Radiation Oncology最新文献

{"title":"Estimation of adaptive radiation therapy requirements for rectal cancer: a two-center study.","authors":"Liyuan Chen, Lei Yu, Huanli Luo, Yanju Yang, Zhen Zhang, Fu Jin, Weigang Hu, Jiazhou Wang","doi":"10.1186/s13014-024-02567-7","DOIUrl":"10.1186/s13014-024-02567-7","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer patients are potential beneficiaries of adaptive radiotherapy (ART) which demands considerable resources. Currently, there is no definite guidance on what kind of patients and when will benefit from ART. This study aimed to develop and validate a methodology for estimating ART requirements in rectal cancer before treatment course.</p><p><strong>Methods and materials: </strong>This study involved 66 rectal cancer patients from center 1 and 27 patients from center 2. The ART requirements were evaluated by comparing 8 dose volume histogram (DVH) metrics of targets and organs at risk (OARs) between planning and treatment fractions. Tolerance ranges of deviation of DVH metrics were derived from 10 patients and applied to assess fractional variability. Eighteen features, encompassing diagnostic, dosimetric, and time-related information, were utilized to formulate a stepwise logistic regression model for fraction-level ART requirement estimation. The super parameters were determined through 5-fold cross-validation with 250 training fractions and the methodology was validated with 109 internal testing fractions and 134 external testing fractions.</p><p><strong>Results: </strong>The area under the curve (AUC) of training dataset was 0.74 (95% CI: 0.61 to 0.85), while in the internal and external testing, the AUC achieved 0.76 (95% CI: 0.60-0.90) and 0.68 (95% CI: 0.56-0.81). Using a best (or clinical applicable) cut-off value of 33.4% (11%), the predictive model achieved a sensitivity of 46.2% (69.2%) and specificity of 97.9% (68.7%). During the modeling, 5 features were retained: Homogeneity index (OR = 6.06, 95% CI: 2.93-14.8), planning target volume (OR = 1.77, 95% CI: 1.17-2.69), fraction dose (OR = 45.37, 95% CI: 5.74-469), accumulated dose (OR = 2.29, 95% CI: 1.35-4.14), and whether neoadjuvant chemoradiotherapy (OR > 1000).</p><p><strong>Conclusion: </strong>ART requirements are associated with target volume, target dose homogeneity, fraction dose, dose accumulation and whether neoadjuvant radiotherapy. The predictive model exhibited the capability to predict fraction-level ART requirements.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"179"},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose to cardiac substructures and cardiovascular events in esophageal cancer patients treated with definitive radiotherapy.","authors":"Victor Nguyen, Jean-Philippe Metges, Moncef Morjani, Pierre-Guillaume Pourreau, Estelle Dhamelincourt, Lucille Quenehervé, Olivier Pradier, Vincent Bourbonne","doi":"10.1186/s13014-024-02560-0","DOIUrl":"10.1186/s13014-024-02560-0","url":null,"abstract":"<p><strong>Introduction: </strong>While there is a growing amount of data on the cardiac toxicity of radiotherapy (RT) in relation to its impact on cardiac sub-structures (CSS), there are only few studies addressing this issue in patients followed for esophageal cancer (ESOC). We aimed to evaluate the association between independent parameters of dose received by CSS and major cardiac events (MACEs) in this population.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 122 patients treated with exclusive RT or chemo-RT for ESOC. Heart and CSS i.e. right atrium, left atrium (LA), right ventricle, left ventricle and myocardium, have been automatically segmented, and dose volume histogram were extracted. Cardiac events were collected focusing on the occurrence of MACEs of grade 3 or higher (G3+) and grade 4 or higher (G4+) according to the CTCAE v5.0.</p><p><strong>Results: </strong>With a median follow-up of 21.9 months and in a population of high to very high cardiovascular risk (95.5%), 21 (17.2%) and 9 (7.4%) patients had G3 + and G4 + MACEs with a respective median time to event of 13.05 and 9.8 months. After multivariate analysis and among all heart and CSS-based dosimetric features, only the volume of LA receiving 15 Gy or more (V15LA) remained significantly associated with the G3 + and G4 + MACEs. The use of volumetric modulated arctherapy significantly reduced V15LA compared with 3D conformal RT.</p><p><strong>Conclusion: </strong>In a cohort of ESOC patients treated with exclusive RT, incidence of MACEs was associated with V15LA, underlining the importance of CSS. These high cardiovascular (CV) risk patients should benefit from standard CV assessment and strict control of their risk factors.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"175"},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of ground-glass component on prognosis in early-stage lung cancer treated with stereotactic body radiotherapy via Helical Tomotherapy.","authors":"Jintao Ma, Shaonan Fan, Wenhan Huang, Xiaohong Xu, Yong Hu, Jian He","doi":"10.1186/s13014-024-02571-x","DOIUrl":"10.1186/s13014-024-02571-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate the prognostic impact of ground-glass opacity (GGO)-component in early-stage lung cancer patients treated with stereotactic body radiotherapy (SBRT).</p><p><strong>Methods: </strong>From January 2013 to December 2022, 239 early-stage lung cancer patients (T1-2N0M0) underwent SBRT. They were categorized into two groups based on the presence of GGO-component: 65 patients in the subsolid group with a consolidation tumor ratio (CTR) between 0.25 and 1 and 174 patients in the solid group with a CTR of 1. Lung cancer-specific survival (LCSS) and progression-free survival (PFS) were analyzed using Cox regression models for both univariate and multivariate analyses to identify prognostic factors. Stabilized inverse probability of treatment weighting (IPTW) was employed for adjusting confounding factors. Recurrence incidence was assessed using competing risk analysis and compared using Gray's test.</p><p><strong>Results: </strong>In the multivariate analysis, female, peripheral location, and subsolid nodules were favorable prognostic factors for LCSS; peripheral location, subsolid nodules, and adjuvant therapy were favorable prognostic factors for PFS. Between the subsolid (n = 65) and solid groups (n = 174), the median LCSS were not reached (p = 0.003), with 3-, 5-, and 9-year LCSS rates of 94.7% versus 80.3%, 90.9% versus 64.1%, 82.7% versus 53.5%, respectively. The median PFS were 72.5 months and 50.5 months (p = 0.030), with 3-, 5-, and 9-year PFS rates of 75.4% versus 61.2%, 56.6% versus 44.9%, 48.6% versus 23.3%, respectively. After stabilized IPTW (n = 240), the median LCSS were not reached (p = 0.024), with 3-, 5-, and 9-year LCSS rates of 94.0% versus 82.4%, 92.2% versus 67.7%, 85.3% versus 58.2%, respectively. The median PFS were 60.2 months and 50.5 months (p = 0.096), with 3-, 5-, and 9-year PFS rates of 73.8% versus 61.0%, 53.5% versus 46.2%, 46.8% versus 22.4%, respectively. The subsolid group had lower rates of locoregional recurrence (LRR) (10.4% vs. 25.9%, p = 0.035) and distant metastasis (DM) (17.1% vs. 37.9%, p = 0.064) compared to the solid group.</p><p><strong>Conclusions: </strong>The presence of GGO-component in the lesion is an independent prognostic factor for LCSS and PFS. Subsolid nodules treated with SBRT demonstrated better prognosis, with significantly lower rates of local-regional recurrence. We should highlight GGO-component as a practical indicator for risk stratification of SBRT patients to guide treatment decisions.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"177"},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of definitive radiotherapy vs. laryngectomy followed by adjuvant radiotherapy in patients with locally advanced laryngeal squamous cell carcinoma: real-world experience in a referral cancer center.","authors":"Ali Kazemian, Ebrahim Esmati, Reza Ghalehtaki, Borna Farazmand, Nima Mousavi-Darzikolaee, Reyhaneh Bayani, Mahdieh Razmkhah, Maryam Taherioun, Niloufar Saeedi, Farrokh Heidari, Kaveh Zakeri","doi":"10.1186/s13014-024-02565-9","DOIUrl":"10.1186/s13014-024-02565-9","url":null,"abstract":"<p><strong>Background: </strong>Laryngeal cancer is a common head and neck cancer. Surgical treatment can impair patients' voice and swallowing function, making definitive radiotherapy a viable alternative for locally advanced cases.</p><p><strong>Methods: </strong>To compare the outcomes of definitive versus adjuvant radiotherapy in patients with primary locally advanced laryngeal cancer, we retrospectively evaluated consecutive patients treated from 2007 to 2020. We assessed and compared the median and 3-year overall survival (OS), disease-free survival (DFS), distant metastasis control (DMC), and local recurrence-free survival (LRC) in all patients and in T4 patients exclusively.</p><p><strong>Results: </strong>One hundred patients were studied, including definitive (N = 64) and adjuvant (N = 36) radiotherapy. The median follow-up was 29 months. Overall, the median OS in the definitive vs. adjuvant group was 100 months (95%CI = 46.5-153.5) vs. not reached, respectively (log-rank P = 0.506). The median DFS in the definitive vs. adjuvant group was 20 months (95%CI = 7.7-32.3) vs. not reached, respectively (log-rank P = 0.148). Three-year OS and DFS rates in all patients were 64% (95%CI: 48-78) vs. 75% (95%CI: 55-95) and 43% (95%CI:29-57) vs. 61% (95%CI: 41-81) in the definitive vs. adjuvant groups, respectively. Among T4 patients, the median OS in the definitive RT group vs. adjuvant group was not reached vs. 48 (95%CI = 0-105.3), respectively (log-rank P = 0.788). The median DFS in the definitive RT group vs. adjuvant group was 12 months (95%CI = 9.34-14.65) vs. 36 months (95%CI = 4.4-67.5), respectively (log-rank P = 0.868). Three-year OS and DFS rates were 71% (95%CI: 42-100) vs. 75% (95%CI: 50-100) and 40% (95%CI:21-79) vs. 56% (95%CI: 25-87) in the definitive vs. adjuvant groups, respectively.</p><p><strong>Conclusions: </strong>Our analysis suggests that definitive radiotherapy in laryngeal cancer does not lead to a poorer outcome than total laryngectomy followed by adjuvant radiotherapy. In T4 patients, our findings should reassure clinicians and patients about the viability of definitive radiotherapy as a treatment approach.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"180"},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing intra- and interfraction motion and its dosimetric impacts on cervical cancer adaptive radiotherapy based on 1.5T MR-Linac.","authors":"Huadong Wang, Zhenkai Li, Dengxin Shi, Peijun Yin, Benzhe Liang, Jingmin Zou, Qiuqing Tao, Wencheng Ma, Yong Yin, Zhenjiang Li","doi":"10.1186/s13014-024-02569-5","DOIUrl":"10.1186/s13014-024-02569-5","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to quantify the intra- and interfraction motion of the target volume and organs at risk (OARs) during adaptive radiotherapy (ART) for uterine cervical cancer (UCC) using MR-Linac and to identify appropriate UCC target volume margins for adapt-to-shape (ATS) and adapt-to-position (ATP) workflows. Then, the dosimetric differences caused by motion were analyzed.</p><p><strong>Methods: </strong>Thirty-two UCC patients were included. Magnetic resonance (MR) images were obtained before and after each treatment. The maximum and average shifts in the centroid of the target volume and OARs along the anterior/posterior (A/P: Y axes), cranial/caudal (Cr/C: Z axes), and right/left (R/L: X axes) directions were analyzed through image contours. The bladder wall deformation in six directions and the differences in the volume of the organs were also analyzed. Additionally, the motion of the upper, middle and lower rectum was quantified. The correlation between OAR displacement/deformation and target volume displacement was evaluated. The planning CT dose distribution was mapped to the MR image to generate a plan based on the new anatomy, and the dosimetric differences caused by motion were analyzed.</p><p><strong>Results: </strong>For intrafraction motion, the clinical tumor volume (CTV) range of motion along the XYZ axes was within 5 mm; for interfraction motion, the range of motion along the X axis was within 5 mm, and the maximum distances of motion along the Y axis and Z axis were 7.45 and 6.59 mm, respectively. Additionally, deformation of the superior and anterior walls of the bladder was most noticeable. The largest magnitude of motion was observed in the upper segment of the rectum. Posterior bladder wall displacement was correlated with rectal and CTV centroid Y-axis displacement (r = 0.63, r = 0.50, P < 0.05). Compared with the interfractional plan, a significant decrease in the planning target volume (PTV) D98 (7.5 Gy, 7.54 Gy) was observed. However, there were no significant differences within the intrafraction.</p><p><strong>Conclusion: </strong>During ART for UCC patients using MR-Linac, we recommend an ATS workflow using isotropic PTV margins of 5 mm based on intrafraction motion. Based on interfraction motion, the recommended ATP workflow uses anisotropic PTV margins of 5 mm in the R/L direction, 8 mm in the A/P direction, and 7 mm in the Cr/C direction to compensate for dosimetric errors due to motion.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"176"},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone matching versus tumor matching in image-guided carbon ion radiotherapy for locally advanced non-small cell lung cancer.","authors":"Jing Mi, Shubin Jia, Liyuan Chen, Yaqi Li, Jiayao Sun, Liwen Zhang, Jingfang Mao, Jian Chen, Ningyi Ma, Jingfang Zhao, Kailiang Wu","doi":"10.1186/s13014-024-02564-w","DOIUrl":"10.1186/s13014-024-02564-w","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study evaluates the dosimetric impact of tumor matching (TM) and bone matching (BM) in carbon ion radiotherapy for locally advanced non-small cell lung cancer.</p><p><strong>Materials and methods: </strong>Forty patients diagnosed with locally advanced non-small cell lung cancer were included in this study. TM and BM techniques were employed for recalculation based on re-evaluation computed tomography (CT) images of the patients, resulting in the generation of dose distributions: Plan-T and Plan-B, respectively. These distributions were compared with the original dose distribution, Plan-O. The percentage of the internal gross tumor volume (iGTV) receiving a prescription dose greater than 95% (V95%) was evaluated using dose-volume parameters. Statistical analysis was performed using a paired signed-rank sum test. Additionally, the study investigated the influence of tumor displacement, volume changes, and rotational errors on target dose coverage.</p><p><strong>Results: </strong>The median iGTV V95% values for the Plan-O, Plan-T, and Plan-B groups were 100%, 99.93%, and 99.60%, respectively, with statistically significant differences observed. TM demonstrated improved target dose coverage compared to BM. Moreover, TM exhibited better target coverage in case of larger tumor displacement. TM's increased adjustability in rotation directions compared to BM significantly influenced dosimetric outcomes, rendering it more tolerant to variations in tumor morphology.</p><p><strong>Conclusion: </strong>TM exhibited superior target dose coverage compared to BM, particularly in cases of larger tumor displacement. TM also demonstrated better tolerance to variations in tumor morphology.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"178"},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic body radiotherapy as metastasis-directed therapy in oligometastatic prostate cancer: a systematic review and meta-analysis of randomized controlled trials.","authors":"Astrid E Persson, Andreas Hallqvist, Louise Bjørn Larsen, Mette Rasmussen, Jonas Scherman, Per Nilsson, Hanne Tønnesen, Adalsteinn Gunnlaugsson","doi":"10.1186/s13014-024-02559-7","DOIUrl":"10.1186/s13014-024-02559-7","url":null,"abstract":"<p><strong>Background: </strong>The use of stereotactic body radiotherapy (SBRT) to definitively treat oligometastases in prostate cancer has drawn large clinical and research interests within radiation oncology. However, the evidence is considered in its early stages and there is currently no systematic review of randomized controlled trials (RCTs) in this field. We aimed to evaluate the efficacy and safety of SBRT as metastasis-directed therapy (MDT) in oligometastatic prostate cancer (OMPC) compared to no MDT reported in RCTs.</p><p><strong>Methods: </strong>MEDLINE, Embase, CINAHL Complete, and Cochrane Library were searched on October 28, 2023. Eligible studies were RCTs comparing SBRT as MDT with no MDT in extracranial OMPC, without restrictions on follow-up time, publication status, language, or year. Participant subsets fulfilling the eligibility criteria were included. Critical outcomes were overall survival and grade ≥ 3 toxicity, and additional important outcomes were progression-free survival (PFS), local control, grade 5 toxicity, health-related quality of life, and systemic therapy-free survival. Meta-analyses were planned. Risk of bias was assessed using the Cochrane risk-of-bias tool version 2, and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Results: </strong>In total, 1825 unique study reports were identified and seven phase II RCTs with 559 eligible participants were included. Four trials included multiple types of primary cancer. Outcome definitions were heterogeneous except for overall survival and toxicity. For overall survival, only one study reported events in both arms. Meta-analysis of the grade ≥ 3 toxicity results from two trials showed no difference (pooled risk ratio 0.78, 95% confidence interval 0.37-1.65, p = 0.52). Four trials reported significantly longer PFS, with a pooled hazard ratio of 0.31 (95% confidence interval 0.21-0.45, p < 0.00001). Risk of bias was of some concerns or high. Quality of evidence was low or moderate.</p><p><strong>Conclusions: </strong>Phase II trials have shown promising improvements in PFS for several OMPC states without excess toxicity. Overall survival comparisons are immature. In future confirmatory phase III trials, adequately large sample sizes, blinding of outcome assessors, and/or increased adherence to assigned intervention could improve the quality of evidence. PROSPERO registration number: CRD42021230131.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"173"},"PeriodicalIF":3.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term and long-term oncological outcomes of chemoradiotherapy for rectal cancer patients with or without oxaliplatin: a propensity score-matched retrospective analysis.","authors":"Amirali Azimi, Fatemeh Sadat Tabatabaei, Kasra Kolahdouzan, Hamideh Rashidian, Forouzan Nourbakhsh, Maryam Abedini Parizi, Nima Mousavi Darzikolaee, Reyhaneh Bayani, Samaneh Salarvand, Azadeh Sharifian, Farzaneh Bagheri, Saeed Rezaei, Naeim Nabian, Reza Nazari, Negin Mohammadi, Mohammad Babaei, Marzieh Lashkari, Farshid Farhan, Mahdi Aghili, Felipe Couñago, Maria Antonietta Gambacorta, Reza Ghalehtaki","doi":"10.1186/s13014-024-02562-y","DOIUrl":"10.1186/s13014-024-02562-y","url":null,"abstract":"<p><strong>Background/aim: </strong>Current approaches for locally advanced rectal cancer (LARC) typically recommend neoadjuvant chemoradiotherapy (nCRT) with 5-fluorouracil (5FU) or its oral analogs followed by surgery as the standard of care. However, the question of whether intensifying concurrent chemotherapy by adding oxaliplatin to the 5FU-based backbone can yield better outcomes remains unresolved. This study aimed to investigate the benefits of incorporating oxaliplatin into fluoropyrimidine-based chemoradiotherapy (CRT) to increase locoregional control and survival.</p><p><strong>Methods: </strong>Among 290 patients with LARC admitted to the Iran Cancer Institute's radiation oncology department between January 2008 and December 2019, 29 received CAPEOX (capecitabine 625 mg/m²/bid on RT days and weekly oxaliplatin 50 mg/m²), whereas 293 received capecitabine (825 mg/m² twice daily or rarely 5FU in the first 4 days and last week of radiotherapy (RT)). Variables potentially affecting treatment outcomes were used for propensity score matching. Kaplan‒Meier and log-rank tests were employed for overall survival (OS) and disease-free survival (DFS) analyses and were adjusted with propensity score matching.</p><p><strong>Results: </strong>Data from 29 patients who received CAPEOX and 216 patients who received capecitabine were analyzed after propensity score matching without replacement. After propensity score matching, in the multivariate analysis, CAPEOX significantly increased the likelihood of achieving a pathologic complete response (pCR) by 4.38 times (CI: 1.90-10.08, p value < 0.001). However, CAPEOX did not demonstrate any statistically significant predictive value for DFS (P = 0.500) or OS (P = 0.449).</p><p><strong>Conclusion: </strong>The addition of oxaliplatin resulted in a significantly higher rate of pCR without any translation into long-term survival outcomes.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"172"},"PeriodicalIF":3.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of antipsychotic drugs during radiotherapy in adult cancer patients in Korea: a nationwide retrospective cohort study based on the national health insurance service database.","authors":"In Gyu Hwang, Song E Park, Sun Mi Kim, Dae Ryong Kang, Tae-Hwa Go, Se Hwa Hong, Yong-Chan Ha, Shin Young Park, Hyunho Lee, Jin Hwa Choi","doi":"10.1186/s13014-024-02558-8","DOIUrl":"10.1186/s13014-024-02558-8","url":null,"abstract":"<p><strong>Background: </strong>Antipsychotic drugs (APDs) are used for treating mental illnesses and are also used by cancer patients. This study aimed to evaluate APD use in adult cancer patients who received radiotherapy (RT) in South Korea and assess the effects of APD use during RT on survival.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the National Health Insurance Service database database of Korea. We included adult cancer patients who underwent RT or chemotherapy (CTx, cisplatin, or 5-Fluorouracil) between 2010 and 2020. The APDs included in the analysis were aripiprazole, quetiapine, olanzapine, risperidone, haloperidol, and chlorpromazine.</p><p><strong>Results: </strong>Overall, 725,897 patients received RT, and 115,500 received concomitant chemo-radiotherapy (CCRT). Of them, 41,118 (5.6%) took APDs during RT, and 8,129 (7%) took APDs during CCRT. Overall, 27,789 (67.58%) patients who took APDs during RT were men, and 28,004 (68.2%) were aged ≥ 60 years. The most frequently used APD during RT was quetiapine (64.93%). Patients who took APDs during RT and during CCRT had higher mortality rates (HR: 3.45 and 1.72, p < 0.0001, respectively) compared to the non-APD patients. Of the patients who used APDs during RT, patients accompanying psychiatric diagnosis, taking high-dose APD, and taking APD for more than 3 months had lower mortality than patients without psychiatric diagnosis, taking low-dose APD, and taking APD for less than 3 months, respectively (HR: 0.88, 0.87 and 0.80, respectively, p < 0.0001).</p><p><strong>Conclusions: </strong>Only 5.6% of patients who underwent RT used APDs, and quetiapine was the most frequently prescribed APD during RT. The use of APD during RT may adversely affect survival. Further studies are required to elucidate the effects of APDs on cancer patients.</p><p><strong>Trial registration: </strong>This study is retrospectively registered.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"171"},"PeriodicalIF":3.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose prediction of CyberKnife Monte Carlo plan for lung cancer patients based on deep learning: robust learning of variable beam configurations.","authors":"Yuchao Miao, Jiwei Li, Ruigang Ge, Chuanbin Xie, Yaoying Liu, Gaolong Zhang, Mingchang Miao, Shouping Xu","doi":"10.1186/s13014-024-02531-5","DOIUrl":"10.1186/s13014-024-02531-5","url":null,"abstract":"<p><strong>Background: </strong>Accurate calculation of lung cancer dose using the Monte Carlo (MC) algorithm in CyberKnife (CK) is essential for precise planning. We aim to employ deep learning to directly predict the 3D dose distribution calculated by the MC algorithm, enabling rapid and accurate automatic planning. However, most current methods solely focus on conventional intensity-modulated radiation therapy and assume a consistent beam configuration across all patients. This study seeks to develop a more versatile model incorporating variable beam configurations of CK and considering the patient's anatomy.</p><p><strong>Methods: </strong>This study proposed that the AB (anatomy and beam) model be compared with the control Mask (only anatomy) model. These models are based on a 3D U-Net network to investigate the impact of CK beam encoding information on dose prediction. The study collected 86 lung cancer patients who received CK's built-in MC algorithm plans using different beam configurations for training/validation (66 cases) and testing (20 cases). We compared the gamma passing rate, dose difference maps, and relevant dose-volume metrics to evaluate the model's performance. In addition, the Dice similarity coefficients (DSCs) were calculated to assess the spatial correspondence of isodose volumes.</p><p><strong>Results: </strong>The AB model demonstrated superior performance compared to the Mask model, particularly in the trajectory dose of the beam. The DSCs of the AB model were 20-40% higher than that of the Mask model in some dose regions. We achieved approximately 99% for the PTV and generally more than 95% for the organs at risk (OARs) referred to the clinical planning dose in the gamma passing rates (3 mm/3%). Relative to the Mask model, the AB model exhibited more than 90% improvement in small voxels (p < 0.001). The AB model matched well with the clinical plan's dose-volume histograms, and the average dose error for all organs was 1.65 ± 0.69%.</p><p><strong>Conclusions: </strong>Our proposed new model signifies a crucial advancement in predicting CK 3D dose distributions for clinical applications. It enables planners to rapidly and precisely predict MC doses for lung cancer based on patient-specific beam configurations and optimize the CK treatment process.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"19 1","pages":"170"},"PeriodicalIF":3.3,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}