Strahlentherapie und Onkologie最新文献

{"title":"Implant-based reconstruction and adjuvant radiotherapy in breast cancer patients-current status and DEGRO recommendations.","authors":"M D Piroth, D Krug, R Baumann, V Strnad, K Borm, S Combs, S Corradini, M N Duma, J Dunst, G Fastner, P Feyer, R Fietkau, W Harms, T Hehr, J Hörner-Rieber, C Matuschek, C Schmeel, W Budach","doi":"10.1007/s00066-024-02334-3","DOIUrl":"10.1007/s00066-024-02334-3","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this review is to give an overview of the results of prospective and retrospective studies using allogenic reconstruction and postmastectomy radiotherapy (PMRT) in breast cancer and to make recommendations regarding this interdisciplinary approach.</p><p><strong>Materials and methods: </strong>A PubMed search was conducted to extract relevant articles from 2000 to 2024. The search was performed using the following terms: (breast cancer) AND (reconstruction OR implant OR expander) AND (radiotherapy OR radiation). Data from the literature on allogenic breast reconstruction and radiation are presented and discussed in relation to toxicity and cosmesis.</p><p><strong>Conclusion and recommendations: </strong>Breast reconstruction is also feasible if PMRT is necessary. Patients need to be informed about the relevant risk of capsular fibrosis and implant failure. A planned reconstruction is no reason to forgo PMRT nor is an indication for PMRT a reason to forego implant-based breast reconstruction if desired by the patient. It is important to provide detailed information here to enable shared decision-making. There is still no clear consensus regarding implant-based reconstruction (IBR) and PMRT. However, in clinical practice, both a one-stage (immediate \"implant-direct\" IBR) procedure with PMRT up to the final implant and a two-stage (immediate-delayed IBR) procedure with PMRT up to the tissue expander (TE) and later exchange of the TE are used; both approaches have their specific advantages and disadvantages. Depending on patient-specific factors and the surgeon's experience and estimates, both IBR procedures are also possible in combination with PMRT. When using a TE/implant approach, completing skin stretching by adequately filling the expander before PMRT may be favorable. This approach is particularly practical when adjuvant chemotherapy is planned but may lead to postponement of radiotherapy when primary systemic therapy is given. According to the latest data, moderate hypofractionation also appears to be safe in the context of the IBR approach. It is important to have a closely coordinated interdisciplinary approach and to fully inform patients about the increased rate of potential side effects.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"353-367"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of radiotherapy on the hippocampus and hippocampal neurogenesis: a systematic review of preclinical studies.","authors":"Sandra Leskinen, Samir Alsalek, A Gabriella Wernicke","doi":"10.1007/s00066-024-02341-4","DOIUrl":"10.1007/s00066-024-02341-4","url":null,"abstract":"<p><strong>Purpose: </strong>A comprehensive literature review was undertaken to understand the effects and underlying mechanisms of cranial radiotherapy (RT) on the hippocampus and hippocampal neurogenesis as well as to explore protective factors and treatments that might mitigate these effects in preclinical studies.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Web of Science, and Embase were queried for studies involving the effects of radiation on the hippocampus and hippocampal neurogenesis. Data extraction followed the Animal Research Reporting of In Vivo Experiments (ARRIVE) guidelines, and a risk of bias assessment was conducted for the included animal studies using the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) risk of bias tool.</p><p><strong>Results: </strong>Ninety studies were included, with 48 assessing radiation-induced changes and 42 examining possible interventions. The majority of studies (97.8%) used experimental animal models. Studies demonstrated that cranial irradiation reduces hippocampal neurogenesis, particularly in the neurogenic niches of the dentate gyrus; causes alterations in gene expression and enzymatic activity; induces inflammation; promotes apoptosis; and often results in cognitive impairment. Potential protective strategies include pharmacological agents like metformin and peroxisome proliferator-activated receptor-α (PPAR-α) agonists or behavioral interventions like voluntary running. In a risk of bias assessment, many studies were rated as having an unclear risk of bias.</p><p><strong>Conclusion: </strong>Radiotherapy, while essential for managing brain tumors, can have adverse effects on hippocampal function and structure in animal models. These effects manifest in reduced neurogenesis, molecular alterations, and increased inflammation, leading to cognitive deficits. Further research is needed to identify and improve interventions and develop comprehensive therapeutic approaches that balance effective tumor control with the preservation of cognitive health.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"383-397"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972212","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":"[Definitive radiotherapy with cetuximab or durvalumab for locoregionally advanced head and neck cancer in patients with a contraindication to cisplatin (NRG-HN004)].","authors":"Josephine Beier, Alexander Rühle","doi":"10.1007/s00066-025-02370-7","DOIUrl":"10.1007/s00066-025-02370-7","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"475-477"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189460","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":"Evaluating the impact of cardiac substructure dosimetric parameters on survival in lung cancer patients undergoing postoperative radiotherapy.","authors":"Melek Tugce Yilmaz, Pervin Hurmuz, Ezgi Gurlek, Demet Yildiz, Mustafa Cengiz","doi":"10.1007/s00066-024-02339-y","DOIUrl":"10.1007/s00066-024-02339-y","url":null,"abstract":"<p><strong>Purpose: </strong>The association of cardiac dosimetric parameters with survival in lung cancer patients is well established. However, most research has concentrated on patients undergoing definitive treatment. This study aims to investigate the relationship between cardiac dosimetric parameters and survival in patients receiving postoperative radiotherapy (PORT).</p><p><strong>Methods: </strong>Sixty patients who received PORT between 2011 and 2021 were retrospectively evaluated. The substructures of the heart were delineated on the simulation computed tomography scans of the patients. Univariate and multivariate Cox regression analyses were conducted to investigate the correlation between dosimetric parameters and overall survival. The Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY, USA) was utilized for statistical analyses.</p><p><strong>Results: </strong>Right atrium (RA) maximum dose (Dmax) was the only variable that was significantly associated with a shorter OS. Further receiver operating characteristic (ROC) analysis revealed that the optimum cut-off value for RA Dmax was 43.6 Gy, with a sensitivity of 69% and a specificity of 62%. In addition, inclusion of the upper right paratracheal (2R), lower right paratracheal (4R), left pulmonary ligament (9L), and right hilus (10R) lymphatic stations in the treatment field led to an increase in RA Dmax.</p><p><strong>Conclusion: </strong>The results of this retrospective study show that RA Dmax appears to have an impact on overall survival in patients undergoing PORT. Limiting the RA Dmax dose to below 43.6 Gy and avoiding elective nodal irradiation might potentially enhance survival in this patient cohort.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"452-462"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786864","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":"Radiation-induced heart disease in breast cancer patients: a narrative review of epidemiology, risk factors, radiotherapy parameters, and prevention.","authors":"Aline Van der Vorst, Maarten Lambrecht, Lucas Van Aelst, Jelle Verhoeven, Johanna Jacobs, Adinda Baten, Caroline Weltens","doi":"10.1007/s00066-024-02362-z","DOIUrl":"10.1007/s00066-024-02362-z","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most prevalent cancer in women worldwide; nevertheless, the prognosis is good, with a 5-year overall survival of 80-90%. Therefore, it becomes crucial to strive for high quality of life after cure by minimizing treatment-related toxicity. One such concern is radiation-induced heart disease, which remains a significant focus of ongoing investigations.</p><p><strong>Purpose: </strong>The aim of this review is to summarize current knowledge on radiation-induced heart disease in breast cancer patients by giving an overview of its epidemiology, risk factors, radiation parameters related to its development, solutions in radiation practice, and prevention. The goal is to raise awareness and maximize prevention of radiation-induced heart disease.</p><p><strong>Methods: </strong>The PubMed database was screened for articles published between January 2013 and November 2023 related to the keywords <breast cancer>, <radiotherapy>, <cardiac toxicity>, and <heart-sparing techniques>. Moreover, by screening the literature lists of these publications, additional articles were added.</p><p><strong>Results: </strong>Ninety-four relevant papers remained for final review.</p><p><strong>Conclusion: </strong>Radiation-induced heart disease is a rare complication after breast cancer radiotherapy and represents a clinical spectrum of various cardiovascular conditions. Several heart-sparing techniques have been developed, and more attention has been paid to early diagnosis and prevention of radiation-induced heart disease. However, further research remains important to refine radiotherapy techniques and deepen our understanding for improved prevention and treatment of this condition in the future. This clinical review summarizes the existing evidence and literature on radiation-induced heart disease following modern breast cancer radiotherapy, offering clinical guidance for physicians.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"368-382"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459648","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":"Association of long-term treatment outcomes with changes in PET/MRI characteristics and the type of early treatment response during concurrent radiochemotherapy in patients with locally advanced cervical cancer.","authors":"Radovan Vojtíšek, Jan Baxa, Petr Hošek, Petra Kovářová, Martin Vítovec, Emília Sukovská, Jan Kosťun, Pavel Vlasák, Jiří Presl, Jiří Ferda, Jindřich Fínek","doi":"10.1007/s00066-025-02389-w","DOIUrl":"https://doi.org/10.1007/s00066-025-02389-w","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to find predictive tumour characteristics as detected by interim positron-emission tomography/magnetic resonance imaging (PET/MRI) in cervical cancer patients. We also investigated the type of interim response. Furthermore, we compared the investigated parameters with disease-free (DFS) and overall survival (OS) outcomes.</p><p><strong>Methods: </strong>We evaluated 108 patients treated between August 2015 and January 2023 with external-beam radiotherapy (EBRT) and image-guided adaptive brachytherapy (IGABT) who had undergone pretreatment staging, subsequent mid-treatment evaluation after completed EBRT and definitive restaging 3 months after completing the whole treatment using PET/MRI. Patients were then divided into two groups based on the RECIST and PERCIST criteria: responders (achieving complete metabolic response, CMR) and non-responders (non-CMR). These two groups were compared using selected parameters obtained at pre-PET/MRI and mid-PET/MRI. The early response to treatment as evaluated by mid-PET/MRI was categorized into three types: interim complete metabolic response, interim nodal response and interim nodal persistence.</p><p><strong>Results: </strong>Mid-TLG‑S (the sum of total lesion glycolysis for the primary tumour plus pelvic and para-aortic lymph nodes) parameter showed the best discriminatory ability for predicting non-CMR. The second factor with significant discriminatory ability was mid-MTV‑S (the sum of the metabolic tumour volume of the primary tumour plus pelvic and para-aortic lymph nodes). The strongest factor, mid-TLG‑S, showed a sensitivity of 40% and a specificity of 90% at a threshold value of 70. We found a statistically significant association of DFS and OS with the following parameters: number of chemotherapy cycles, early response type and CMR vs. non-CMR.</p><p><strong>Conclusion: </strong>We were able to identify thresholds for selected parameters that can be used to identify patients who are more likely to have worse DFS and OS. The type of early response during concurrent chemoradiotherapy (CCRT) was also significantly associated with DFS and OS. These aspects represent an important contribution to the possible stratification of patients for subsequent individualised adjuvant treatment.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754550","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":"Re-irradiation in progressive diffuse infiltrative pontine glioma in children and young adults.","authors":"Alper Kahvecioglu, Mustafa Cengiz, Guzide Burca Aydin, Mustafa Tezer Kutluk, Gokcen Coban Cifci, Gozde Yazici","doi":"10.1007/s00066-025-02394-z","DOIUrl":"https://doi.org/10.1007/s00066-025-02394-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess oncological outcomes in children and young adults with diffuse infiltrative pontine glioma (DIPG) who have progressed after initial radiotherapy (RT), with an emphasis on the role of re-irradiation.</p><p><strong>Methods: </strong>Data from 33 patients aged 25 years or younger with progressive disease after initial RT were retrospectively analyzed.</p><p><strong>Results: </strong>The median age at diagnosis was 8 years (range 4-24 years), and the median initial RT dose was 54 Gy (range 39-54 Gy). The median time between initial RT and progression was 8 months (range 3-40 months). In addition to systemic therapy, 15 patients (46%) received re-irradiation due to progression, with a median dose of 23.4 Gy (range 19.8-36 Gy), while 18 patients (54%) were treated with systemic therapy alone. In patients who received re-irradiation after progression, the 1‑year post-progression overall survival (OS) was significantly higher compared to those treated with systemic therapy alone (27% vs. 0%, p = 0.01). Among the 15 re-irradiated patients, 9 out of 12 with available data (75%) showed improvement in neurological symptoms following re-irradiation. No patient exhibited acute or late RT-related ≥ grade 3 toxicity.</p><p><strong>Conclusion: </strong>Palliative re-irradiation in children and young adults with progressive DIPG after initial RT provides an approximately 3‑month OS benefit and clinical improvement without significant toxicity and should be considered as a standard-of-care approach.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711365","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":"Biomarkers in prostate cancer: current status and future directions in radiotherapy-statement from the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO).","authors":"S K B Spohn, D M Aebersold, C Albrecht, D Boehmer, U Ganswindt, N-S Schmidt-Hegemann, S Hoecht, T Hölscher, S A Koerber, A-C Mueller, P Niehoff, J C Peeken, M Pinkawa, B Polat, M Shelan, F Wolf, C Zamboglou, D Zips, T Wiegel","doi":"10.1007/s00066-025-02388-x","DOIUrl":"https://doi.org/10.1007/s00066-025-02388-x","url":null,"abstract":"<p><strong>Purpose: </strong>Prostate cancer (PCa) is the most frequently diagnosed malignancy among men in Germany. Advances in diagnostics and treatment have transformed PCa into a chronic disease. Given the heterogeneity of PCa, there is a need for additional stratification tools. This review focuses on updating the evidence for genomic classifiers (GC; Decipher [Veracyte Inc. San Diego, CA, USA], Prolaris [Myriad Genetics, Inc., Salt Lake City, UT], and Oncotype DX [Exact Sciences, Madison, WI, USA] tests) and artificial intelligence (AI)-based digital histopathology biomarkers (ArteraAI Prostate Test) in the context of radiotherapy (RT) for PCa.</p><p><strong>Methods: </strong>The members of the Prostate Cancer Working Group of the German Society of Radiation Oncology (DEGRO) conducted an updated literature search on GCs and histopathological biomarkers in PCa, covering original articles published between January 2022 and February 2024 in the PubMed database.</p><p><strong>Results: </strong>In addition to previous reviews, 11 relevant studies were identified, of which nine studies analyzed biomarkers within prospective phase II or III trials. Eight trials focused on genomic biomarkers, of which three addressed GCs in primary localized PCa, three in recurrent PCa in the setting of salvage RT, and two in metastatic castration-sensitive PCa. In localized PCa, GCs could be validated in a retrospective analysis of randomized controlled trials. Additionally, three studies reported on AI-based histopathology biomarkers.</p><p><strong>Conclusion: </strong>Genomic classifiers and AI-based digital histopathology models might have superior prognostic and predictive value compared to established clinical and pathological parameters in localized, recurrent, and metastatic PCa. Despite promising results, prospective validation of these biomarkers in randomized trials remains limited. This review underscores the need for further prospective trials to confirm the usefulness of these biomarkers in PCa.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711330","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 for spinal and non-spinal bone metastases: a patterns-of-care analysis in German-speaking countries as part of a project of the interdisciplinary Radiosurgery and Stereotactic Radiotherapy Working Group of the DEGRO/DGMP.","authors":"F Nägler, N Gleim, I Seiler, A Rühle, K Hering, C Seidel, E Gkika, D Krug, O Blanck, C Moustakis, T B Brunner, A Wittig-Sauerwein, N H Nicolay","doi":"10.1007/s00066-025-02387-y","DOIUrl":"https://doi.org/10.1007/s00066-025-02387-y","url":null,"abstract":"<p><strong>Background and purpose: </strong>Bone metastases constitute a common indication for both conventional radiotherapy (RT) and stereotactic body radiotherapy (SBRT). Although in recent years guidelines have been proposed for SBRT of spinal and non-spinal metastases, little is known about the use of bone SBRT and the actual patterns of care in German-speaking countries.</p><p><strong>Material and methods: </strong>We performed an online survey among radiation oncologists (ROs) registered with the interdisciplinary Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and the German Society for Medical Physics (DGMP) to collect valuable and robust cross-sectional data on patterns of care for bone SBRT in German-speaking countries.</p><p><strong>Results: </strong>Of the registered ROs, 35.5% (75/211) completed the online survey. ROs working in high-volume centers irradiating more than 100 patients with bone metastases annually represented the largest group, with 58.7%. Ablative SBRT was mostly performed for bone oligometastases (78.7%). For symptom-directed palliative radiotherapy, the majority of responding physicians (84.3%) still mostly recommend moderately hypofractionated treatment. Nevertheless, 60.9% of participating ROs stated using bone SBRT at least occasionally, also for palliative purposes such as pain control. Our survey also revealed a certain reluctance for the concomitant use of systemic therapies with bone SBRT and heterogeneity regarding target volume definition and dosing for bone SBRT.</p><p><strong>Conclusion: </strong>Our survey demonstrates that bone SBRT for spinal and non-spinal metastases for oligometastatic disease (OMD) is broadly available in clinical routine care in German-speaking countries. A large heterogeneity regarding indications, dose, and fractionation concepts remains, requiring further efforts for standardization of bone SBRT.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658639","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":"Comparison of integral doses to normal tissue and organs at risk between interstitial high-dose-rate brachytherapy and modern external-beam radiotherapy techniques in breast and head and neck cancer patients.","authors":"Tibor Major, Csaba Polgár, Zoltán Takácsi-Nagy","doi":"10.1007/s00066-025-02382-3","DOIUrl":"https://doi.org/10.1007/s00066-025-02382-3","url":null,"abstract":"<p><strong>Background: </strong>Although a cornerstone of modern cancer treatment, radiotherapy (RT) is associated with a risk of secondary cancer due to irradiation of non-target tissues. Techniques such as intensity-modulated RT (IMRT), volumetric modulated RT (VMAT), and stereotactic body RT (SBRT) provide highly conformal target dose distributions and reduce doses to nearby organs at risk (OARs), albeit at the cost of larger normal tissue volumes being irradiated with lower doses. In brachytherapy (BT), the low-value isodoses cannot be changed: they are a consequence of the inverse-square law. This study evaluates and compares the normal tissue integral doses (NTIDs) delivered by BT and modern external-beam RT (EBRT) techniques in breast and head and neck (H&N) cancer patients.</p><p><strong>Methods: </strong>Included were the BT and IMRT plans of 34 women with early-stage breast cancer treated with interstitial high-dose-rate (HDR) BT and two groups of head and neck (H&N) patients: 38 patients with mobile tongue, floor of the mouth, and base of the tongue cancer treated definitively with interstitial HDR BT for whom VMAT treatment plans were also prepared and 20 patients with tongue and floor of the mouth tumors who received postoperative interstitial HDR BT for whom VMAT and stereotactic CyberKnife (CK, Accuray Inc., Sunnyvale, CA, USA) plans were also created. The NTIDs for three normal tissue volumes (NT_V10, NT_V5, NT_V2) and OARs were calculated and compared.</p><p><strong>Results: </strong>Brachytherapy resulted in 39%, 32%, and 26% lower NTIDs compared to IMRT for NT_V10, NT_V5, and NT_V2, respectively, in patients with breast cancer. In H&N cancer, the NTIDs were always lower for BT compared to VMAT. The reductions in NTID achieved with BT were 45%, 36% and 27% with the same planning target volumes in BT and VMAT, and 56%, 48% and 37% with larger planning target volumes in VMAT. For CK, the NTID reductions were 54%, 49% and 41% compared to BT. In breast cases, BT resulted in a significant reduction in ipsilateral lung NTID, and in H&N cases, salivary glands NTIDs were always lower with BT than with VMAT.</p><p><strong>Conclusion: </strong>For patients with breast and head and neck cancer, interstitial BT results in lower integral dose to normal tissue and OARs compared to modern EBRT techniques. The clinical implications require further detailed investigation.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650895","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}