Strahlentherapie und Onkologie最新文献

{"title":"Thyroid avoidance in treatment planning for breast cancer patients irradiated to the supraclavicular nodes.","authors":"Alessandro Clivio, Daniel R Zwahlen, Sonja Koch, Cezarina Negreanu, Enrico Barletta, Helmut Haerle, Elena Hofmann, Christoph Oehler","doi":"10.1007/s00066-024-02321-8","DOIUrl":"10.1007/s00066-024-02321-8","url":null,"abstract":"<p><strong>Purpose: </strong>Hypothyroidism affects up to 21% of women with breast cancer after supraclavicular node irradiation. The PENTEC (pediatric normal tissue effects in the clinic) initiative highlighted the need to minimize the thyroid dose, albeit without giving a specific constraint. This study aimed to define a reasonable target thyroid mean dose (D_mean) between 10 and 15 Gy using intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) and examine its impact on the hypothyroidism risk.</p><p><strong>Methods: </strong>Forty-three breast cancer patients with supraclavicular irradiation neglecting the thyroid in terms of dose protection were included from 01/2020 to 04/2021. An IMRT or VMAT technique was used in 23 and 20 patients, respectively. Replanning aimed for a thyroid D_mean of 10 Gy. IMRT plans still exceeding 10 Gy were converted into VMAT plans. Fisher's sign test compared original and revised plans and the hypothyroidism risk was calculated.</p><p><strong>Results: </strong>Initial radiotherapy plans had a thyroid D_mean of 18.4 ± 7.9 Gy (IMRT: 20.4 ± 8.8 Gy, VMAT: 16.2 ± 6.2 Gy). Replanning significantly reduced D_mean to 10.3 ± 4.5 Gy (-44%) overall (IMRT: -50%, VMAT: -35%), with 56% achieving ≤ 10 Gy (IMRT: 33.3%, VMAT: 61%). Furthermore, an IMRT to VMAT conversion yielded a thyroid D_mean of 9.2 ± 3.5 Gy, with 74.4% of patients ≤ 10 Gy, albeit at the cost of higher doses to the contralateral breast. Clinical and planning target volume (CTV/PTV) coverage remained uncompromised. The calculated hypothyroidism risk significantly decreased from 24.5% to 13.3% (D_mean = 10 Gy) or 16.3% (D_mean = 13.5 Gy).</p><p><strong>Conclusion: </strong>Implementing a thyroid organ at risk (OAR) constraint D_mean of 13.5 Gy was feasible in 88% of patients without compromising other OARs and CTV/PTV coverage, and resulted in a 33-46% reduction of the hypothyroidism risk.</p><p><strong>Trial registration: </strong>Retrospectively registered.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":"589-600"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710670","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":"Balancing barriers: Family, career, and gender equality in radiation oncology and radiation research-An interdisciplinary prospective survey among the young workforce.","authors":"Maike Trommer, Maximilian Grohmann, Alexander Fabian, Felix Ehret, Julia Hess, Michael Rückert, Johann Matschke, Sarah Stefanowicz, Alexander Rühle, Simone Ferdinandus, Ricarda Merten, Angela Besserer, Livia Schmidt, Elena Sperk, Alina Depardon, Florian Putz, Cordula Petersen, Marlen Haderlein, Annemarie Schröder, Thomas Weissmann, Lisa Deloch","doi":"10.1007/s00066-025-02402-2","DOIUrl":"https://doi.org/10.1007/s00066-025-02402-2","url":null,"abstract":"<p><strong>Purpose: </strong>There is an urgent need to recruit and retain young professionals in radiation oncology and radiation research as the healthcare system faces major challenges. Our study investigated the experiences and needs of young professionals in this field, focusing on the impact of unpaid care work and gender-related issues.</p><p><strong>Methods: </strong>A web-based survey was created and distributed over a six-week period, featuring one general questionnaire along with three occupation-specific versions tailored for physicians, biologists, and medical physicists involved in radiation oncology and research.</p><p><strong>Results: </strong>Most participants with care responsibilities have temporary contracts, especially female physicians and biologists, while female medical physicists are more likely to hold permanent positions. Research is often conducted outside regular hours, with limited cover arrangements and part-time options varying by field. Key career risks include economic pressure, work-life balance, and uncertain contracts, with employees with care duties feeling less supported overall. In addition, men seem to be more involved in care work and thus face unique challenges, such as insufficient career support and fears of poor future perspective. The study emphasizes the need for strategies to address relevant issues, such as flexible working arrangements, better mentoring support, and clear substitution policies that can ensure that young professionals can balance caring responsibilities with work and career demands.</p><p><strong>Conclusion: </strong>Addressing these challenges is critical for sustaining a diverse and qualified workforce in radiation oncology and radiation research, ensuring excellence in patient care and scientific progress.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151896","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":"Postoperative therapy patterns for thymic carcinoma with complete resection: retrospective analysis of 120 patients.","authors":"Yan Gao, Xingwen Fan, Hong Zheng, Yingshan Cui, Qiong Yi, Yaqi Li, Yulei Pei, Kailiang Wu","doi":"10.1007/s00066-025-02410-2","DOIUrl":"https://doi.org/10.1007/s00066-025-02410-2","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to determine the role of postoperative adjuvant therapy in patients with thymic carcinoma following complete resection.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with stage I-III or N1+ thymic carcinomas who underwent complete resection at our center between 2006 and 2020. Data on the clinical characteristics and postoperative adjuvant therapies were collected.</p><p><strong>Results: </strong>One hundred and twenty patients were enrolled. Five (4.2%) patients received only postoperative chemotherapy, 36 (33.0%) received only postoperative radiotherapy, 75 (62.5%) received postoperative chemoradiotherapy, and four (3.3%) did not receive any postoperative therapy. During a median follow-up period of 65 months, disease failure was observed in 46 (38.3%) patients, and 28 (23.3%) patients died. The 5‑year disease-free survival (DFS) and overall survival (OS) rates were 58.7 and 81.4%, respectively. Patients who underwent different postoperative therapies exhibited varying prognoses. Radiotherapy reduced the risks of failure (p < 0.001) and death (p < 0.001), whereas chemotherapy did not (p = 0.198 and 0.260 respectively). Subgroup analyses revealed that stage III/IV patients who received chemotherapy had a lower relapse risk (p = 0.045) and improved OS (p = 0.064). Multivariate analysis demonstrated that radiotherapy alone (hazard ratio [HR], 0.24; p = 0.023) independently predicted OS.</p><p><strong>Conclusions: </strong>Adjuvant radiotherapy should be recommended for patients with thymic carcinoma who have undergone complete resection. Further exploration is needed to clarify the role of adjuvant chemotherapy.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128718","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":"Multimodal chemoradiotherapy including interstitial brachytherapy enhances outcomes in FIGO stage IVA cervical cancer: a focus on tumor control and quality of life.","authors":"Maria Neu, Carolin Michaela Wöhrl, Renate Walter, Nikolaos Balagiannis, Christoph Poettgen, Lukas Käsmann, Martin Stuschke, Christian Dannecker, Georg Stüben, Klaus-Henning Kahl","doi":"10.1007/s00066-025-02407-x","DOIUrl":"https://doi.org/10.1007/s00066-025-02407-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study was performed to evaluate the outcomes of advanced radiotherapy techniques, including image-guided adaptive brachytherapy (IGABT), in International Federation of Gynecology and Obstetrics (FIGO) stage IVA cervical cancer patients with adjacent organ infiltration. A further aim was to identify prognostic factors influencing overall survival (OS) and local control (LC) in these patients, with a particular focus on toxicity and patient-reported outcomes (PROs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective, single-center study included 31 patients with FIGO stage IVA cervical cancer treated with definitive chemoradiotherapy between 2010 and 2020. All 31 patients underwent external-beam radiotherapy (EBRT), with concurrent cisplatin-based chemotherapy (CTX) administered in 25 cases and additional high-dose-rate brachytherapy (BT) performed in 24 cases. Treatment-related adverse events were categorized in accordance with the Common Terminology Criteria for Adverse Events (CTCAE; version 5.0) [1]. PROs were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30), while sexual function was assessed through three specific questions adapted from the EORTC QLQ-BR23 module.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Median OS was estimated at 51.7 months, with 2‑ and 5‑year OS rates of 58.1 and 46.2%, respectively. Median progression-free survival (PFS) was 48.1 months (95% CI: 0-96.2 months), with 2‑ and 5‑year PFS rates of 52 and 37%. The 10-year LC probability was 70.4%, showing a significant association with improved OS (p = 0.0039). Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.014) and nodal involvement were identified as prognostic factors. The estimated median OS was 108 months for patients treated with BT and 51.7 months for those without. Patients receiving six fractions or a cumulative BT dose of ≥ 24 Gy demonstrated improved 5‑year OS rates of 62.3%, although the difference was not statistically significant. Acute toxicities were reported in 83.9% of patients, primarily grades 1-2, with severe complications such as fistula formation occurring in 16.1%. Late toxicities, predominantly affecting the gastrointestinal and urogenital systems, were observed in 45.2% of patients. Patient-reported outcomes indicated mild to moderate impairments of quality of life, with fatigue and gastrointestinal symptoms being the most frequently reported issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Advanced radiotherapy, particularly IGABT, achieves durable LC in patients with FIGO stage IVA cervical cancer, supporting its use as a cornerstone of curative-intent treatment. However, systemic progression remains a major challenge, highlighting the need for novel therapeutic strategies, including immunotherapy and liquid biopsy for treatment monitoring. Future prospective trials are essential to validate these findings and refine therapeu","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120891","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":"Oncological outcomes of breast cancer patients after planned IORT boost with low-kV x-rays-results of the TARGIT BQR prospective phase IV trial.","authors":"Lukas Goerdt, Janina Pömsl, Uta Kraus-Tiefenbacher, Viktoria Brück, Christina Kaiser, Ralf Keymer, Yasser Abo-Madyan, Katharina Fleckenstein, Sebastian Berlit, Benjamin Tuschy, Marc Sütterlin, Frederik Wenz, Elena Sperk","doi":"10.1007/s00066-025-02412-0","DOIUrl":"https://doi.org/10.1007/s00066-025-02412-0","url":null,"abstract":"<p><strong>Purpose: </strong>The TARGIT BQR (boost quality registry) phase IV trial investigates clinical outcomes of breast cancer patients with standard external-beam radiotherapy (EBRT) of the whole breast and intraoperative radiotherapy (IORT) with low-kV x‑rays as an anticipated tumor bed boost in a real-world setting.</p><p><strong>Methods: </strong>Intraoperative radiotherapy was performed immediately after breast-conserving surgery in one fraction. External-beam radiotherapy and systemic treatment were given according to the German S3 guideline for breast cancer and local tumor board recommendations. Outcome parameters were death, local recurrence, metastasis, local lymph node recurrence, and ipsilateral and contralateral invasive breast cancer. Kaplan-Meier estimates were used to calculate overall survival, metastasis-free survival, local recurrence-free survival, and disease-free survival.</p><p><strong>Results: </strong>From 10 centers, 1133 patients were recruited. This analysis included 871 patients with 879 cancers, with a median follow-up of 36 months (up to 12 years). An IORT boost was performed in 82% and whole-breast irradiation in 84%. Overall survival was 98.4% after 3 years, 96.8% after 5 years, and 95.4% after 10 years (16 deaths; 1.8%). Metastasis and local recurrence occurred in 11 patients each (1.3%). At 5 years, the local control rate was 97.4% and local recurrence-free survival was 94.4%. Ipsilateral breast cancer occurred in 2 patients, contralateral breast cancer in 3 patients, and local lymph node recurrence in 2 patients. Disease-free survival was 92.9% after 5 years and 82.6% after 10 years.</p><p><strong>Conclusion: </strong>This phase IV trial confirms previously reported outcomes on upfront IORT boost, with excellent disease-control outcomes.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094851","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":"Implementing total skin electron irradiation in radiotherapy: a structured change management approach.","authors":"Andrea Baehr, Maximilian Grohmann, Volker Platz, Nina Booken, Cordula Petersen","doi":"10.1007/s00066-025-02408-w","DOIUrl":"https://doi.org/10.1007/s00066-025-02408-w","url":null,"abstract":"<p><strong>Background: </strong>Total skin electron irradiation (TSEI) is a specialized radiotherapy technique used to treat cutaneous T‑cell lymphoma, including mycosis fungoides and Sézary syndrome. Despite its clinical benefits, TSEI is rarely implemented in clinical practice due to significant technical and organizational challenges. This study explores a structured approach to integrating TSEI into clinical routines by applying a comprehensive change management framework in a German radiotherapy department.</p><p><strong>Methods: </strong>The implementation process was based on Kotter's eight-step change management model and carried out from 2022 to 2024 by a multidisciplinary team. Key steps included creating a sense of urgency, forming a guiding coalition, developing and communicating a clear vision, and pilot testing to generate short-term successes. A dynamic stakeholder analysis was conducted to continuously identify and manage factors that could promote or hinder the change.</p><p><strong>Results: </strong>The structured approach facilitated integration of TSEI into routine practice. The project enabled comprehensive staff training, adaptation of technical workflows, and development of necessary protocols and equipment. Key milestones were achieved, including initial patient treatments and positive staff feedback, demonstrating the method's feasibility and acceptance. The stakeholder analysis was instrumental in reducing apprehensions and maintaining alignment among team members.</p><p><strong>Conclusion: </strong>This study demonstrates that a structured change management approach is effective in integrating complex techniques like TSEI into clinical practice. The findings highlight that a systematic framework can help to overcome organizational and technical challenges, thereby enhancing patient care and operational efficiency. Future efforts should continue to employ structured methodologies for the sustainable integration of new medical technologies.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080596","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":"Proton therapy in young breast cancer patients with germline TP53 and ATM mutations: a case series.","authors":"Pierre Loap, Farid Goudjil, Ludovic de Marzi, Kim Cao, Rémi Dendale, Youlia Kirova","doi":"10.1007/s00066-025-02411-1","DOIUrl":"https://doi.org/10.1007/s00066-025-02411-1","url":null,"abstract":"<p><strong>Background: </strong>Young breast cancer patients with germline radiosensitivity mutations, such as in TP53 and ATM, face an increased risk of radiation-induced toxicities and secondary malignancies. Proton therapy offers dosimetric advantages by reducing the radiation exposure of healthy tissues, potentially mitigating these risks. However, clinical data on the use of proton therapy in this specific population are limited.</p><p><strong>Materials and methods: </strong>We conducted a single-center retrospective study in patients with non-metastatic breast cancer with germline TP53 or ATM mutations treated with intensity-modulated proton therapy (IMPT) at the Institut Curie Proton Therapy Center between June 2019 and November 2024. Patient demographics, treatment characteristics, and toxicity profiles were analyzed. Acute and late toxicities were graded according to CTCAE v5.0. Survival outcomes were calculated from the date of histological diagnosis.</p><p><strong>Results: </strong>Four young patients (median age 25 years; range 24-29) with TP53 (n = 2) or ATM (n = 2) mutations received IMPT targeting the chest wall and regional lymph nodes. All patients had hormone receptor-positive, node-positive breast cancer; one patient was also HER2 positive. Treatments included chemotherapy, surgery, and adjuvant hormonal therapy; three patients received additional targeted therapies. The median mean heart dose was 1.25 Gy (range 0.5-1.5 Gy). One patient experienced acute grade 2 radiodermatitis, while two patients had grade 1 radiodermatitis. After a median follow-up of 18 months (range 11-49 months), one patient exhibited persistent grade 1 skin pigmentation. No other late toxicities, including cardiac or pulmonary complications, were observed. There were no secondary malignancies or recurrences, resulting in 100% overall and recurrence-free survival.</p><p><strong>Conclusion: </strong>Proton therapy was well tolerated in this small cohort of young breast cancer patients with germline TP53 or ATM mutations, demonstrating minimal acute toxicity and no significant late effects over a median follow-up of 18 months. These preliminary findings suggest that proton therapy may be a safe treatment option for this high-risk population. Larger studies with extended follow-up are necessary to confirm these results and to inform clinical guidelines.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014426","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":"Ceftriaxone has a neuroprotective effect in a whole-brain irradiation-induced neurotoxicity model by increasing GLT-1 and reducing oxidative stress.","authors":"Nilsu Cini, Özüm Atasoy, Yigit Uyanikgil, Gökhan Yaprak, Mümin Alper Erdoğan, Oytun Erbas","doi":"10.1007/s00066-025-02405-z","DOIUrl":"https://doi.org/10.1007/s00066-025-02405-z","url":null,"abstract":"<p><strong>Background: </strong>Radiation-induced brain injury is a prominent side effect of whole-brain irradiation (IR) due to triggered oxidative and inflammatory processes, often resulting in severe and debilitating cognitive dysfunction and neuronal damage. The development of persistent oxidative stress results from radiation-induced reactive oxygen species. Another result is the initiation of glutamate excitotoxicity, which is closely associated with changes in glutamate levels. Elevated release or reduced glutamate uptake disrupts neuronal homeostasis, leading to oxidative stress, mitochondrial dysfunction, and neuroinflammation. The neuroprotective and antioxidant properties of ceftriaxone (CTX) have been linked to its ability to reduce glutamate excitotoxicity, inflammation, and to modulate oxidative stress.</p><p><strong>Materials and methods: </strong>Twenty-one female Wistar rats were included in the study, and 14 of them underwent whole-brain IR with a single dose of 20 Gy on day 7. Saline and CTX applications continued for 21 days. The animals were divided into three groups: group 1: normal control; group 2: IR + saline; and group 3: IR + CTX. To compare the groups, a one-way analysis of variance (ANOVA) statistical test was employed, with a significance threshold set at p < 0.05.</p><p><strong>Results: </strong>Ceftriaxone treatment had a positive impact on the results of various assessments, e.g., behavioral tests including the three-chamber sociability test, the open-field test, and passive avoidance learning. It also led to increased counts of hippocampal CA1, CA3, and Purkinje neurons as well as elevated brain levels of brain-derived neurotrophic factor (BDNF), glutamate transporter 1 (GLT-1), and superoxide dismutase (SOD) activity. Conversely, CTX reduced the glial fibrillary acidic protein (GFAP) immunostaining index as well as brain levels of malondialdehyde (MDA) and tumor necrosis factor alpha (TNF-α).</p><p><strong>Conclusion: </strong>Ceftriaxone demonstrated promising effectiveness in mitigating radiation-induced neurocognitive impairments and the deterioration of social memory capacity. This effect is achieved by reducing neuronal loss, oxidative stress, and neuroinflammation in irradiated rat brains. Furthermore, the application of CTX facilitated removal of excess glutamate from synapses, thus preventing glutamate excitotoxicity and protecting neurons from excitotoxic cell death.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038408","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":"Real world comparison of adjuvant vs. salvage radiation therapy on cancer-control outcomes after radical prostatectomy.","authors":"Mike Wenzel, Katrin Burdenski, Nikolaos Tselis, Claus Rödel, Christian Brandts, Marit Ahrens, Jens Koellermann, Markus Graefen, Clara Humke, Carolin Siech, Benedikt Hoeh, Severine Banek, Felix K H Chun, Philipp Mandel","doi":"10.1007/s00066-025-02400-4","DOIUrl":"https://doi.org/10.1007/s00066-025-02400-4","url":null,"abstract":"<p><strong>Purpose: </strong>Outcomes of adjuvant (aRT) or salvage radiation therapy (sRT) after radical prostatectomy are under investigation regarding cancer-control outcomes.</p><p><strong>Methods: </strong>Relying on the University Cancer Center database elaborating differences in metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) of aRT vs. sRT-treated patients between 2014-2024. Sensitivity analyses addressed high-risk patients with pN1 and/or Gleason score 8-10 and/or pT3-4 stage.</p><p><strong>Results: </strong>Of 1862 patients, 7.1% underwent aRT and 93% were in the sRT group. Median PSA at sRT was 0.33 ng/ml. Patients with aRT harbored significantly worse baseline tumor and pathological characteristics such as PSA level (12.0 vs. 7.6 ng/ml), Gleason score 9-10 (30% vs. 9.8%), D'Amico high risk prostate cancer (97% vs. 56%), as well as pT3-4, pN1 and positive surgical margins rates (all p < 0.001). Similar observations were made for high-risk patients. No differences were observed for aRT vs. sRT with 60-month MFS rates of 85.1% vs. 95.4% (hazard ratio [HR] 0.60, p = 0.18). 60-months CSS-rates of 96.8% vs. 99.1% and 60-month OS-rates of 91.0% vs. 89.1% respectively (all p ≥ 0.15). Neither sensitivity analyses of high-risk patients nor multivariable adjusted Cox regression models revealed significant differences regarding MFS, CSS or OS in aRT vs. SRT comparison (all p ≥ 0.05), despite aRT showing qualitatively better OS results.</p><p><strong>Conclusion: </strong>Within real-world setting, patients undergoing aRT harbor wore tumor characteristics. However, these differences did not translate into significant differences of mid-term oncological outcomes, relative to sRT patients. Similar observations were made within analyses of high-risk patients with pT3-4 and/or Gleason 8-10 and/or pN1 stage, nevertheless aRT showed slightly higher OS rates within this subgroup.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046601","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":"Survival determinants and toxicity of second-course radiotherapy for isolated nodal recurrences in breast cancer.","authors":"Cezara Cheptea, Youlia Kirova, Jeremy Baude, Fatima Laki, Alain Fourquet, Pierre Loap","doi":"10.1007/s00066-025-02409-9","DOIUrl":"https://doi.org/10.1007/s00066-025-02409-9","url":null,"abstract":"<p><strong>Background: </strong>Isolated nodal recurrence (INR) after localized breast cancer is rare, with an incidence of less than 1%. Curative management typically includes surgical resection, often with axillary lymph node dissection (ALND), followed by regional nodal radiotherapy. However, evidence-based guidelines remain limited due to the rarity of this clinical scenario. The aim of this study was to evaluate survival determinants and the acute and long-term toxicities associated with second-course regional nodal irradiation as part of curative strategies for INR after localized breast cancer.</p><p><strong>Materials and methods: </strong>This retrospective study included 11 patients with localized breast cancer who developed ipsilateral, nonmetastatic INR between 2003 and 2019. All patients were treated with curative intent, including regional nodal irradiation. Overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), local control, and treatment toxicities were analyzed. Survival probabilities were calculated using the Kaplan-Meier method, and Cox regression was used to assess prognostic factors.</p><p><strong>Results: </strong>The 5‑year OS and CSS were 71.6%, while MFS was 62.3%. Inclusion of internal mammary chain (IMC) irradiation significantly improved OS, CSS, and MFS (p < 0.01). Triple-negative breast cancer (TNBC) INRs were associated with worse survival outcomes. Acute grade 2 toxicities included radiodermatitis (36.4%), and late grade 2 toxicities were limited to fibrosis (18.2%). No cardiac, pulmonary, or grade 3 or higher toxicities were reported.</p><p><strong>Conclusion: </strong>This study highlights the favorable survival outcomes and safety profile of contemporary curative strategies for INRs following localized breast cancer, with a 5-year OS rate exceeding historical benchmarks. Internal mammary chain irradiation appears to improve survival without increased toxicity. However, the poor prognosis associated with TNBC INR underscores the need for effective systemic therapies. Prospective multicenter trials are essential to validate these findings and optimize treatment protocols.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032432","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}