Seminars in Radiation Oncology最新文献

Novel biomarkers for guiding treatment for prostate cancer 指导前列腺癌治疗的新生物标志物

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.002

David D. Yang, Paul L. Nguyen

引用次数: 0

The Use of Particle Therapy in Prostate Cancer 粒子疗法在前列腺癌中的应用

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.03.001

Abigail Pepin, Arun Goel, Neha Vapiwala

引用次数: 0

Postoperative Radiation Therapy and Controversies Regarding Hormonal Therapy in the Management of Prostate Cancer 前列腺癌术后放射治疗及激素治疗争议

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.009

Vérane Achard , Alan Dal Pra , Paul Sargos

{"title":"Postoperative Radiation Therapy and Controversies Regarding Hormonal Therapy in the Management of Prostate Cancer","authors":"Vérane Achard , Alan Dal Pra , Paul Sargos","doi":"10.1016/j.semradonc.2025.04.009","DOIUrl":"10.1016/j.semradonc.2025.04.009","url":null,"abstract":"<div><div>Biochemical recurrence (BCR) after radical prostatectomy (RP) remains a clinical challenge, with significant heterogeneity in outcomes and optimal management strategies. Salvage radiotherapy (sRT) is the standard approach, yet the role and duration of concurrent hormonal therapy (ADT) are still debated. Four key randomized controlled trials—RTOG 9601, GETUG-AFU 16, RTOG 0534 SPPORT, and RADICALS-HD—have explored the addition of ADT to sRT. While ADT consistently improved progression-free survival metastasis-free survival (MFS) benefit was not consistently observed, and overall survival (OS) gains were limited and primarily confined to patients with higher pre-sRT PSA levels (>0.6-0.7 ng/mL). Toxicity associated with long-term ADT, including metabolic and cardiovascular effects, underscores the importance of patient selection. Emerging tools such as PSMA PET/CT and the Decipher genomic classifier show promise in refining risk stratification. PSMA PET/CT can identify occult metastases and guide treatment planning, while Decipher can help predict who may benefit from ADT. Retrospective and prospective data support their integration into clinical practice. Recent trials evaluating intensified systemic therapy with androgen receptor pathway inhibitors (ARPIs) in combination with sRT suggest potential benefit in high-risk BCR populations, although added toxicity remains a concern. The optimal role and timing of ARPIs in the early salvage setting require further investigation. In conclusion, the decision to add ADT to sRT in BCR patients should be individualized based on PSA kinetics, imaging, and genomic profiling. Shared decision-making and future biomarker-driven trials will be key to personalizing therapy and improving outcomes while minimizing harm.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 439-449"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271458","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}

引用次数: 0

Advancing Prostate Cancer Treatment: A Review of CT and MR-Guided Online Adaptive Radiotherapy Techniques 推进前列腺癌治疗：CT和mr引导的在线适应性放疗技术综述

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.007

Jesus E. Juarez Casillas, Luca F. Valle, Jonathan Pham, Dylan O’Connell, X. Sharon Qi, James M. Lamb, Melissa Ghafarian, Michael L. Steinberg, Minsong Cao, Amar U. Kishan

{"title":"Advancing Prostate Cancer Treatment: A Review of CT and MR-Guided Online Adaptive Radiotherapy Techniques","authors":"Jesus E. Juarez Casillas, Luca F. Valle, Jonathan Pham, Dylan O’Connell, X. Sharon Qi, James M. Lamb, Melissa Ghafarian, Michael L. Steinberg, Minsong Cao, Amar U. Kishan","doi":"10.1016/j.semradonc.2025.04.007","DOIUrl":"10.1016/j.semradonc.2025.04.007","url":null,"abstract":"<div><div>Radiotherapy remains a cornerstone in the management of prostate cancer (PCa) with continuous technological advancements significantly improving precision and reducing treatment-related toxicity. Among these innovations, adaptive radiotherapy (ART) is revolutionizing the field by enhancing treatment precision through advanced imaging, real-time motion tracking, and on-table adaptive planning. ART carries the potential to optimize therapeutic outcomes by adjusting radiation dose in response to anatomical changes that previously could not be accounted for, thus minimizing damage to healthy tissue and increasing the delivery of dose to therapeutic targets. Magnetic resonance (MR) and computed tomography (CT) imaging have played pivotal roles in ART by providing detailed anatomical and functional insights for treatment planning and realtime guidance. This review explores the technical principles, clinical applications, and recent technological developments of ART in the management of PCa. It describes both offline and online ART workflows and compares CT-guided and MR-guided approaches, outlining how each modality enhances the precision of radiation delivery through improved visualization, auto-segmentation, and plan adaptation capabilities. As ART technologies continue to evolve, these imaging-guided modalities are poised to refine prostate RT by enabling safer dose escalation, minimized toxicity, and ultimately, improved patient outcomes.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 342-352"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271437","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}

引用次数: 0

Optimizing Radiation Therapy for Localized Prostate Cancer: Exploring Synergies With Androgen Deprivation Therapy and Novel Systemic Agents 优化局部前列腺癌的放射治疗：探索雄激素剥夺疗法和新型全身药物的协同作用

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.001

Krishnan R. Patel , Melissa Abel , Spyridon P. Basourakos , Deborah E. Citrin , Ravi A. Madan

引用次数: 0

Debate 3: Metastasis Directed Therapy in Oligometastatic Prostate Cancer 争论3：转移性前列腺癌的定向治疗

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.012

Maneesh Singh MD , Vedang Murthy MD , Piet Ost MD, PhD

{"title":"Debate 3: Metastasis Directed Therapy in Oligometastatic Prostate Cancer","authors":"Maneesh Singh MD , Vedang Murthy MD , Piet Ost MD, PhD","doi":"10.1016/j.semradonc.2025.04.012","DOIUrl":"10.1016/j.semradonc.2025.04.012","url":null,"abstract":"<div><div>Oligometastatic prostate cancer (OMPC), characterized by limited metastatic burden (≤5 lesions), encompasses 3 major subtypes: de novo synchronous oligometastatic hormone-sensitive prostate cancer (om-HSPC), metachronous oligorecurrent HSPC (or-HSPC), and oligoprogressive castrate-resistant prostate cancer (op-CRPC). Metastasis-directed therapy (MDT), particularly stereotactic body radiotherapy (SBRT), has been widely adopted and offers a noninvasive approach for delaying disease progression and achieving durable local control while maintaining the quality of life (QoL). This review examines the evolving evidence supporting MDT across OMPC spectrum. In de novo om-HSPC, early prospective studies suggest benefit when combining MDT with systemic therapy and local prostate radiation therapy (RT). However, conclusive randomized evidence for benefit of MDT in de-novo om-HSPC is lacking. For or-HSPC, randomized trials (STOMP, ORIOLE) demonstrate that SBRT-MDT safely delays systemic therapy initiation and prolongs progression-free survival (PFS). In nodal or-HSPC, the PEACE V-STORM trial has shown superior biochemical and locoregional control with elective nodal radiotherapy (ENRT) compared to SBRT alone. For well selected patients with OMPC, systemically augmented MDT (SBRT with short-course ADT±ARPI) is an attractive strategy to improve outcomes with no added QoL detriment and has shown more durable responses than either modality alone (EXTEND, RADIOSA trials). The recent WOLVERINE meta-analysis has shown that MDT improves PFS and overall survival across OMPC subtypes. Patient selection remains crucial, with PSA kinetics, PSMA-PET findings, and genomic factors emerging as potential biomarkers for personalizing the OMPC therapeutic landscape. While several phase III trials are ongoing, current evidence supports MDT integration into clinical practice for appropriately selected OMPC patients.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 423-432"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271456","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}

引用次数: 0

Debate 3: Oligometastatic Hormone Sensitive Prostate Cancer Management: Systemic Therapy Approach 辩论3：低转移性激素敏感性前列腺癌的管理：全身治疗方法

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.011

Gunhild von Amsberg MD , Moritz Kaune MD , Anja Coym MD , Nadja Strewinsky MD , Fabian Falkenbach MD , Jan Lukas Hohenhorst MD , Derya Tilki MD , Sergey Dyshlovoy PhD

{"title":"Debate 3: Oligometastatic Hormone Sensitive Prostate Cancer Management: Systemic Therapy Approach","authors":"Gunhild von Amsberg MD , Moritz Kaune MD , Anja Coym MD , Nadja Strewinsky MD , Fabian Falkenbach MD , Jan Lukas Hohenhorst MD , Derya Tilki MD , Sergey Dyshlovoy PhD","doi":"10.1016/j.semradonc.2025.04.011","DOIUrl":"10.1016/j.semradonc.2025.04.011","url":null,"abstract":"<div><div>Oligometastatic prostate cancer (OMPC) represents an intermediate stage between localized and extensive metastatic disease, characterized by a limited number of metastatic lesions. While metastasis-directed therapy (MDT) has gained traction for its potential to delay systemic therapy, systemic therapy itself is falling behind. In our view, this is not appropriate at the current stage. In the context of this controversy, we highlight the points that emphasize the role of systemic therapy in OMPC and point out weaknesses of data available on local treatment concepts. The lack of a standardized OMPC definition complicates the comparison of results across studies. Imaging inconsistencies, ranging from conventional techniques to advanced PSMA-PET/CT, further challenge accurate classification. Additionally, the biological basis of OMPC remains unclear, with no definitive biomarkers distinguishing it from polymetastatic disease. While MDT has demonstrated improved progression-free survival in small trials, its impact on overall survival remains inconclusive. Conversely, systemic therapy with androgen receptor pathway inhibitors (ARPIs) has shown a significant survival advantage in phase 3 trials. Subgroup analyses from large trials indicate a benefit of systemic therapy, particularly in low-volume disease. Combination strategies incorporating MDT and systemic therapy may optimize outcomes. Further research is needed to refine patient selection, integrate molecular biomarkers, and establish the optimal treatment paradigm. Until robust evidence emerges, systemic therapy remains the standard of care for OMPC.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 433-438"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271457","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}

引用次数: 0

Debate 1: Radical Prostatectomy For the Right Patient With High-Risk Prostate Cancer 辩论1：根治性前列腺切除术适合高危前列腺癌患者

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.05.001

Vinaik M. Sundaresan, Michael S. Leapman

{"title":"Debate 1: Radical Prostatectomy For the Right Patient With High-Risk Prostate Cancer","authors":"Vinaik M. Sundaresan, Michael S. Leapman","doi":"10.1016/j.semradonc.2025.05.001","DOIUrl":"10.1016/j.semradonc.2025.05.001","url":null,"abstract":"<div><div>Prostate cancer is a heterogeneous disease with varying degrees of metastatic potential and responsiveness to treatment. Whether surgical removal or radiation therapy combined with androgen deprivation therapy (ADT) is the best initial course of treatment for those with ‘high risk’ features poses an enduring clinical dilemma. In the absence of an adequate randomized clinical trial to resolve this question, contemporary decision-making seeks to balance expected treatment effectiveness and health-related quality of life over the long time horizon expected by most facing this choice. In this article, we distill the following 5 evidence-based arguments that commonly motivate patients to select radical prostatectomy as initial treatment of ‘high-risk’ prostate cancer. The first is that surgery alone provides excellent long-term cancer control and disease-related survival. Second, radical prostatectomy provides definitive local and regional disease staging, serving as the backbone for multimodality treatment if needed. Third, the sequencing of surgery before radiation is viewed as preferable beca by preserving options for effective local salvage. Fourth, initial surgery successfully defers or avoids the adverse effects of long-term androgen deprivation therapy in a substantial proportion of patients. Lastly, fifth, prostatectomy offers manageable impacts on urinary and sexual function, minimizing risk of gastrointestinal toxicity or secondary malignancy, and averts local symptomatic progression in most.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 385-392"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271441","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}

引用次数: 0

Radiopharmaceuticals in Prostate Cancer: General Considerations and Utility in Combination With EBRT 放射性药物治疗前列腺癌：与EBRT联合的一般考虑和效用

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.003

Caner Civan , Nika Guberina , Ulrich Krafft , Wolfgang P. Fendler , Martin Stuschke , Ken Herrmann

{"title":"Radiopharmaceuticals in Prostate Cancer: General Considerations and Utility in Combination With EBRT","authors":"Caner Civan , Nika Guberina , Ulrich Krafft , Wolfgang P. Fendler , Martin Stuschke , Ken Herrmann","doi":"10.1016/j.semradonc.2025.04.003","DOIUrl":"10.1016/j.semradonc.2025.04.003","url":null,"abstract":"<div><div>The management of prostate cancer has posed challenges for clinicians in determining optimal treatment strategies. Over the years, various radiopharmaceuticals have been utilized for both the diagnosis and treatment of the prostate cancer. Recent advancements in prostate specific membrane antigen (PSMA) based imaging have enabled the early and precise detection of local recurrence, lymph nodes or distant metastases, resulting a paradigm shift, which significantly influenced clinical decision making. Moreover, PSMA targeted treatments, as a part of theranostic approach, have introduced novel treatment options for patients with castration resistant metastatic prostate cancer, who were previously limited to palliative treatment alternatives. The clinical integration of PSMA based imaging and treatment has led to the commencement of collaborative studies across multiple disciplines including radiation oncology. Radiopharmaceuticals led by PSMA have the potential to facilitate accurate treatment decision making through earlier and more precise lesion detection, as well as improve patient outcomes when combined with radiotherapy. We aimed to review the role of radiopharmaceuticals in diagnosis and treatment of prostate cancer, focusing on their utility in guiding radiotherapy and the potential benefits of combining these radiopharmaceuticals with radiotherapy.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 463-473"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271449","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}

引用次数: 0

PSMA-PET Guided Radiotherapy in Prostate Cancer: A Critical Review of Current Applications and Future Directions PSMA-PET引导前列腺癌放射治疗：当前应用和未来方向的综述

IF 2.6 3区医学

Seminars in Radiation Oncology Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.05.004

Valentino Dragonetti , Marzia Colandrea , Laura Travaini , Lighea Simona Airò Farulla , Francesco Ceci , Francesco Mattana

{"title":"PSMA-PET Guided Radiotherapy in Prostate Cancer: A Critical Review of Current Applications and Future Directions","authors":"Valentino Dragonetti , Marzia Colandrea , Laura Travaini , Lighea Simona Airò Farulla , Francesco Ceci , Francesco Mattana","doi":"10.1016/j.semradonc.2025.05.004","DOIUrl":"10.1016/j.semradonc.2025.05.004","url":null,"abstract":"<div><div>Prostate-specific membrane antigen/positron emission tomography (PSMA-PET) changed the diagnostic approach in prostate cancer (PCa), providing superior diagnostic accuracy compared to conventional imaging (CI) modalities like computed tomography (CT), bone scintigraphy (BS) or other PET radiopharmaceuticals like choline or fluciclovine. This improved diagnostic accuracy plays a crucial role in its synergy with radiotherapy, particularly in the context of metastasis-directed therapy. Even in advanced stages of prostate cancer, the synergy with radiotherapy is evident in the promising results emerging from the combination of RT and RLT. To evaluate the value of PSMA as biomarker, the technological advancements in PSMA-PET, and its integration into clinical practice, focusing on its impact on RT and RLT. A comprehensive nonsystematic literature review was performed using PubMed/MEDLINE and EMBASE biomedical databases. Literature search was updated until March 2025. The most relevant studies have been summarized, giving priority to registered clinical trials and multicenter collaborations. The higher accuracy of PSMA-PET is advancing RT planning in PCa, from initial staging to salvage and metastasis-directed therapy. Ongoing trials combining RLT with external beam radiotherapy (EBRT) may expand its role into earlier stages. Key challenges include the need for long-term outcome data, standardization, cost-effectiveness, and avoiding overtreatment. Future efforts should optimize PSMA-guided RT, evaluate novel RLT combinations, and identify predictive biomarkers for personalized care. The synergy between PSMA-PET and radiotherapy enables a more effective therapeutic approach across both early and advanced stages of PCa, particularly through the promising integration with RLT.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 317-324"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271434","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}

引用次数: 0