(25)04697-3","url":null,"abstract":"<div><h3>Purpose:</h3><div>Palliative radiotherapy (PRT) integrated with supportive care provided by a multidisciplinary team (MDT) improves symptoms and quality of life. At our centre, PRT consultations occur in either the general outpatient department (OP) or with a dedicated specialist Palliative Radiation Oncology (PRO) clinic. We explored the differential impact of PRT consult pathway on clinical outcomes.</div></div><div><h3>Materials and Methods:</h3><div>Consecutive adults with four primary cancers prescribed ≤10 fractions of PRT (03-06/2023) with 4-week follow-up were retrospectively reviewed. Data abstracted included patient-reported symptom scores, urgent unplanned cancer centre encounters triggered by symptoms, hospital admissions, analgesic escalation, and MDT referrals. Descriptive and summary statistics were calculated.</div></div><div><h3>Results:</h3><div>Of 110 patients (78 assessed in PRO and 32 in OP), 33.6% had breast, 28.2% GU, 20.9% lung, and 17.3% GI cancers. Overall, 93.6% completed PRT as prescribed. At four weeks post-PRT, in PRO patients, pain improved in 32/78 (41.0%), was stable in 45/78 (57.7%), and worse in 1/78 (1.3%). For OP patients (one pain score missing), pain improved in 2/31 (6.5%), was stable in 20/31 (64.5%) and worse in 9/31 (29.0%). Just over half required &gt;1 urgent unplanned outpatient encounter (55.1% of PRO versus 56.3% of OP patients). 13/78 (16.7%) PRO versus 6/32 (18.8%) OP patients required hospital admission. Analgesic adjustment was required by 43.6% (34/78) of PRO and 50% (16/32) of OP patients. Most MDT referrals were made through the PRO Clinic. Median survival was 42.4 wks (95% CI 25.3- 53.1wks) for PRO patients versus 29.6 wks (95%CI 10.1-52.1 wks) for OP patients.</div></div><div><h3>Conclusions:</h3><div>Patients managed through the dedicated PRO program were more likely to report improved pain and be referred for multidisciplinary supportive care, while analgesic escalation and acute care admission occurred more often in OP patients. Integrating PRT delivery with holistic symptom management delivered by a specialized MDT optimizes personalized care.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S18"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE IMPACT OF STEREOTACTIC BODY RADIOTHERAPY ON THE DYNAMICS OF CIRCULATING TUMOUR DNA IN PATIENTS WITH OLIGO-PROGRESSIVE DISEASE","authors":"Joelle Helou ,&nbsp;Eric Zhao ,&nbsp;Philip Ye ,&nbsp;Scott Bratman ,&nbsp;Jinfeng Zou ,&nbsp;Neelabh Rastogi ,&nbsp;Emma Hill ,&nbsp;Ekaterina Kalashnikova ,&nbsp;Rachel Glicksman ,&nbsp;Aisling Barry","doi":"10.1016/S0167-8140(25)04736-X","DOIUrl":"10.1016/S0167-8140(25)04736-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose:&lt;/h3&gt;&lt;div&gt;Stereotactic Body Radiotherapy (SBRT) is increasingly used as an ablative treatment in patients with limited progressive metastatic disease (oligo-progression (OP)). Results from recent trials are controversial, suggesting a need for better patient selection. Novel biomarkers such as circulating DNA (ctDNA) offers a unique opportunity to utilize early on-treatment changes in ctDNA for real-time assessment of therapeutic response and outcome, with a potential to ultimately aid clinical decision in this setting. Herein we aim to assess early ctDNA changes in patients with OP treated with SBRT as part of a prospective clinical trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods:&lt;/h3&gt;&lt;div&gt;RADIANT is a Phase II prospective single institutional study of patients with OP (≤5 progressing metastatic lesions), treated with SBRT. We prospectively collected frozen plasma samples (3-4mL) and whole blood (Peripheral blood mononuclear cells or germline DNA-MTM/mL) at five timepoints (TP)-baseline (TP1), post fraction 1 of SBRT (TP2), post final fraction (TP3), 6-weeks (TP4) and 3-months post SBRT (TP5). Descriptive statistics were computed using SAS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;Of 70 patients enrolled, nineteen with 73 plasma samples were included in this analysis, of which 5 (26%), 9 (47%), 4 (21%) and 1 (5%) had a gastrointestinal (GI), hormone receptor positive breast, genito-urinary (GU) and skin cancer diagnosis respectively. Median progression free survival in this cohort was 4.8 months (IQR 3.2-7.7), and median time to change in next line systemic therapy was 5.6 (IQR 4.6-10.3) months. Among all plasma samples (n=73), ctDNA levels were detectable in 49 (67%) samples. Seventeen (89.5%) patients had detectable ctDNA in at least one TP. Median ctDNA level for patients with detectable ctDNA at each TP (1-5) was: 2.4 (n=13) [TP1], 5.1 (n=9) [TP2], 0.6 (n=14) [TP3], 0.6 (n=8) [TP4], and 0.1 (n=5) [TP 5] MTM/mL. At baseline, 13 patients had detectable ctDNA levels; of those, 2 (breast/GU) cleared by TP4, 1 (breast) cleared by TP5. Six patients had undetectable levels at baseline; 2/6 (Breast) were never detectable, 1/6 (GU) experienced a small rise at TP2 (0.06MTM/ Ml), and 3/6 patients at TP3 [0.38 (Breast), 0.45 (Prostate), 0.94 (Breast) MTM/mL], all returned to undetectable levels by week 6 post SBRT. Gastro-intestinal cancers (N=5) had detectable ctDNA at each TP. Compared with other cancer types, GI cancers had significantly higher ctDNA levels at TP1 (14.9 versus 0.17, p=0.04) and TP3 (16.2 versus 0.33 p=0.04).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions:&lt;/h3&gt;&lt;div&gt;Among patients with OP, ctDNA levels at each TP varied according to primary diagnosis, with lower median levels post SBRT completion. Patients with GI cancer had greater levels compared to other cancers. ctDNA holds promise as a non-invasive tool to potentially guide treatment for patients with OP cancer. Its predictive and prognostic role in the OP setting warrants further","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S34"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100108","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":"IMPLEMENTATION OF NON-OPERATIVE MANAGEMENT / ORGAN PRESERVATION FOR LOCALLY ADVANCED RECTAL CANCER IN CANADA: A NATIONAL SURVEY OF CLINICAL PRACTICE","authors":"Kristopher Dennis ,&nbsp;Victoria Ivankovic ,&nbsp;Doris Goubran ,&nbsp;Eliane Paglicaucan ,&nbsp;Mariam Alsobaei ,&nbsp;Nicole Alcasid ,&nbsp;Mary Farnand ,&nbsp;Megan Delisle","doi":"10.1016/S0167-8140(25)04706-1","DOIUrl":"10.1016/S0167-8140(25)04706-1","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose:&lt;/h3&gt;&lt;div&gt;Non-operative management/organ preservation (NOM/ OP) strategies can achieve oncologic outcomes similar to those involving total mesorectal excision (TME), and they are being increasingly offered to patients with locally-advanced rectal cancer. Our study aimed to describe the implementation of these strategies in Canada.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods:&lt;/h3&gt;&lt;div&gt;Through non-probabilistic convenience sampling we recruited a clinical expert representative from each of the 44 Canadian centres that offer radiotherapy, systemic therapy and surgery. Representatives completed an electronic survey to describe NOM/OP strategies for patients with locally-advanced rectal cancer at their centres in terms of availability, patient selection, treatment protocols, response assessments, surveillance, quality assurance resources and perceived challenges. A primary OP strategy was defined as one where neoadjuvant therapy is administered with the explicit initial goal of achieving a complete clinical response (cCR) or a near-complete clinical response (nCR), thereby avoiding an immediate TME. A secondary OP strategy was defined as one where a cCR or nCR allows for previously unplanned avoidance of an immediate TME due to an initial explicit goal of proceeding with surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results:&lt;/h3&gt;&lt;div&gt;From June to August 2023, 40/44(91%) of representatives responded: 24/40(60%) radiation oncologists, 13/40(32.5%) surgeons and 3/40(7.5%) medical oncologists. All provinces were represented: Atlantic (NFL/PEI/NS/NB) 4/40(10%), Quebec 10/40(25%), Ontario 15/40(37.5%), Prairies (MB/SK/AB) 5/40(12.5%), British Columbia 6/40(15%). Of the responding centres, 31/40(77.5%) offered some form of NOM/OP, with 20/40(50%) offering both primary and secondary, 11/40(27.5%) offering only secondary, 8/40(20%) offering neither and 1/40(2.5%) not clarifying. Of the 31 centres offering NOM/OP, 58.6% always/frequently did so after a cCR (17/29 responses) and 14.3% always/frequently did so after a nCR (4/28 responses). Of the 20 centres offering primary OP, 17/20(85%) always/frequently used long course chemoradiation followed by consolidation chemotherapy and 6/20(30%) always/ frequently used long course chemoradiation alone. Standardized criteria for response assessments were used by 18/20(90%) centres for MRI (with 12/20, 60% having synoptic templates) and by 12/20(60%) centres for endoscopy (with only 1/20, 5% having a synoptic template). Among all respondents, the most commonly reported challenges to implementing primary OP were access to MRI (21/40, 52.5%), clinic time/space for the number of required assessments (18/40, 45%), access to timely surgery when required (16/40, 40%), lack of comfort/familiarity with long-term outcomes of supporting evidence (15/40, 37.5%), and staff capacity for the number of required assessments (14/40, 35%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions:&lt;/h3&gt;&lt;div&gt;Canadian centres are increasingly using non-operative manage","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S21"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100199","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":"FEASIBILITY OF INTEGRATING RECTAL HYDROGEL SPACER FOR SALVAGE TREATMENT USING STEREOTACTIC ABLATIVE BODY RADIOTHERAPY FOR LOCALLY RECURRENT PROSTATE CANCER","authors":"Amandeep Taggar ,&nbsp;Andrea Deabreu ,&nbsp;John Hudson ,&nbsp;Hans Chung ,&nbsp;Gerard Morton ,&nbsp;Andrew Loblaw","doi":"10.1016/S0167-8140(25)04741-3","DOIUrl":"10.1016/S0167-8140(25)04741-3","url":null,"abstract":"<div><h3>Purpose:</h3><div>Salvage stereotactic ablative body radiotherapy (SBRT) is an emerging option for radio-recurrent prostate cancer (PCa). To mitigate the increased risk of rectal toxicity, the use of a rectal spacer is an attractive option. However, increased fibrosis in previously irradiated tissue can make spacer placement a challenge. We aimed to assess the feasibility of successful rectal spacer placement in patients receiving SBRT for radio-recurrent PCa.</div></div><div><h3>Materials and Methods:</h3><div>This is a single institution Phase-I/II feasibility study. All patients had histologically confirmed locally recurrent PCa without any evidence of distant metastasis. All patients received 25 Gy to the whole gland and 35 Gy to the recurrent lesion in 5 weekly fractions following placement of a rectal spacer. The primary endpoint was the feasibility of spacer placement, defined as the ability to successfully deploy the spacer without complications. Secondary endpoints included acute and late toxicity (graded per CTCAE v5.0), quality of life using EPIC and IPSS as well as biochemical disease-free survival-based on PSA kinetics.</div></div><div><h3>Results:</h3><div>Between 2022-2024, 10 patients were enrolled. Median age and PSA at recurrence were 68.1 years (IQR: 66.1-72.7) and 3.45 (IQR: 3.2-4.8), respectively. Six and 4 patients had ISUP Grade group 2 and 3 disease. Rectal spacer placement was successfully performed in 9 of the 10 patients (90%). Spacer placement was unsuccessful in 1 patient due to inability to hydrodissect. No acute or late complications were reported with spacer placement. Radiation related acute Grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicities were observed in 10% and 30% of patients, respectively. No acute Grade ≥3 toxicities were reported (Table 1). At a median follow-up of 19.6 months, PSA kinetics was available for 8 patients, and all were alive without evidence of local or distant failure. The PSA nadir achieved a median value of 0.07 ng/mL at a median time of 12.6 months.</div></div><div><h3>Conclusions:</h3><div>Rectal spacer placement in conjunction with SBRT for radio-recurrent prostate cancer was feasible in most patients, with no acute or late complications. This treatment option provides acceptable toxicity and encouraging early oncologic outcomes. Longer follow-up is necessary to assess long-term efficacy and safety.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S35-S36"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100103","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 SEVERE RADIATION INDUCED SKIN TOXICITY (RIST) IN BLACK WOMEN RECEIVING ADJUVANT RADIOTHERAPY FOR BREAST CANCER IN ZIMBABWE. A PROSPECTIVE COHORT STUDY","authors":"Melinda Mushonga ,&nbsp;Shirley Chibonda ,&nbsp;Anna Mary Nyakabau ,&nbsp;Danielle Rodin ,&nbsp;Philip Ye ,&nbsp;Zhihui Amy Liu ,&nbsp;Mercia Mutimuri ,&nbsp;Ntokozo Ndlovu ,&nbsp;Webster Kadzatsa ,&nbsp;Albert Nyamhunga ,&nbsp;Nomsa Tsikai ,&nbsp;Nothando Mutizira ,&nbsp;Edith Matsikidze ,&nbsp;Tinashe Mazhindu ,&nbsp;Patience Musiwa ,&nbsp;Silas Mafuhure","doi":"10.1016/S0167-8140(25)04705-X","DOIUrl":"10.1016/S0167-8140(25)04705-X","url":null,"abstract":"<div><h3>Purpose:</h3><div>Radiotherapy is an essential component of breast cancer treatment, but fear of radiation induced skin toxicity (RIST) in Zimbabwe has been suggested to be associated with hesitancy to undergo treatment. This study sought to determine the incidence of severe RIST in Black women and identify modifiable predictive factors to allow development of patient-oriented strategies to mitigate negative perceptions of radiotherapy which potentially reduce compliance to treatment.</div></div><div><h3>Materials and Methods:</h3><div>A prospective cohort study of Zimbabwean women undergoing adjuvant radiotherapy for breast cancer was conducted. Patient reported and Physician reported skin toxicity assessments were completed using validated skin toxicity scoring tools during radiotherapy. The level of agreement between patient and physician reported incidence of RIST was tested using kappa statistics. Predictive factors for severe RIST were analyzed using a univariate logistics regression.</div></div><div><h3>Results:</h3><div>Fifty-six patients met eligibility criteria. The most common physician and patient reported skin type was type V at 65% and 85% respectively. A total of 54 (96%) patients had at least 2 patient reported assessments and 46 (82%) had at least 2 physician reported assessments. The incidence of physician reported severe RIST was 12.8%, lower than patient reported one (26.8%), p=0.09. There was a low level of agreement between the patient and physician reported severe RIST, kappa= -0.08 (-0.31, 0.14). No patient characteristics were predictive of severe patient reported RIST. More patients with severe RIST had higher median fraction number, 25 (16.0-30.) (p=.05), total dose, 5500 cGy (4250-60000) (p=.016) and maximum dose 6023.5 cGy (5101-6580) (p=.045). Total dose was predictive of severe patient reported RIST, OR 1.12 (1.01-1.25) p=0.038. More patients using a cream had severe patient reported toxicity when compared to patients who did not report severe RIST, 93% compared to 34% (p=&lt;0.001).</div></div><div><h3>Conclusions:</h3><div>The patient’s reported incidence of severe RIST was higher than the physician reported. Radiotherapy prescription, maximum dose and use of a cream were associated with worse patient reported toxicity. Findings support consideration of hypo fractionated treatment regiments in patients receiving adjuvant radiotherapy and exploration of ideal skin care creams/ interventions for use during treatment are needed to improve treatment experience mitigating negative perceptions associated with radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S20-S21"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100198","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 PHASE I DUAL DOSE ESCALATION STUDY OF RADIATION AND NAB-PACLITAXEL IN PATIENTS WITH UNRESECTABLE AND BORDERLINE RESECTABLE PANCREATIC CANCER","authors":"Uri Amit ,&nbsp;John Plastaras ,&nbsp;Rohi Gheewala ,&nbsp;James Metz ,&nbsp;Ursina Teitelbaum ,&nbsp;Nevena Damjanov ,&nbsp;Charles Schneider ,&nbsp;Major Kenneth Lee ,&nbsp;Mark O’Hara ,&nbsp;Kim Reiss-Binder ,&nbsp;Erica Carpenter ,&nbsp;Thomas Karasic ,&nbsp;Andre Konski ,&nbsp;Paul Wileyto ,&nbsp;Edgar Ben-Josef","doi":"10.1016/S0167-8140(25)04683-3","DOIUrl":"10.1016/S0167-8140(25)04683-3","url":null,"abstract":"<div><h3>Purpose:</h3><div>This Phase I dual dose-escalation study aimed to evaluate the safety, feasibility, and toxicity profile of combining dose-escalated radiation therapy with high-dose nab-paclitaxel in patients with unresectable or borderline resectable pancreatic cancer. The primary objective was to determine the maximum tolerated radiation dose for the combination.</div></div><div><h3>Materials and Methods:</h3><div>Twenty-one evaluable patients were enrolled and allocated three radiation dose levels, 55 Gy, 57.5 Gy, and 60 Gy, administered over five weeks in 25 fractions. Concurrent nab-paclitaxel was given weekly at a dose of 125 mg/m². Radiation dose escalation was guided by a time-to-event continual reassessment method. Toxicities were monitored and classified according to CTCAE v4.0, with dose-limiting toxicities (DLT) defined as Grade 3 or higher gastrointestinal events or substantial decline in performance status. Surgical resection was pursued in patients achieving sufficient tumour downstaging.</div></div><div><h3>Results:</h3><div>Hematologic toxicities were the most common Grade ≥3 adverse events occurring in 76.2% of patients. Non-hematologic toxicities were less frequent (57.1%). Two Grade 3 gastrointestinal DLT cases occurred at dose levels 57.5 Gy and 60 Gy. The maximum tolerated dose was determined to be 60 Gy with a probability of DLT of 0.155 at this dose. Surgical resection with negative margins (R0) was achieved in 33.3% of patients, including all borderline resectable cases and 22.2% of initially unresectable cases. The median overall survival and time to local progression from the start of radiation therapy were 22.3 months and 20.3 months, respectively.</div></div><div><h3>Conclusions:</h3><div>This study demonstrates the feasibility and safety of combining dose-escalated radiation with high-dose nab-paclitaxel in locally advanced pancreatic cancer. The regimen is associated with manageable toxicity and promising local control and survival. These findings support further evaluation in larger trials to assess its impact on clinical outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S12"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100224","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}