Radiation Oncology最新文献

{"title":"The role of radiotherapy planning images in monitoring malnutrition and predicting prognosis in head and neck cancer patients: a pilot study.","authors":"Beste M Atasoy, Birsen Demirel, Feyza Nur Ekşi Özdaş, Bennur Devran, Zehra Nur Kılıç, Dilek Gül","doi":"10.1186/s13014-025-02645-4","DOIUrl":"https://doi.org/10.1186/s13014-025-02645-4","url":null,"abstract":"<p><strong>Background: </strong>Adaptive treatment planning can be made in radiotherapy of head and neck cancer patients for reasons such as changes in tumor volume or weight loss. This study aims to find the role of treatment planning images in monitoring radiotherapy-induced malnutrition and predicting the malnutrition-induced prognosis in head and neck cancer patients.</p><p><strong>Methods: </strong>For this study, we analyzed 30 patients who received radiotherapy in our clinic between September 2018 and September 2021. Those patients, both regular and completed weekly dietitian counseling notes during radiotherapy and available adaptive radiotherapy planning images, were included in the analysis. All patients had weekly nutritional interventions, including nutritional and anthropometric changes in weight, height, body mass index (BMI), and lean body mass (LBM). Skeletal muscle volume, called cervical muscle gauge (CMG), was measured from the simulation images of beginning and adaptive radiotherapy. Inflammatory parameters, including the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the systemic inflammatory index (SII), were also calculated from weekly total blood counts. For the analysis, anthropometric measurements were compared at the beginning and adaptive treatment time. Progression-free (PFS) and overall (OS) survival were calculated according to weight and CMG changes.</p><p><strong>Results: </strong>The median weight loss percentage was 4.8% (0 to 24%). The mean percentage of weight changes, LBM, and CMG were 6.33%, 3.47%, and 9.28%, respectively. Results indicated that BMI (p = 006), weight (p < 0.001), LBM (p < 0.001), and CMG (p = 0.057) decreased during radiotherapy. Hemoglobin levels decreased (p = 0.005), and inflammatory markers increased. There were significant correlations between weight and LBM (p < 0.0001) and CMG (p = 0.005) loss. The median follow-up was 26 months. Loss of weight (PFS; 65.5% vs. 35.7%, p = 0.09, OS; 73.7% vs. 32.1%, p = 0.09), LBM (PFS; 75% vs. 41.1%, p = 0.118, OS; 65.6% vs. 52%, p = 0.221) and CMG (PFS; 56.3% vs. 47.1%, p = 0.516, OS;76.9% vs. 32.4%, p = 0.059) negatively affected three-year survival.</p><p><strong>Conclusions: </strong>Cervical muscle volume measurement may help predict malnutrition in patients receiving radiotherapy for head and neck cancer. Our study shows adaptive planning images may be used for this approach. In addition, this method may help to predict prognosis due to malnutrition in patients undergoing radiotherapy.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"70"},"PeriodicalIF":3.3,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043214","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":"Implementation of a comprehensive clinical quality assurance system in radiation oncology.","authors":"Anja Alessandra Joye, Matea Zosso-Pavic, Jeannifer Beckmann, Jérôme Bonzon, Sebastian Stolz, Jonas Willmann, Maiwand Ahmadsei, Sebastian M Christ, Nicolaus Andratschke, Matthias Guckenberger, Stephanie Tanadini-Lang, Michael Mayinger","doi":"10.1186/s13014-025-02633-8","DOIUrl":"https://doi.org/10.1186/s13014-025-02633-8","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this project was to develop and evaluate a comprehensive clinical quality assurance system for radiation oncology, and assess the system using definitive radiation therapy for prostate cancer as a first use case.</p><p><strong>Methods: </strong>The Zurich Clinical Quality Assurance System in Radiation Oncology (ZH-CLASSIC) was initiated to allow for continuous quality assurance in radiation oncology with respect to indication for radiation therapy, practice of radiation therapy and patient outcome. Data from the sources of the hospital information system, the Radiation Oncology Record and Verify System and a dedicated follow-up database were automatically retrieved, and combined using a unique patient-ID. Data aggregation, continuous analysis and reporting was performed using ten distinct patient care pathways as the basis which covers all aspects of radiation therapy treatments and indications as well as the different follow-up schemes (in-clinic, telemedicine, and external follow-up). The follow-up system was validated through analysis of patients with prostate cancer (≥ 18 years, cT1-3 cN0 cM0) who underwent curative, primary stereotactic radiation therapy. Survival, treatment effectiveness, tumor control, acute and late toxicity, and performance status were analyzed.</p><p><strong>Results: </strong>Since May 2021, a total of 4,515 individual patients were being managed in ZH-CLASSIC. Personal resources amounted to 0.75 full time equivalent (FTE) project manager for one year prior to implementation, 0.13 FTE physician and 1.00 FTE follow-up manager as ongoing expenses. Compliance with respect to reporting data into ZH-CLASSIC by the physicians increased from a mean of 54% in 2021 to 92% in 2024. For all patients, follow-up was performed as in-clinic visits (51%), via telephone (7%) or as an external query (43%), with missing information (5%) originating from external requests in 96%. Instead of an intended first in-clinic follow-up visit, telemedicine appointments were conducted in 10% and external follow-ups were performed in 22%. Oncological outcomes and toxicities were evaluated for all prostate cancer patients (n = 209) treated with daily online-adaptive SBRT on the MRIdian using 5 × 7.25 Gy every other day or 5 × 7.5 Gy weekly. After a median follow-up of 15 months (range, 6-41 months), 208/209 patients were alive. Over this time period, reported CTCAE toxicities included genitourinary grade 2: 12%, grade 3: 1%, and gastrointestinal grade 2: 3%, grade 3: 0%.</p><p><strong>Conclusions: </strong>The ZH-CLASSIC system allowed for automated and structured documentation and analysis of the quality with regards to the indication, treatment and outcome of radio-oncological cancer patients. Dedicated staff are needed in the start-up period but personal resources are expected to continuously decrease. Analyses of patients treated with SBRT for localized prostate cancer resulted in plausible results i","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"69"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054379","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":"Real-time morphological and dosimetric adaptation in nasopharyngeal carcinoma radiotherapy: insights from autosegmented fractional fan-beam CT.","authors":"Xiao-Li Yu, Jiang Hu, Yu-Xian Yang, Guang-Yu Wang, Xin Yang, Wen-Chao Diao, Lu Liu, Xiao-Bo Jiang, Chen-di Xu, Liu-Wen Lin, Le-Cheng Jia, Hua Li, Yan-Fei Liu, Ying Sun, Guan-Qun Zhou","doi":"10.1186/s13014-025-02643-6","DOIUrl":"https://doi.org/10.1186/s13014-025-02643-6","url":null,"abstract":"<p><strong>Background: </strong>To quantify morphological and dosimetric variations in nasopharyngeal carcinoma (NPC) radiotherapy via autosegmented fan-beam computed tomography (FBCT) and to inform decision-making regarding appropriate objectives and optimal timing for adaptive radiotherapy (ART).</p><p><strong>Methods: </strong>This retrospective study analyzed 23 NPC patients (681 FBCT scans) treated at Sun Yat-sen Cancer Center from August 2022 to May 2024. The inclusion criterion was as follows: ≥1 weekly FBCT via a CT-linac with ≤ 2 fractions between scans. Four deep learning-based autosegmentation models were developed to assess weekly volume, Dice similarity coefficient (DSC), and dose variations in organs at risk (OARs) and target volumes.</p><p><strong>Results: </strong>A systematic review of autosegmentation on FBCT scans demonstrated satisfactory accuracy overall, and missegmentation was manually modified. Linear decreases in volume and/or DSC were observed in the parotid glands, submandibular glands, thyroid, spinal cord, and target volumes (R² > 0.7). The linear dose variation included coverage of the low risk planning target volume (-3.01%), the mean dose to the parotid glands (+ 2.45 Gy) and thyroid (+ 1.18 Gy), the D1% of the brainstem (+ 0.56 Gy), and the maximum dose to the spinal cord (+ 1.12 Gy). The greatest reduction in target volume coverage was noted in PGTVns, reaching 7.15%. The most significant dose changes occurred during weeks 3-6.</p><p><strong>Conclusions: </strong>During NPC radiotherapy, the progressive dose deviations may not be corrected through repositioning alone, necessitating ART intervention. As dose variations in OARs rarely exceed 3 Gy and target coverage fluctuations remain within 10%, ART does not need to be performed frequently, and weeks 3-6 represent the most appropriate window.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"68"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036646","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":"Cardiac substructure dose distributions in node-positive and node-negative breast cancer patients undergoing 3D-CRT: comparing the predictive accuracy of mean heart dose and mean left ventricular dose.","authors":"Mohammad Gunda Nuruddeen, Noor Khairiah A Karim, Gokula Kumar A/L Appalanaido, Mohd Hafiz Mohd Zin, Khairil Amir Sayuti, Mohamad Nazrulhisham Mad Naser","doi":"10.1186/s13014-025-02607-w","DOIUrl":"https://doi.org/10.1186/s13014-025-02607-w","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cardiotoxicity is a concern, especially in left breast cancer (BC) radiotherapy (RT), and accurate dosimetry is essential for minimizing cardiac exposure. This study evaluated the radiation exposure of cardiac substructures in node-positive and node-negative BC patients who underwent three-dimensional conformal therapy (3D-CRT) and compared the predictive accuracy of mean heart dose (MHD) and mean left ventricular dose (MLVD) in estimating dose distribution to cardiac substructures.</p><p><strong>Materials and methods: </strong>This study included 55 patients with left-sided breast cancer, comprising 39 with node-positive and 16 with node-negative disease. All underwent adjuvant whole-breast irradiation using 3D-CRT. The heart, ventricles, atria, right coronary (RC), left anterior descending coronary (LADCA), and left circumflex (LCx) arteries were contoured. Dosimetric distributions were evaluated, and Pearson's correlation and linear regression analyses were used to assess the relationship between cardiac substructures.</p><p><strong>Results: </strong>The distribution of doses to cardiac substructures was heterogeneous, with LADCA receiving the highest doses: 15.6 Gy in node-positive and 13.2 Gy in node-negative breast cancer patients. Linear regression analysis revealed a weak to moderate predictive ability of MHD/MLVD to predict doses received by the cardiac substructure in both groups, with MLVD demonstrating marginally better results. For node-positive patients, the analysis revealed an R² of 0.40 (p < 0.001) for the association between MHD and LADCA and an R² of 0.45 (p < 0.001) for MLVD and LADCA. In node-negative patients, the R² values were 0.27 (p < 0.001) for MHD versus LADCA and 0.30 (p < 0.03) for MLVD versus LADCA. Pearson's correlation analysis for node-positive patients indicated r = 0.63 (p < 0.001) for MHD versus LADCA and r = 0.67 (p < 0.001) for MLVD versus LADCA. For node-negative patients, the correlation coefficients were r = 0.52 (p < 0.001) for MHD versus LADCA and r = 0.54 (p < 0.001) for MLVD versus LADCA.</p><p><strong>Conclusion: </strong>Radiation exposure to cardiac substructures during 3D-CRT for left breast cancer was heterogeneous, with the LADCA receiving the highest mean dose, followed by the LV. MLVD demonstrated superior predictive accuracy over mean heart dose (MHD) for estimating doses to critical substructures, particularly in node-positive patients.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"65"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055767","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":"Correction: Neurocognitive impact of different irradiation modalities for patients with grade I-II skull base meningioma: a prospective multi-arm cohort study (CANCER COG).","authors":"Paul Lesueur, Florence Joly, Benedicte Clarisse, Justine Lequesne, Dinu Stefan, Jacques Balosso, Marie Lange, Sebastien Thureau, Aurelie Capel, Marie Castera, Berenice Legrand, Nicolas Goliot, Jean Michel Grellard, Thomas Tessonnier, Helene Castel, Samuel Valable","doi":"10.1186/s13014-025-02650-7","DOIUrl":"https://doi.org/10.1186/s13014-025-02650-7","url":null,"abstract":"","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"67"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056209","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 investigation of opening modes of head and neck thermoplastic mask for radiotherapy based on finite element analysis.","authors":"Guobao Pang, Ying Lu, Yannan Xu, Qiaoyu Meng, Jianbo Song","doi":"10.1186/s13014-025-02648-1","DOIUrl":"https://doi.org/10.1186/s13014-025-02648-1","url":null,"abstract":"<p><p>Radiotherapy is a crucial treatment modality for head and neck tumors. Precise patient positioning is vital for ensuring the reproducibility and accuracy of the treatment. Clinically, thermoplastic head and neck masks are used for positioning, and patients often require openings in these masks. However, the relationship between opening locations and the fixation effectiveness of the masks has not been thoroughly studied. This study reconstructs a patient's imaging data to create finite element models with 10 different opening patterns. By assigning various thicknesses and material properties to the fixation masks, we analyzed the displacement distribution of different opening models under diverse loading conditions. The results indicate that the opening location significantly impacts fixation effectiveness under different loading conditions. In particular, the opening in the forehead area has the most significant impact on the fixation effect of the mask near the region of interest (ROI). Therefore, in clinical practice, the design of openings in the forehead area should be carefully considered. This study provides valuable insights into the fixation effectiveness of thermoplastic masks and serves as a reference for future personalized positioning treatments.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"64"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041965","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":"Application of 3D-printed compensators for proton pencil beam scanning of shallowly localized pediatric tumors.","authors":"Agnieszka Wochnik, Tomasz Kajdrowicz, Gabriela Foltyńska, Dawid Krzempek, Katarzyna Krzempek, Krzysztof Małecki, Marzena Rydygier, Jan Swakoń, Paweł Olko, Renata Kopeć","doi":"10.1186/s13014-025-02646-3","DOIUrl":"https://doi.org/10.1186/s13014-025-02646-3","url":null,"abstract":"<p><strong>Background: </strong>In modern proton radiotherapy facilities with pencil beam scanning technology, the lowest energy of a proton beam typically ranges between 60 and 100 MeV, corresponding to a proton range in water of 3.1-7.5 cm. The irradiation of superficial lesions usually requires the application of a range shifter (RS) to further reduce the proton range. A certain distance from the patient to the RS increases the spot size, causing worse plan conformity. As an alternative solution, a patient-specific 3D-printed proton beam compensator (BC) can be applied to reduce the air gap and beam scattering.</p><p><strong>Materials and methods: </strong>This study is based on treatment planning system simulations using retrospectively selected data from six pediatric patients with diagnosed sarcomas located in the head and neck area. For three of these patients, 3D-printed compensators were utilized during the treatment phase, prior to the retrospective analysis. Treatment plans for children with shallow lesions treated using RSs and BCs were compared. Planning target volume constraints (D_98% >95%, D_2%< 107%) and organs-at-risk (brainstem, spinal cord, visual organs, chiasm, cochlea) constraints (D_2%, D_max and D_Mean) were applied. The entire process of using a BCs in the treatment of pediatric superficial tumors is presented, including 3D printing procedure (via fused filament fabrication method), dosimetric verification of the material (Water Equivalent Ratio measurements) and assessment of its homogeneity, print quality and Hounsfield Unit specification. Beam parameters analysis including spot sizes and penumbras, were performed. Treatment plans were compared in terms of plan conformity and sparing of critical organs.</p><p><strong>Results: </strong>The application of BCs reduced the low-dose irradiation areas, improved conformity and reduced critical organs exposure. BCs decreased the lateral spot size by approximately 57% and the penumbras by 41-47% at different depths in the cube target. The variation in BC homogeneity was less than 3.5%, meeting the criteria for plan robustness evaluation.</p><p><strong>Conclusions: </strong>Compared with RS placement at the nozzle, the placement of 3D-printed BCs in the near vicinity of the patient for the treatment of superficial tumors led to a more conformal dose distribution.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"66"},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037281","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":"Combined Spatial and Dosimetric Recurrence Pattern Analysis in Head and Neck Squamous Cell Carcinoma Following Postoperative (Chemo)radiotherapy.","authors":"Philipp Schröter, Hoi Hin Lau, Florian Stritzke, Henrik Franke, Katharina Weusthof, Sebastian Regnery, Lukas Bauer, Maximilian Deng, Katharina Dvornikovich, Anna Hofmann, Lars Wessel, Karl Semmelmayer, Julius Moratin, Oliver Ristow, Jürgen Hoffmann, Peter Plinkert, Gerhard Dyckhoff, Jürgen Debus, Thomas Held","doi":"10.1186/s13014-025-02641-8","DOIUrl":"https://doi.org/10.1186/s13014-025-02641-8","url":null,"abstract":"<p><strong>Background: </strong>Advancements in nodal staging for head and neck squamous cell carcinoma (HNSCC) have prompted radiotherapy de-escalation trials to reduce irradiation of electively treated neck regions, with the goal of improving treatment tolerability. While volumetric de-escalation has shown promise in definitive radiotherapy of HNSCC, limited data exist regarding its safety in the postoperative treatment setting. This study aimed to assess dose-level-specific locoregional recurrence patterns following standard postoperative (chemo)radiotherapy in a mixed HNSCC cohort to inform risk-adaptive radiotherapy strategies.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 203 HNSCC patients (75% HPV-negative, 25% HPV-positive) treated with curative intent postoperative (chemo)radiotherapy from 2017 to 2021. Recurrence imaging was co-registered with planning CT, and recurrent tumor volumes were dosimetrically compared to the target volume dose and spatially analyzed using a center-of-mass-based approach. We classified five recurrence types: A (central high-dose), B (peripheral high-dose), C (central intermediate- or low-dose), D (peripheral intermediate- or low-dose), and E (extraneous dose).</p><p><strong>Results: </strong>With a median follow-up of 39.7 months, the three-year local, regional, and distant control of HPV-negative HNSCC were 84%, 87%, and 87%, respectively. Of 56 recurrences, 17 were local, 13 regional, 3 locoregional, 9 combined local/regional with concomitant distant failure, and 14 distant only. Of 40 analyzed recurrences, we identified 47.5% as type A/B, 5% as type C/D intermediate-dose, and 20% as type E, half of which were secondary cancers. Among the 27.5% (11/40) type C/D low-dose recurrences in the elective target volume, 15% (6/40) were true nodal failures, resulting in an overall elective neck failure rate of 3% (6/203).</p><p><strong>Conclusion: </strong>The predominance of high-dose recurrences suggests that biological tumor resistance is a key driver of treatment failure, highlighting the necessity to refine postoperative risk stratification and integrate tumor biology into dose escalation decisions. The low incidence of isolated nodal recurrences in electively treated neck regions supports the feasibility of volumetric de-escalation of postoperative radiotherapy. This approach might not only be feasible for HPV-associated oropharyngeal cancers but also for HPV-negative tumors, provided that accurate nodal staging has been conducted.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"63"},"PeriodicalIF":3.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994954","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":"Early experience with proton craniospinal irradiation in adult patients with leptomeningeal disease.","authors":"Felix Ehret, Ammy M Yuan, Ariel E Marciscano, Stephen Zieminski, Peggy A Leland, Melin J Khandekar, Kevin S Oh, Helen A Shih","doi":"10.1186/s13014-025-02618-7","DOIUrl":"https://doi.org/10.1186/s13014-025-02618-7","url":null,"abstract":"<p><strong>Background: </strong>Leptomeningeal disease (LMD) is a fatal complication of cancer linked to poor survival rates and limited treatment options. While photon involved-field radiotherapy is the standard of care for local palliation and symptom alleviation, it lacks durable disease control. Recent data suggest proton craniospinal irradiation (pCSI) to be a promising treatment option, potentially prolonging progression-free survival (PFS) and overall survival (OS). Herein, we report our initial experience with pCSI for treating LMD from solid malignancies.</p><p><strong>Methods: </strong>Adult patients treated with pCSI for LMD were identified, with analysis of patient, tumor, and treatment characteristics as well as clinical outcomes.</p><p><strong>Results: </strong>Nine patients were eligible for analysis who were treated between February 2023 and February 2024. The median age at pCSI and Karnofsky performance status (KPS) were 58.6 years and 80%, respectively. The primary disease was breast cancer in 33.3%, and LMD involved both the brain and spine in 55.5%. Approximately half of the patients (55.5%) had a cerebrospinal fluid diversion before treatment, and nearly all patients underwent pCSI with 30 Gy (relative biological effectiveness) in 10 fractions. All patients completed pCSI as planned. The median clinical and central nervous system (CNS) radiographic follow-up periods were both 3.5 months. Six deaths were observed during the available follow-up. The median PFS, CNS PFS, and OS were 2.7, 4.0, and 4.0 months, respectively. Younger age, higher KPS, and concurrent treatment with targeted therapy were associated with longer OS, while cases with LMD involving both the brain and spine had shorter survival. The observed toxicity was manageable, without any occurrence of grade 4 or 5 toxicity.</p><p><strong>Conclusion: </strong>pCSI can be an effective and safe treatment option for a highly selected population of patients with LMD. Further data and prospective studies are warranted to clarify its role in the management of LMD.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"61"},"PeriodicalIF":3.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010251","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":"Optimal dose-volume histogram thresholds for radiation pneumonitis prevention in lung cancer patients receiving immunotherapy.","authors":"Yechen Ma, Ziyang Feng, Hao Zhou, Xuewen Liu, Zewen Song","doi":"10.1186/s13014-025-02639-2","DOIUrl":"https://doi.org/10.1186/s13014-025-02639-2","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the incidence of symptomatic radiation pneumonitis (RP) in lung cancer patients receiving immunotherapy and radiotherapy.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 389 lung cancer patients who underwent thoracic radiotherapy with/without immunotherapy at the Third Xiangya Hospital (January 2015-September 2024). Propensity score matching (PSM) was employed to compare RP incidence. Univariate, multivariate, and stepwise regression analyses were conducted to identify predictors of grade ≥ 2 RP.</p><p><strong>Results: </strong>Symptomatic RP occurred in 30.33% (118/389) and 7.46% (29/389) of patients for grades ≥ 2 and ≥ 3, respectively. Patients receiving concurrent immunotherapy-radiotherapy demonstrated a significantly lower incidence of grade ≥ 2 RP compared to other treatment groups (p < 0.05). Multivariable analysis revealed no significant association between immunotherapy administration and RP risk. Lung V20 (≤ 20% vs. > 20%) emerged as a critical predictor: grade ≥ 2 RP incidence was 4.05-8.73% with V20 ≤ 20%, versus 53.8-65.5% when V20 exceeded 20%.</p><p><strong>Conclusions: </strong>Immunotherapy did not raise the risk of grade ≥ 2 RP. Maintaining lung V20 ≤ 20% may serve as an optimal dosimetric threshold for RP prevention in patients undergoing combined-modality therapy.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":49639,"journal":{"name":"Radiation Oncology","volume":"20 1","pages":"60"},"PeriodicalIF":3.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005534","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}