Strahlentherapie und Onkologie最新文献

{"title":"PET/CT-based target volume definition in involved-site radiotherapy for treatment of early-stage nodal follicular lymphoma.","authors":"Antje Wark, Ji-Young Kim, Elena Mavriopoulou, Christian la Fougère, Thomas Wiegel, Christian W Scholz, Christian Baues, Minglun Li, Thomas Gauler, Stephanie E Combs, Klaus Herfarth","doi":"10.1007/s00066-024-02356-x","DOIUrl":"https://doi.org/10.1007/s00066-024-02356-x","url":null,"abstract":"<p><strong>Purpose: </strong>Recent advancements in imaging, particularly 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT), have improved the detection of involved lymph nodes, thus influencing staging accuracy and potentially treatment outcomes. This study is a post hoc analysis of the GAZAI trial data to evaluate the impact of FDG-PET/CT versus computed tomography (CT) alone on radiation target volumes for involved-site radiotherapy (IS-RT) in early-stage follicular lymphoma (FL).</p><p><strong>Methods: </strong>All patients in the GAZAI trial underwent pretherapeutic FDG-PET/CT examinations, which were subject to central quality control. Lymph nodes with pathological metabolism were assessed for CT morphology. Differential regional involvement and the impact on radiation target volume for IS-RT were compared between PET/CT-based to solely CT-based staging.</p><p><strong>Results: </strong>In 54 patients with PET-positive lymph nodes after initial surgery, 170 involved lymph nodes were identified in total. FDG-PET/CT identified additionally involved lymph nodes not detected by CT in 61% of the patients, leading to a significant change in radiation treatment fields for 30% of the cohort. Only 58% of all involved lymph nodes exhibited pathological CT morphology. The findings were robust across different Deauville score thresholds and CT morphological metrics.</p><p><strong>Conclusion: </strong>The findings confirm the essential role of FDG-PET/CT in accurately defining the radiation volume for treatment of early-stage follicular lymphomas with radiotherapy. These results support the integration of FDG-PET/CT into the standard diagnostic pathway and its inclusion in the service catalogue of statutory health insurance, emphasizing its importance for optimal treatment planning and the potential impact on patient outcomes.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979871","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":"Simultaneous integrated boost to lateral pelvic lymph nodes during chemoradiotherapy in high-risk rectal cancer.","authors":"Marcel Büttner, Simon Böke, Sabrina Baumeister, Robert Bachmann, Michael Bitzer, Hans Bösmüller, Dörte Wichmann, Maximilian Niyazi, Cihan Gani","doi":"10.1007/s00066-024-02354-z","DOIUrl":"https://doi.org/10.1007/s00066-024-02354-z","url":null,"abstract":"<p><strong>Background: </strong>Preoperative chemoradiotherapy combined with total mesorectal excision (TME) is a standard treatment for locally advanced rectal cancer (LARC). However, lateral pelvic lymph nodes (LPLNs) are often inadequately treated with standard regimens. This study examines the treatment and postoperative outcomes in LARC patients receiving a simultaneous integrated boost (SIB) for LPLNs during long-course chemoradiotherapy.</p><p><strong>Methods: </strong>This retrospective study included high-risk LARC patients (UICC, \"Union Internationale Contre le Cancer\", stage III) treated with preoperative chemoradiotherapy and SIB to LPLNs. Radiotherapy was delivered to the primary tumor and elective volumes with 50.4 Gy in 28 fractions, and an SIB with a median dose of 60.2 Gy was administered to clinically positive LPLNs. TME quality and postoperative complications were assessed using MERCURY and Clavien-Dindo, respectively. Time-to-event data were analyzed according to Kaplan-Meier.</p><p><strong>Results: </strong>Between 2019 and 2023, 27 patients with high-risk LARC and LPLN metastases were treated with chemoradiotherapy. After a median follow-up of 19 months, 2‑year overall survival was 80%, disease-free survival 80%, and local control of dose-escalated lymph nodes 100%. Three patients were managed nonoperatively after a clinical complete response on endoscopy and imaging. Of the 22 patients who had surgery, only one had complications higher than Clavien-Dindo grade I; TME was graded as MERCURY I in 73%.</p><p><strong>Discussion and conclusion: </strong>The SIB approach for LPLNs in LARC is feasible, does not increase postoperative morbidity, and achieves excellent local control. This study supports the consideration of dose-escalated radiotherapy for LPLNs to address high local recurrence risks.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979880","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":"Prostate motion in magnetic resonance imaging-guided radiotherapy and its impact on margins.","authors":"Johannes Kusters, René Monshouwer, Peter Koopmans, Markus Wendling, Ellen Brunenberg, Linda Kerkmeijer, Erik van der Bijl, Martijn Kusters","doi":"10.1007/s00066-024-02346-z","DOIUrl":"https://doi.org/10.1007/s00066-024-02346-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study focused on reducing the margin for prostate cancer treatment using magnetic resonance imaging-guided radiotherapy by investigating the intrafractional motion of the prostate and different motion-mitigation strategies.</p><p><strong>Methods: </strong>We retrospectively analyzed intrafractional prostate motion in 77 patients with low- to intermediate-risk prostate cancer treated with five fractions of 7.25 Gy on a 1.5 T magnetic resonance linear accelerator. Systematic drift motion was observed and described by an intrafractional motion model. The planning target volume (PTV) margin was calculated in a cohort of 77 patients and prospectively evaluated for geometric coverage in a separate cohort of 24 patients.</p><p><strong>Results: </strong>The intrafractional model showed that the prostate position starts out of equilibrium for the anterior-posterior (-1.8 ± 3.1 mm) and superior-inferior (1.7 ± 2.6 mm) directions, with relaxation times of 12 and 15 min, respectively. Position verification scans are acquired at 30 min on average. At that time, the transient drift motion becomes indistinguishable from the residual random intrafractional motion. PTV margins can be reduced to 1.8 mm (left-right), 3.2 mm (anterior-posterior), and 2.9 mm (superior-inferior). Evaluation of the overlap with the clinical target volume (CTV) was performed for a total of 120 fractions of 24 patients. The overlap range between the CTV and the PTV was 93-100% and the applied 3‑mm PTV margin for the CTV had a 99.5% averaged geometric overlap for all patients.</p><p><strong>Conclusion: </strong>A PTV margin reduction to 3 mm is feasible. A patient-specific approach could reduce the margins further.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979877","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 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":"https://doi.org/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":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-12","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":"[Can stereotactic radiotherapy for neovascular age-related macular degeneration (STAR trial) enhance quality of life?]","authors":"Stephanie Göller, Heinz Schmidberger","doi":"10.1007/s00066-024-02351-2","DOIUrl":"https://doi.org/10.1007/s00066-024-02351-2","url":null,"abstract":"","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972199","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":"Predicting acute and late toxicity in prostate cancer stereotactic ablative radiotherapy: the role of dosimetric parameters and prostate volume.","authors":"Gokhan Ozyigit, Pervin Hurmuz, Pantea Bayatfard, Burak Tilki, Yagiz Yedekci, Melek Tugce Yilmaz","doi":"10.1007/s00066-024-02343-2","DOIUrl":"https://doi.org/10.1007/s00066-024-02343-2","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to identify the dosimetric parameters and prostate volume that most accurately predict the incidence of acute and late gastrointestinal (GI) and genitourinary (GU) toxicity in prostate cancer stereotactic ablative radiotherapy (SABR) treatments.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 122 patients who received SABR for prostate cancer at our clinic between March 2018 and September 2022 using a five-fraction SABR regimen. The existing plans of these patients were re-evaluated according to our institutional protocols (Hacettepe University [HU-1] and HU-2) as well as PACE‑B, RTOG 0938, and NRG GU005 dose-volume constraints. Univariate and multivariate logistic regression analyses were performed using SPSS version 23.0 (IBM, Armonk, NY, USA).</p><p><strong>Results: </strong>The median follow-up was 24.7 months (0.8-94.4 months). For acute GU toxicity, moderate-dose regions were predictive for grade 1-2 toxicity, while high-dose regions were more associated with grade 3-4 toxicity. For late GU toxicity, moderate-high-dose regions were predictive. For GI toxicity, moderate-dose regions were important for both acute and late toxicity. The HU protocol encompassed all significant dosimetric factors influencing toxicity outcomes. A prostate volume threshold of 60 cc was predictive of acute grade 3-4 GU toxicity.</p><p><strong>Conclusion: </strong>Our study highlighted the critical role of moderate-dose regions for acute and late GI and GU toxicity. Prostate treatment plans should be rigorously evaluated, and moderate doses should be minimized. The HU protocol is an eligible choice for five-fraction SABR plans.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955397","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":"Influence of radiotherapy on cardiac implantable devices and leads-a single-institution analysis and critical evaluation of current guidelines.","authors":"Jakob Warmbrunn, Christoph Straube, Hans-Ulrich Haase, Daniel Sinnecker, Karl-Ludwig Laugwitz, Stephanie E Combs, Simon Schneider, Daniel Habermehl","doi":"10.1007/s00066-024-02345-0","DOIUrl":"https://doi.org/10.1007/s00066-024-02345-0","url":null,"abstract":"<p><strong>Purpose: </strong>Increasing life expectancy and advances in cancer treatment will lead to more patients needing both radiation therapy (RT) and cardiac implantable electronic devices (CIEDs). CIEDs, including pacemakers and defibrillators, are essential for managing cardiac arrhythmias and heart failure. Telemetric monitoring of CIEDs checks battery status, lead function, settings, and diagnostic data, thereby identifying software deviations or damage. This study evaluates the German Society for Radiation Oncology (DEGRO)/German Society for Cardiology (DGK) guideline, assessing real-world complications and risk factors and analyzing pacemaker and implantable cardioverter-defibrillator (ICD) lead function for their predictive value concerning device malfunction.</p><p><strong>Methods: </strong>A total of 54 patients with pacemakers or ICDs who underwent radiation therapy were identified. Demographics, treatment courses, and device information from physical and digital records were extracted. DEGRO/DGK risk groups and pacemaker dependency at the start of RT were assessed. Delineation of the devices and lead insertion sites was performed in the treatment planning system. Dosimetric information from the treatment plans was then correlated with reports of standardized device checks.</p><p><strong>Results: </strong>Over 80% of patients were treated with dual-chamber pacemakers or cardiac resynchronization therapy (CRT), and 16.7% had ICDs. One third of patients were pacemaker dependent. 59.3% of patients were in the low-risk category, 29.3% in the medium-risk, and 11.1% in the high-risk category. Thoracic irradiation resulted in the highest median dose to devices. Lead parameter deviations exceeding thresholds were found in 14.8% for the stimulation threshold and 13.5% for sensing. Device malfunctions occurred in 3.7% of cases, both involving electrical resets and neutron-producing radiation (beam energy 10 megaelectron volt (MV) or higher).</p><p><strong>Conclusion: </strong>Collecting lead parameters in addition to secure malfunctions like electrical restarts and memory erasure revealed a significant proportion of treatment courses with temporary changes, though no correlation with individual treatment plans or adverse events was found. The focus on reducing neutron-producing radiation could be further supported.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955445","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":"Patient- and clinician-based evaluation of large language models for patient education in prostate cancer radiotherapy.","authors":"Christian Trapp, Nina Schmidt-Hegemann, Michael Keilholz, Sarah Frederike Brose, Sebastian N Marschner, Stephan Schönecker, Sebastian H Maier, Diana-Coralia Dehelean, Maya Rottler, Dinah Konnerth, Claus Belka, Stefanie Corradini, Paul Rogowski","doi":"10.1007/s00066-024-02342-3","DOIUrl":"https://doi.org/10.1007/s00066-024-02342-3","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate the capabilities and limitations of large language models (LLMs) for providing patient education for men undergoing radiotherapy for localized prostate cancer, incorporating assessments from both clinicians and patients.</p><p><strong>Methods: </strong>Six questions about definitive radiotherapy for prostate cancer were designed based on common patient inquiries. These questions were presented to different LLMs [ChatGPT‑4, ChatGPT-4o (both OpenAI Inc., San Francisco, CA, USA), Gemini (Google LLC, Mountain View, CA, USA), Copilot (Microsoft Corp., Redmond, WA, USA), and Claude (Anthropic PBC, San Francisco, CA, USA)] via the respective web interfaces. Responses were evaluated for readability using the Flesch Reading Ease Index. Five radiation oncologists assessed the responses for relevance, correctness, and completeness using a five-point Likert scale. Additionally, 35 prostate cancer patients evaluated the responses from ChatGPT‑4 for comprehensibility, accuracy, relevance, trustworthiness, and overall informativeness.</p><p><strong>Results: </strong>The Flesch Reading Ease Index indicated that the responses from all LLMs were relatively difficult to understand. All LLMs provided answers that clinicians found to be generally relevant and correct. The answers from ChatGPT‑4, ChatGPT-4o, and Claude AI were also found to be complete. However, we found significant differences between the performance of different LLMs regarding relevance and completeness. Some answers lacked detail or contained inaccuracies. Patients perceived the information as easy to understand and relevant, with most expressing confidence in the information and a willingness to use ChatGPT‑4 for future medical questions. ChatGPT-4's responses helped patients feel better informed, despite the initially standardized information provided.</p><p><strong>Conclusion: </strong>Overall, LLMs show promise as a tool for patient education in prostate cancer radiotherapy. While improvements are needed in terms of accuracy and readability, positive feedback from clinicians and patients suggests that LLMs can enhance patient understanding and engagement. Further research is essential to fully realize the potential of artificial intelligence in patient education.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955461","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":"Linear regression analysis for complete blood count parameters during radiotherapy.","authors":"Aniwat Berpan, Nattapatch Janhom","doi":"10.1007/s00066-024-02344-1","DOIUrl":"https://doi.org/10.1007/s00066-024-02344-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the correlations between complete blood count (CBC) during radiotherapy and patient and treatment factors.</p><p><strong>Patients and methods: </strong>Data of cancer patients, including age, sex, concurrent chemotherapy (CCRT), radiotherapy dose (equivalent dose in 2‑Gy fractions with an alpha/beta value of 10 Gy, EQD2Gy10), radiotherapy location, and baseline CBC were collected. Linear regression was used to determine results during radiation. Validation data comprised 20% of the whole cohort.</p><p><strong>Results: </strong>A total of 496 radiotherapy courses and 1884 weekly CBC results during treatment were analyzed. Baseline hemoglobin (Hb) was positively associated with subsequent Hb. Each 1 g/dL increase in baseline Hb predicted a 0.73 g/dL increase in Hb during treatment (95% confidence interval [CI] 0.7-0.76). Male sex was associated with a 0.16 g/dL higher Hb (95% CI 0.04-0.29), while female sex showed the opposite trend. CCRT was associated with a 0.18 g/dL reduction in Hb (95% CI -0.33 to -0.03). Radiotherapy to the pelvis, bone, and head and neck regions resulted in Hb reductions of 0.18, 0.34, and 0.94 g/dL, respectively (95% CI -0.33 to -0.03, -0.53 to -0.15, and -1.26 to -0.62, respectively), while brain irradiation increased Hb by 0.22 g/dL (95% CI 0.05-0.38). Age, cumulative dose, and thoracic irradiation did not show a significant correlation with Hb changes. Adjusted R‑squared for the development and validation data were 0.6 and 0.71 for Hb, 0.42 and 0.11 for white blood cell count, 0.36 and 0.32 for neutrophils, 0.42 and 0.06 for absolute neutrophil count, and 0.43 and 0.36 for platelets, respectively.</p><p><strong>Conclusion: </strong>Hb levels during radiotherapy could be explained using linear regression, although they did not negatively correlate with cumulative dose.</p>","PeriodicalId":21998,"journal":{"name":"Strahlentherapie und Onkologie","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955457","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":"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":"https://doi.org/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":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}