Radiation Oncology最新文献

{"title":"Prophylactic cranial irradiation in resected early stage small cell lung cancer: an updated systematic review and meta-analysis.","authors":"Ze Yuan, Dan Tao, Dingyi Yang, Yong Jiang, Erha Munai, Siwei Zeng, Zhiying Zhou, Wei Zhou, Yongzhong Wu","doi":"10.1186/s13014-025-02644-5","DOIUrl":"10.1186/s13014-025-02644-5","url":null,"abstract":"<p><strong>Background: </strong>The use of prophylactic cranial irradiation (PCI) in early stage small cell lung cancer (SCLC) patients post-surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of PCI in resected early stage SCLC patients.</p><p><strong>Methods: </strong>Relevant literature was reviewed through PubMed, Cochrane, and Embase databases. The pooled hazard ratios (HRs) for overall survival (OS) were analyzed for the overall population, as well as for pathologically node-negative (pN0) and pathologically node-positive (pN+) patients. We also assessed the pooled HRs for brain metastasis-free survival (BMFS) in all patients. Sensitivity analyses were conducted to validate these results.</p><p><strong>Results: </strong>A total of 13 retrospective studies were included, encompassing 3,530 postoperative SCLC patients, of whom 880 received PCI treatment. In the overall patient population, PCI significantly improved OS compared to non-PCI group (HR: 0.66, 95% CI 0.58-0.74, p < 0.001). For pN0 patients, there was no significant OS benefit from PCI (HR: 0.85, 95% CI 0.65-1.10, p = 0.22). In contrast, pN + patients showed a significant OS improvement with PCI (HR: 0.52, 95% CI 0.41-0.66, p < 0.001). Furthermore, PCI significantly improved BMFS in all patients (HR: 0.42, 95% CI 0.29-0.60, p < 0.001). Sensitivity analyses confirmed the stability of these results.</p><p><strong>Conclusions: </strong>PCI was associated with a significant improvement in OS and BMFS in resected early stage SCLC patients. The benefits of PCI were particularly pronounced in pN + patients, whereas pN0 patients did not experience a significant OS benefit. These findings supported the selective use of PCI based on nodal status to optimize treatment outcomes in postoperative SCLC patients.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"82"},"PeriodicalIF":3.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112459","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":"The role of radiotherapy in small cell carcinoma of the esophagus: a retrospective study.","authors":"Hui Yang, Yan Li, Hong Ge","doi":"10.1186/s13014-025-02662-3","DOIUrl":"10.1186/s13014-025-02662-3","url":null,"abstract":"<p><strong>Background: </strong>Primary small cell carcinoma of the esophagus (SCCE) is an aggressive carcinoma with a rare incidence. Most patients were diagnosed with stage III-IV and have a poor prognosis. The poor therapeutic outcomes of SCCE reveal the need for more rational therapies.</p><p><strong>Methods: </strong>We retrospectively reviewed 15,463 patients with esophageal carcinoma from January 2015 to December 2020. 235 (1.52%) patients were pathologically diagnosed with primary SCCE. Clinical characteristics and treatment information were extracted from medical records. All statistical analyses were performed with the SPSS software. Patients were divided into radiotherapy (RT) group and non-RT group. The chi-square test was conducted to analyze the difference in baseline characteristics and propensity score matching (PSM) was used to balance the patient characteristics. Univariate and multivariate analysis was used to identify independent prognostic factors and calculated the estimated hazard ratio (HR) and 95% confidence interval (CI). The Kaplan-Meier method was used to draw survival curves, calculate the median overall survival (OS), and compare prognosis between groups with the log-rank p test. The two-tailed p value less than 0.05 indicated a significant difference.</p><p><strong>Results: </strong>The median OS was 15.2 months (range:13.4-17.1 months). The addition of RT improved median OS from 14.3 months to 16.5 months, but the difference was not statistically significant (p = 0.657). After PSM, the median OS of the RT group was longer than the non-RT group (16.5 months vs. 11.5 months, p < 0.001). Multivariate analysis identified RT (HR: 0.711, 95%CI: 0.533-0.949, p = 0.020), surgery (HR: 0.490, 95%CI: 0.365-0.660, p < 0.001), and smoking history (HR: 1.335, 95%CI: 1.010-1.765, p = 0.042) as independent prognostic factors. Subgroup analysis showed that RT was not a prognostic factor in patients with surgery (p = 0.450), but could significantly improve OS in patients without surgery (HR: 0.585, 95%CI: 0.415-0.824, p = 0.002). Both middle and lower thoracic SCCE patients could benefit from the addition of RT. RT could improve OS regardless of Ki67 expression level. Subgroup analyses also indicated that stage IV, age ≥ 60, no smoking history, pure SCCE, Syn-positive, CgA-positive, CD56-positive patients could benefit from RT.</p><p><strong>Conclusions: </strong>SCCE patients could benefit from RT, especially those without surgery. Further studies are required for confirmation of the conclusion.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"79"},"PeriodicalIF":3.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103090","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":"Deep learning-powered radiotherapy dose prediction: clinical insights from 622 patients across multiple sites tumor at a single institution.","authors":"Zhen Hou, Lang Qin, Jiabing Gu, Zidong Liu, Juan Liu, Yuan Zhang, Shanbao Gao, Jian Zhu, Shuangshuang Li","doi":"10.1186/s13014-025-02634-7","DOIUrl":"10.1186/s13014-025-02634-7","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate pre-treatment dose prediction is essential for efficient radiotherapy planning. Although deep learning models have advanced automated dose distribution, comprehensive multi-tumor analyses remain scarce. This study assesses deep learning models for dose prediction across diverse tumor types, combining objective and subjective evaluation methods.</p><p><strong>Methods and materials: </strong>We included 622 patients with planning data across various tumor sites: nasopharyngeal carcinoma (n = 29), esophageal carcinoma (n = 82), left-sided breast carcinoma (n = 107), right-sided breast carcinoma (n = 95), cervical carcinoma treated with radical radiotherapy (n = 84), postoperative cervical carcinoma (n = 122), and rectal carcinoma (n = 103). Dose predictions were generated using U-Net, Flex-Net, and Highres-Net models, with data split into training (60%), validation (20%), and testing (20%) sets. Quantitative comparisons used normalized dose difference (NDD) and dose-volume histogram (DVH) metrics, and qualitative assessments by radiation oncologists were performed on the testing set.</p><p><strong>Results: </strong>Predicted and clinical doses correlated well, with NDD values under 3% for tumor targets in nasopharyngeal, breast, and postoperative cervical cancer. Qualitative assessments revealed that U-Net, Flex-Net, and Highres-Net achieved the highest accuracy in cervical radical, breast/rectal/postoperative cervical, and nasopharyngeal/esophageal cancers, respectively. Among the test cases (n = 123), 53.7% were deemed clinically acceptable and 32.5% required minor adjustments. The \"Best Selection\" approach, combining strengths of all three models, raised clinical acceptance to 62.6%.</p><p><strong>Conclusion: </strong>This study demonstrates that automated dose prediction can provide a robust starting point for rapid plan generation. Leveraging model-specific strengths through the \"Best Selection\" approach enhances prediction accuracy and shows potential to improve clinical efficiency across multiple tumor types.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"80"},"PeriodicalIF":3.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103089","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":"Iodine-125 plesiotherapy for murine tumor treatment.","authors":"Audrey Glory, Rodin Chermat, Julie Lafontaine, Danh Tran-Thanh, Philip Wong","doi":"10.1186/s13014-025-02657-0","DOIUrl":"10.1186/s13014-025-02657-0","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy (RT) is one of the four pillars of cancer treatment. Plesiotherapy, or contact brachytherapy, involves irradiating a tumor by placing small radioactive sources directly on the skin's surface above the tumor. In this study, we evaluated the efficacy of a novel local external radiation technique using iodine-125 seeds enclosed within a 3D-printed case, positioned externally on the tumor surface.</p><p><strong>Methods: </strong>First, the protocol was tested on the skin of NodRag1 mice with doses up to 10 Gy (at the skin), and the results demonstrated no signs of skin toxicity. Subsequently, this protocol was used to locally irradiate subcutaneous MDA-MB-231 triple-negative breast cancer and MCA-205 fibrosarcoma tumors via a single 10 Gy dose at the tumor center.</p><p><strong>Results: </strong>RT significantly hindered tumor growth, with irradiated tumors being approximately half the size of nonirradiated tumors on the same day. Importantly, the irradiated mice exhibited no apparent systemic side effects, as evidenced by stable body weight and unaffected behavior, including alertness, appearance, and activity levels. Moreover, no instances of skin toxicity were observed.</p><p><strong>Conclusions: </strong>This in vivo plesiotherapy protocol offers a straightforward and cost-effective means of advancing research on RT in a variety of laboratory settings.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"78"},"PeriodicalIF":3.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086917","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":"The role of deep hyperthermia in IMRT in elderly patients with esophageal cancer: a retrospective cohort study.","authors":"Mengjiao Wang, Jian Yang, Dafei Wang, Juying Zhou, Songbing Qin, Yang Jiao, Lili Wang","doi":"10.1186/s13014-025-02661-4","DOIUrl":"10.1186/s13014-025-02661-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to assess the clinical utility of deep hyperthermia in elderly patients with esophageal cancer(EC) who underwent intensity-modulated radiotherapy(IMRT).</p><p><strong>Patients and methods: </strong>This retrospective analysis included 177 elderly patients with EC who underwent IMRT between 2017 and 2023, 42 of whom had combined deep hyperthermia (HT). Propensity score matching (PSM) was used to balance the covariates between the thermoradiotherapy (HTRT) group and IMRT-alone groups. Treatment outcomes and toxicities were compared between the two groups. We used the Kaplan-Meier method to estimate survival curves and the log-rank test to compare survival curves. Cox multivariate analysis was performed to analyze the prognostic factors in these patients.</p><p><strong>Results: </strong>After PSM (42 patients in each group), the HTRT group had a greater objective response rate (ORR) than the IMRT-alone group (83% vs. 62%, P = 0.028). The HTRT group had less radiotherapy-related toxicity, including a lower incidence of leukopenia (14% vs. 33%, P = 0.040) and RP grade ≥ 2 (P = 0.012). However, the 1-, 2-, and 3-year overall survival (OS) rates and 1-, 2-, and 3-year disease-free survival (DFS) rates were not significantly different (P = 0.730, 0.964). Grade ≥ 2 hypoproteinemia (odds ratio [OR] = 3.798, P = 0.004), radiotherapy dose ≤ 60 Gy (OR = 0.445, P = 0.006), and tumor location in the lower esophagus (OR = 0.387, P = 0.005) were adverse prognostic factors for OS. Hypoproteinemia grade ≥ 2 (OR = 3.676, P < 0.001) was also a crucial prognostic factor for DFS.</p><p><strong>Conclusion: </strong>Adding deep hyperthermia to IMRT can improve the ORR in elderly patients with EC. In addition, it significantly reduces radiotherapy-related toxicity. Although this approach does not improve the long-term prognosis, it is still practical and has low toxicity, making it suitable for clinical use.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"76"},"PeriodicalIF":3.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081615","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":"Are treatment plans optimized on the basis of acuros XB dose calculation robust against anatomic changes during online adaptive radiotherapy for lung cancer regarding dose homogeneity?","authors":"Khouya Aymane, Santiago Alina, Ringbaek Toke, Guberina Nika, Guberina Maja, Gauler Thomas, Lübcke Wolfgang, Zylka Waldemar, Pöttgen Christoph, Stuschke Martin","doi":"10.1186/s13014-025-02656-1","DOIUrl":"10.1186/s13014-025-02656-1","url":null,"abstract":"<p><strong>Introduction: </strong>The Acuros XB dose calculation algorithm implements advanced modelling of lateral electron transport, making dose distributions sensitive to density changes between source and subsequent CT. The aim of this study was to analyse the robustness of dose distribution in the central bronchial wall (CBW) of treatment plans from lung cancer patients treated with adaptive radiotherapy.</p><p><strong>Material and methods: </strong>IMRT or VMAT plans from patients with locally advanced lung cancer from a prospective registry cohort were analysed, who received definitive radiotherapy in surface-guided inspiratory breath-hold on the Ethos™ closed-bore linac, equipped with the HyperSight™ cone beam CT (CBCT). Dose homogeneity of the scheduled plans, optimized on planning CT (CTplan), was verified on the initial CBCT of a dose fraction (CBCT1). The adaptive plans were verified on a subsequent post-adaptation CBCT (CBCT2) of the same dose fraction. A predictive model was built for maximum dose (Dmax) in CBW in dependence on plan sensitivity in the central bronchial air lumen overlapping the planning target volume (CBAL_PTV) to water override (WOR) of the air lumen.</p><p><strong>Results: </strong>Ninety-one dose-fractions from 10 patients were analysed. Dmax values in the CBW of the scheduled plans showed over all significant inter-fractional increases from CTplan to subsequent CBCT1 (p < 0.0001, Wilcoxon test, stratified by patient) with significant heterogeneity between patients (p < 0.0001, Kruskal-Wallis Test). The median Dmax increase per dose fraction was 2.15% (-3.15 - 19.30%). Reducing the PTV overlap of scheduled plans with CBAL led to lower inter-fractional Dmax increases in CBW (p < 0.0001, signed rank test). Dose accumulation showed, that Dmax and D1cc values in CBW over the treatment course stayed in all patients below 110.5% and 107.5% and that the equivalent uniform dose in CTV around the CBW stayed > 95% for scheduled plans. A predictive model showed the dependence of inter-fractional Dmax increases in CBW of scheduled plans on an interaction between plan sensitivity on CTplan to WOR in CBAL_PTV and density change at the Dmax point in CBCT1 between CTplan and CBCT1 (p < 0.0001, t-test). Intra-fractional Dmax increases of adaptive plans in CBW amounted to only 20% +/- 1.1% of the inter-fractional increases of scheduled plans, as intra-fractional deformations were smaller than inter-fractional (p < 0.0001, signed rank test).</p><p><strong>Conclusion: </strong>Dose homogeneity in CBW of Ethos plans were found sufficiently robust against intra-fractional deformations during course of online adaptive radiotherapy. Plan sensitivity to anatomic changes can be detected and controlled on the planning CT by the WOR of air in CBAL_PTV.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"75"},"PeriodicalIF":3.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081542","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":"Feasibility study of automatic radiotherapy treatment planning for cervical cancer using a large language model.","authors":"Shuoyang Wei, Ankang Hu, Yongguang Liang, Jingru Yang, Lang Yu, Wenbo Li, Bo Yang, Jie Qiu","doi":"10.1186/s13014-025-02660-5","DOIUrl":"10.1186/s13014-025-02660-5","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy treatment planning traditionally involves complex and time-consuming processes, often relying on trial-and-error methods. The emergence of artificial intelligence, particularly Large Language Models (LLMs), surpassing human capabilities and existing algorithms in various domains, presents an opportunity to automate and enhance this optimization process.</p><p><strong>Purpose: </strong>This study seeks to evaluate the capacity of LLMs to generate radiotherapy treatment plans comparable to those crafted by human medical physicists, focusing on target volume conformity and organs-at-risk (OARs) dose sparing. The goal is to automate the optimization process of radiotherapy treatment plans through the utilization of LLMs.</p><p><strong>Methods: </strong>Multiple LLMs were employed to adjust optimization parameters for radiotherapy treatment plans, using a dataset comprising 35 cervical cancer patients treated with volumetric modulated arc therapy (VMAT). Customized prompts were applied to 5 patients to tailor the LLMs, which were subsequently tested on 30 patients. Evaluation metrics included target volume conformity, dose homogeneity, monitor units (MU) value, and OARs dose sparing, comparing plans generated by various LLMs to manual plans.</p><p><strong>Results: </strong>With the exception of Gemini-1.5-flash, which faced challenges due to hallucinations, Qwen-2.5-max and Llama-3.2 produced acceptable VMAT plans in 16.3 ± 5.0 and 9.8 ± 2.1 min, respectively, outperforming an experienced human physicist's time cost of about 20 min. The average conformity index (CI) for Qwen-2.5-max plans, Llama-3.2 plans, and manual plans on the test set were 0.929 ± 0.007, 0.928 ± 0.007, and 0.926 ± 0.007, respectively. The average homogeneity index (HI) was 0.058 ± 0.006, 0.059 ± 0.005, and 0.065 ± 0.006, respectively. While there was a significant difference in target volume conformity between LLM plans and manual plans, OARs dose sparing showed no significant variations. In lateral comparisons among different LLMs, no statistically significant differences were observed in the PTV dose, OARs dose sparing, and target volume conformity between Qwen-2.5-max and Llama-3.2 plans.</p><p><strong>Conclusions: </strong>Through an assessment of LLM-generated plans and clinical plans in terms of target volume conformity and OARs dose sparing, this study provides preliminary evidence supporting the viability of LLMs for optimizing radiotherapy treatment plans. The implementation of LLMs demonstrates the potential for enhancing clinical workflows and reducing the workload associated with treatment planning.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"77"},"PeriodicalIF":3.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081610","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":"Expanded analysis of vertebral endplate disruption and its impact on vertebral compression fracture risk.","authors":"Khaled Dibs, Prasath Mageswaran, Raju Raval, Evan Thomas, Emile Gogineni, Jeff Pan, Brett Klamer, Ahmet Ayan, Eric Bourekas, Daniel Boulter, Nicholas Fetko, Eric Cochran, Vikram Chakravarthy, John McGregor, Esmerina Tili, Joshua Palmer, Natalie Peters, Russell Lonser, Ahmed Elguindy, Eugene Yap, Soheil Soghrati, William Marras, John Grecula, Arnab Chakravarti, James Elder, Dukagjin Blakaj","doi":"10.1186/s13014-025-02658-z","DOIUrl":"https://doi.org/10.1186/s13014-025-02658-z","url":null,"abstract":"<p><strong>Background and objectives: </strong>Vertebral compression fracture (VCF) is a potential serious complication of spinal stereotactic body radiotherapy (SBRT). Previously we noted a correlation between advanced Spinal Instability Neoplastic Score (SINS), tumor-related endplate (EP) disruption, and certain primary pathologies with increased VCF risk. Here, we report on an expanded patient cohort to further examine EP disruption's role in VCF.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single institution, gathering demographic and treatment data from patients who underwent spinal SBRT between 2013 and 2020. EP disruption was identified on pre-SBRT CT scans. Chronic steroid use was defined as steroids administered for 4 weeks or more. The 1-year cumulative incidence of VCF was evaluated by follow-up MRI and CT scans at 3-month intervals post-treatment. Based on multivariate analysis, a nomogram was created using four independent predictors: EP disruption, steroid use, SINS ≥ 7, and adverse histology.</p><p><strong>Results: </strong>A total of 173 patients were included. The median follow-up was 19 months. Approximately 69 patients (40%) had EP disruption. Thirty patients (17%) experienced a VCF at a median of 4.8 months from SBRT. Patients with adverse histology (HR 2.98, 95% CI [1.42-6.30], p 0.004), steroid use (HR 3.60, 95% CI [1.36-9.51], p 0.01), EP disruption (HR 4.16, 95% CI [1.57-11.05], p 0.004) and a SINS of ≥ 7 (HR 3.63, 95% CI [1.39-9.46], p 0.001) were associated with increased risk of VCF. Based on these findings, a nomogram was created with these four variables stratifying groups at low, intermediate, and high risk of VCF correlating with rates of 2%, 21% and 58% risk (P <.001).</p><p><strong>Conclusion: </strong>In this expanded pooled analysis, consistent with previously published findings, EP disruption, adverse pathology, and higher SINS scores were associated with an increased risk of VCF. Additionally, we found that chronic steroid use for four weeks or greater also correlated with a higher risk of VCF.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"74"},"PeriodicalIF":3.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081546","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":"Risk stratification of node-positive early-stage cervical cancer treated with radical hysterectomy followed by chemoradiotherapy: a retrospective single-center study.","authors":"Shuang-Zheng Jia, Duan Yang, Xue-Jiao Yang, Rui Wang, Xi Yang, Man-Ni Huang, Ju-Sheng An","doi":"10.1186/s13014-025-02655-2","DOIUrl":"10.1186/s13014-025-02655-2","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the effectiveness of concurrent chemoradiotherapy (CRT) using intensity-modulated radiation therapy (IMRT) after radical surgery in patients with node-positive early-stage cervical cancer. This study aimed to identify prognostic factors and categorize patients into risk groups for personalized adjuvant therapy.</p><p><strong>Methods: </strong>The study included consecutive patients with pathologically confirmed node-positive cervical cancer who underwent radical hysterectomy and lymphadenectomy followed by CRT from January 2013 to October 2024 at our institute. Patients with parametrial invasion or positive resection margins were excluded. All patients received modern volumetric-modulated arc therapy with platinum-based concurrent chemotherapy. Data on clinicopathologic features, treatment details, and oncologic outcomes were collected. Univariate and multivariate Cox regression analyses were conducted to identify factors associated with disease-free survival (DFS) and overall survival (OS). Patients were further stratified into distinct risk categories for recurrence based on identified prognostic factors.</p><p><strong>Results: </strong>A total of 160 patients were included, with a median age of 44 years. The median number of lymph nodes retrieved was 33, and 11 patients presented with para-aortic lymph node metastasis (LNM). Over a median follow-up period of 39.7 months, 31 patients experienced disease progression, and 12 succumbed to the disease, yielding 3-year DFS and OS rates of 81.3% and 93.7%, respectively. Multivariate analysis identified non-squamous histotype (hazard ratio [HR]: 1.526, 95% confidence interval [CI]: 1.044-2.232, p = 0.029) and LNM ≥ 4 (HR: 1.521, 95% CI: 1.027-2.252, p = 0.036) as independent predictors of poorer DFS. Utilizing these prognostic factors for DFS, a risk stratification system was developed, categorizing patients into low-risk (no risk factors, n = 108) and high-intermediate risk (one or two risk factors, n = 52) groups. The high-intermediate-risk group exhibited significantly inferior DFS and OS compared to the low-risk group (3-year DFS: 67.4% versus 87.3%, HR: 1.697, 95% CI: 1.192-2.417, p = 0.002; 3-year OS: 82.5% versus 98.8%, HR: 3.577, 95% CI: 1.668-7.667, p < 0.001, respectively).</p><p><strong>Conclusions: </strong>Node-positive early-stage cervical cancer exhibits heterogeneous outcomes following radical hysterectomy and postoperative CRT. In patients with non-SCC histotype or ≥ 4 LNM, consolidation chemotherapy does not confer an additional survival benefit, indicating a need for innovative therapeutic strategies.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"73"},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065119","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":"Risk factors for radiation pneumonitis in NSCLC patients treated with third-generation EGFR TKIs and chest radiotherapy.","authors":"Nan Zhao, Liang Xiong, Xuehong Bai, Wenyan Pan, Ping Hai, Hongqiang Ye, Ting Zhao, Kai Cui, Rong Ma, Yanyang Wang","doi":"10.1186/s13014-025-02649-0","DOIUrl":"https://doi.org/10.1186/s13014-025-02649-0","url":null,"abstract":"<p><strong>Background: </strong>Non-small cell lung cancer (NSCLC) patients receiving third-generation EGFR TKIs with thoracic radiotherapy (TRT) significantly prolong survival and also increase the incidence of radiation pneumonitis (RP). The aim of our study was to investigate the incidence and risk factors of RP in NSCLC patients receiving third-generation EGFR TKIs and TRT.</p><p><strong>Patients and methods: </strong>We retrospectively evaluated NSCLC patients who received both third-generation EGFR TKIs and TRT at the General Hospital of Ningxia Medical University from January 2023 to September 2024. RP was diagnosed by clinical symptoms on computed tomography (CT) scans and graded according to the Common Terminology Criteria for Adverse Events 5.0. Risk factors for RP were determined by univariate and multivariate logistic regression analysis.</p><p><strong>Results: </strong>Of the 42 patients included, 26 (61.9%) developed RP and 14 (33.3%) developed grade ≥ 2 RP. Grade ≥ 2 RP all occurred within 6 months of receiving TRT, and the median time from TRT to RP was 3.69 months (2-10 months). GTV ≥ 39 ml and total lung V20 ≥ 14.95% were found to be independent risk factors for RP development.</p><p><strong>Conclusion: </strong>The strategy of combining a third-generation TKI with TRT significantly increases the incidence of RP, and the risk of RP in these patients can be reduced by adjusting lung radiation dosimetry parameters. In NSCLC patients taking triple-generation TKIs with primary tumour progression, the timing and dose of TRT addition must be strictly controlled to optimise the therapeutic strategy and reduce the incidence of RP.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"72"},"PeriodicalIF":3.3,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049215","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}