Strahlentherapie und Onkologie最新文献

{"title":"Pentoxifylline and vitamin E for treating radiation-induced fibrosis in breast and head and neck cancer patients.","authors":"M Harpsø, C N Andreassen, B V Offersen","doi":"10.1007/s00066-025-02423-x","DOIUrl":"https://doi.org/10.1007/s00066-025-02423-x","url":null,"abstract":"<p><strong>Purpose: </strong>The oncological treatment of breast (BC) and head and neck cancer (H&NC) patients often includes radiotherapy. One serious side effect of this treatment is radiation-induced fibrosis (RIF), for which no established treatment currently exists. Studies have shown a potential effect of pentoxifylline and vitamin E on RIF. In this retrospective analysis, we investigate the effect of pentoxifylline and vitamin E on RIF in a cohort of BC and H&NC patients.</p><p><strong>Methods: </strong>Consecutive BC and H&NC patients referred to the Department of Oncology, Aarhus University Hospital, Denmark, for treatment of severe and discomforting RIF during 2016-2023 were included. After initial evaluation, 61 patients-29 BC and 32 H&NC patients-started treatment with oral pentoxifylline 400 mg and vitamin E (290-350 mg) twice daily. In total, 54 patients-24 BC and 30 H&NC patients-were treated and finally evaluated. The endpoint was patient-reported and/or clinical treatment response.</p><p><strong>Results: </strong>Overall, 18 BC (75%) and 7 H&NC patients (23%) reported subjective improvement following treatment. A clinical treatment response with partial or complete regression of RIF was seen in all patients with subjective effect, except in one BC and one H&NC patient.</p><p><strong>Conclusion: </strong>Pentoxifylline and vitamin E might be an effective treatment for a selected group of patients with RIF. The therapeutic effect was more pronounced in BC patients compared to those with H&NC. Further randomized and blinded studies in larger populations are needed to validate the findings.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5-Aminolevulinic acid as an emerging radiosensitizer for radiodynamic therapy in solid tumors: a systematic review of available data and clinical potential.","authors":"Niklas B Pepper, Fabian M Troschel, Walter Stummer, Hans T Eich","doi":"10.1007/s00066-025-02420-0","DOIUrl":"https://doi.org/10.1007/s00066-025-02420-0","url":null,"abstract":"<p><strong>Background: </strong>5‑Aminolevulinic acid (5-ALA) is a keto-carbon amino acid frequently used in glioma surgery for fluorescence-guided resection. Additionally, cytotoxic properties of 5‑ALA can be induced via stimulation with laser light in photodynamic therapy (PDT). Preclinical in vitro and in vivo trials have also demonstrated this effect to be inducible by photon irradiation as used in radiation treatment. This makes 5‑ALA a potential sensitizer for radiation therapy whose capabilities and limitations have not yet been fully evaluated. In this article, we present results from a systematic literature review regarding the evidence of 5‑ALA's radiosensitizing properties and the context of its use. We discuss these findings in terms of the underlying mechanisms, their limitations, and the questions to be addressed in future clinical trials.</p><p><strong>Methods: </strong>A systematic review in the PubMed database was performed via a specifically designed search term, including all search results that featured the combination of 5‑ALA with ionizing radiation. The last date of search was November 13, 2024. Risk of bias among study data was assessed individually according to the study setup after full-text analysis. The results were synthesized based on the underlying tumor entity.</p><p><strong>Results: </strong>A total of 31 articles were included that examined the combination of 5‑ALA with radiotherapy (RT) in glioma (n = 12), melanoma (n = 6), breast (n = 3), lung (n = 2), prostate (n = 4), and colorectal (n = 1) cancer as well as in sarcoma (n = 2) and primary CNS lymphoma (n = 1). The radiosensitizing effect of 5‑ALA varies among these entities, with glioma and melanoma presenting the strongest body of evidence.</p><p><strong>Conclusion: </strong>These results imply a basis for 5‑ALA as a possible radiosensitizer for RT, but several questions remain unanswered, as limitations arise from the fact that data are predominantly based on in vitro or rodent in vivo trials, with only two ongoing clinical trials and one case report involving human patients. Moreover, trial setups varied in terms of ALA dose and application timing.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing energy consumption in radiotherapy: standard vs. hypo-/ultra-hypofractionation and becoming SMART (specific, measurable, achievable in radiotherapy).","authors":"Ann-Katrin Exeli, Andreas Lurtz, Linda Agolli, Daniel Habermehl","doi":"10.1007/s00066-025-02419-7","DOIUrl":"https://doi.org/10.1007/s00066-025-02419-7","url":null,"abstract":"<p><strong>Purpose: </strong>The healthcare sector is a large greenhouse gas producer. Especially in radiotherapy (RT), a lot of electricity is consumed by the medical linear accelerator (linac) and associated patient travel. Our aim was to ascertain by how much electrical energy consumption and patient travel can be reduced by replacing normofractionated (NF) with emerging moderately hypofractionated (UF) or ultra-hypofractionated (UHF) concepts.</p><p><strong>Methods: </strong>We connected an energy meter to our linac (VersaHD, Elekta©, Stockholm, Sweden) and evaluated different fractionation concepts (NF, HF, UHF) for 30 patients with target volumes of the prostate, breast, and spine. In addition to the energy measurements, we also conducted an analysis of the carbon dioxide (CO₂) emissions associated with the variations in patient travel.</p><p><strong>Results: </strong>This study measured the energy consumption of a linac (in kWh) and its impact on CO₂ emissions for various radiotherapy fractionation concepts. Ultra-hypofractionated regimens consistently showed the lowest energy consumption and variability across prostate, breast, and bone metastasis treatment courses, while NF regimens had significantly higher energy consumption and variability. Transitioning from NF to UHF regimens reduced CO₂ emissions by up to 75%, driven by fewer patient visits and lower electricity consumption. These findings highlight the environmental and logistical benefits of HF and UHF treatment protocols.</p><p><strong>Conclusion: </strong>The adoption of HF and UHF treatment concepts can significantly reduce energy consumption and CO₂ emissions, achieving an up to 75% reduction per treatment course. This is primarily due to decreased patient travel and electricity consumption at the linac. Extrapolated globally, these changes offer further potential to mitigate climate change.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Stereotactic radiotherapy in functionally inoperable but technically resectable pancreatic cancer].","authors":"Gunther Klautke","doi":"10.1007/s00066-025-02429-5","DOIUrl":"https://doi.org/10.1007/s00066-025-02429-5","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CyberKnife radiation therapy for malignant myopericytoma in a pediatric patient: a case report and review of the literature.","authors":"Bence Bukovszky, Júlia Vízkeleti, Levente Jánváry, Gábor Szarvas, Luca Felkai, Rita Bánusz, Edit Varga, Zoltán Sápi, Tibor Major, Monika Csóka","doi":"10.1007/s00066-025-02413-z","DOIUrl":"https://doi.org/10.1007/s00066-025-02413-z","url":null,"abstract":"<p><strong>Background: </strong>Malignant myopericytoma is a very rare malignant soft tissue tumor which usually develops during adulthood. It has a very poor prognosis due to its aggressive nature and frequent distant metastases.</p><p><strong>Methods: </strong>In our case report, we present a 17-month-old girl with malignant myopericytoma who was successfully treated using CyberKnife (Accuray; Sunnyvale, CA, USA) stereotactic radiotherapy.</p><p><strong>Results: </strong>A rare localization of the tumor caused significant challenges during the course of treatment. Radical surgical resection was not achievable due to the tumor's location in the inner ear; therefore chemotherapy was initially given to the patient. However, due to the fast progression of the tumor during chemotherapy, we decided to use CyberKnife stereotactic radiosurgery (SRS; 5 fractions of 7 Gy) in order to prevent further invasion of the surrounding tissues. During SRS, tumor growth stopped and the tumor then gradually regressed. Since completion of treatment (currently almost 5 years) our patient has been in complete remission without any significant side effects of the radiation therapy.</p><p><strong>Conclusion: </strong>In our recent experience, systemic chemotherapy combined with CyberKnife SRS proved to be effective in a patient with a rare malignant myopericytoma.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperglycemia is associated with poor survival in patients with brain metastases treated with radiotherapy.","authors":"Soniya Poudyal, Friederike Rothe, Seong Jeong, Nils Gleim, Peter Hambsch, Franziska Nägler, Kirsten Papsdorf, Thomas Kuhnt, Alonso Barrantes-Freer, Erdem Güresir, Sabine Klagges, Nils Henrik Nicolay, Clemens Seidel","doi":"10.1007/s00066-025-02414-y","DOIUrl":"https://doi.org/10.1007/s00066-025-02414-y","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetes mellitus (DM) is a negative prognostic factor in patients with brain metastases (BM). It is unknown whether a direct impact of serum glucose levels on survival exists. We aimed to detect a potential association of serum glucose levels before and during radiotherapy with survival in patients with BM.</p><p><strong>Methods: </strong>Patients were included in this retrospective exploratory analysis if at least three fasting and non-fasting serum glucose test results before or during treatment were available. Survival was analyzed with uni- and multivariate Cox regression concerning an association with fasting and maximum glucose levels and regarding potentially confounding dexamethasone intake.</p><p><strong>Results: </strong>A total of 62 patients with BM (15 with and 47 without DM) were included. Patients with a mean fasting glucose of more than 7.8 mmol/l (upper quartile) showed significantly shorter survival compared to patients of the lower three quartiles (hazard ratio [HR] = 2.05, p = 0.021). Further, maximum blood glucose levels of > 12.0 mmol/l (upper quartile) were associated with shorter survival (HR = 1.95, p = 0.035). In the subset of patients without DM, a trend toward worse survival in patients with higher fasting glucose levels was observed (HR = 2.54, p = 0.099). The negative association of high maximum glucose levels with survival persisted in multivariate analysis independently of steroid administration.</p><p><strong>Conclusion: </strong>Strong elevations of fasting and maximum serum glucose levels were associated with a worse prognosis in patients with BM with and without DM. This observation warrants further analysis in larger cohorts and has potential implications for clinical practice.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of reduced interval from simulation CT to treatment delivery on dosimetric and positioning accuracy for total marrow lymph-node irradiation.","authors":"Damiano Dei, Nicola Lambri, Claudia Sopranzi, Carmela Galdieri, Ciro Franzese, Marta Scorsetti, Pietro Mancosu","doi":"10.1007/s00066-025-02415-x","DOIUrl":"https://doi.org/10.1007/s00066-025-02415-x","url":null,"abstract":"<p><strong>Purpose: </strong>Total marrow (lymph-node) irradiation (TMI/TMLI) is designed to minimize toxicities of conventional total body irradiation in hematopoietic stem cell transplant conditioning. Planning typically relies on a computed tomography (CT) scan acquired many days before treatment (e.g. 15 days; CT-15) to allow time for plan optimization. However, anatomical changes during this interval, influenced by patient condition and concurrent therapies, can compromise dosimetric accuracy. This study evaluates the impact of shortening the CT-to-treatment timeframe to 4 days (CT-4) on dosimetric and positioning accuracy in TMI/TMLI.</p><p><strong>Methods: </strong>Eighteen patients were enrolled in this prospective study (ClinicalTrials.gov: NCT04976205). Treatment plans, optimized with a multi-isocenter volumetric modulated arc therapy on CT-15, were recalculated on CT‑4 to assess changes in planning target volume (PTV) dose coverage (PTV_D98%). Image matching quality between CT-15/CT‑4 and cone-beam CT acquisitions was assessed with a scale of 1 to 5. Wilcoxon signed-rank test with significance set at p < 0.05 was considered.</p><p><strong>Results: </strong>A significant reduction in median PTV_D98% was found between CT-15 (98.0%, minimum/maximum [98.0, 98.0]%) and CT‑4 (92.2%, [62.9, 98.9]%). Image matching quality improved in 72% of patients using CT‑4 compared to CT-15. In 11% of cases, relevant discrepancies required re-optimization using CT‑4.</p><p><strong>Conclusions: </strong>These findings underscore the benefits of a shorter CT-to-treatment timeframe for improving dosimetric and positioning accuracy in TMI/TMLI. Automated planning tools may further enhance TMI/TMLI workflows, particularly for patients undergoing intensive conditioning protocols.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of concurrent HER2-directed therapy on development of cerebral radionecrosis after stereotactic radiotherapy: a systematic review.","authors":"Clara Grinzinger, Georg Stüben, Maria Neu, Anna Rubeck, Stefan Schiele, Lars Behrens, Klaus-Henning Kahl","doi":"10.1007/s00066-025-02416-w","DOIUrl":"https://doi.org/10.1007/s00066-025-02416-w","url":null,"abstract":"<p><strong>Purpose: </strong>With increasing use of human epithelial growth factor receptor two (HER2)-targeted therapies, outcomes for numerous breast cancer patients have improved. Nevertheless, patients with HER2-positive tumours face a comparatively heightened risk for developing brain metastases (BM), which are often treated with stereotactic radiosurgery (SRS). Radionecrosis represents one of the clinically most significant adverse events of SRS. However, a knowledge gap remains regarding the effects of concurrent use of HER2-targeted therapies with SRS on development of radionecrosis, given conflicting findings in existing studies.</p><p><strong>Methods: </strong>This systematic review was conducted in May 2024 through a search across electronic databases PubMed/MEDLINE and Cochrane library and was supplemented by citation searching and an artificial intelligence (AI) search.</p><p><strong>Results: </strong>The literature search yielded 194 articles. After applying eligibility criteria, a total of 13 studies with 3219 patients total were included, with approximately 270 patients in the topic-relevant subgroup. Investigated substances vary in different publications and include HER2 antibodies, antibody-drug conjugates (ADCs), such as trastuzumab emtansine (T-DM1), and kinase inhibitors. Four of six studies on ADCs demonstrated a higher risk for radionecrosis with concurrent administration. Two studies on lapatinib found no significant effects, as did as most studies investigating mainly HER2 antibodies. One publication reported an even lower risk for radionecrosis (RN) with concurrent use of HER2/EGFR tyrosine kinase inhibitors (TKIs).</p><p><strong>Conclusion: </strong>While concurrent use of T‑DM1/ADCs seems associated to elevated radionecrosis risk, an ambiguous situation for other substances persists. Heterogenous study designs with varying substances, definitions of concurrent use, and radionecrosis parameters must be considered. Included studies are partly limited by sample size and retrospective study design. Therefore, clinical implications remain difficult to claim; further research on this topic is needed.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"28th Annual SASRO Meeting 2024.","authors":"","doi":"10.1007/s00066-025-02421-z","DOIUrl":"https://doi.org/10.1007/s00066-025-02421-z","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated contouring for breast cancer radiotherapy in the isocentric lateral decubitus position: a neural network-based solution for enhanced precision and efficiency.","authors":"Pierre Loap, Rémi Monteil, Youlia Kirova, Jérémi Vu-Bezin","doi":"10.1007/s00066-024-02364-x","DOIUrl":"10.1007/s00066-024-02364-x","url":null,"abstract":"<p><strong>Background: </strong>Adjuvant radiotherapy is essential for reducing local recurrence and improving survival in breast cancer patients, but it carries a risk of ischemic cardiac toxicity, which increases with heart exposure. The isocentric lateral decubitus position, where the breast rests flat on a support, reduces heart exposure and leads to delivery of a more uniform dose. This position is particularly beneficial for patients with unique anatomies, such as those with pectus excavatum or larger breast sizes. While artificial intelligence (AI) algorithms for autocontouring have shown promise, they have not been tailored to this specific position. This study aimed to develop and evaluate a neural network-based autocontouring algorithm for patients treated in the isocentric lateral decubitus position.</p><p><strong>Materials and methods: </strong>In this single-center study, 1189 breast cancer patients treated after breast-conserving surgery were included. Their simulation CT scans (1209 scans) were used to train and validate a neural network-based autocontouring algorithm (nnU-Net). Of these, 1087 scans were used for training, and 122 scans were reserved for validation. The algorithm's performance was assessed using the Dice similarity coefficient (DSC) to compare the automatically delineated volumes with manual contours. A clinical evaluation of the algorithm was performed on 30 additional patients, with contours rated by two expert radiation oncologists.</p><p><strong>Results: </strong>The neural network-based algorithm achieved a segmentation time of approximately 4 min, compared to 20 min for manual segmentation. The DSC values for the validation cohort were 0.88 for the treated breast, 0.90 for the heart, 0.98 for the right lung, and 0.97 for the left lung. In the clinical evaluation, 90% of the automatically contoured breast volumes were rated as acceptable without corrections, while the remaining 10% required minor adjustments. All lung contours were accepted without corrections, and heart contours were rated as acceptable in 93.3% of cases, with minor corrections needed in 6.6% of cases.</p><p><strong>Conclusion: </strong>This neural network-based autocontouring algorithm offers a practical, time-saving solution for breast cancer radiotherapy planning in the isocentric lateral decubitus position. Its strong geometric performance, clinical acceptability, and significant time efficiency make it a valuable tool for modern radiotherapy practices, particularly in high-volume centers.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"601-605"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}