Practical Radiation Oncology最新文献

{"title":"Celiac Plexus Radiosurgery for the Management of Pancreatic Cancer Pain: Key Tips and Considerations.","authors":"Aisling M Glynn, Teo Stanescu, Joanna Javor, Laura A Dawson, Yaacov R Lawrence, Michael Yan","doi":"10.1016/j.prro.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.prro.2025.07.004","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volumetric Changes and Acute Toxicity with ⁶⁸Ga Prostate-Specific Membrane Antigen vs ¹⁸F-Fluciclovine PET/CT Guided Post-Prostatectomy Radiation: Final Analysis of a Randomized Trial.","authors":"Vishal R Dhere, David M Schuster, Subir Goyal, Eduard Schreibmann, Nikhil T Sebastian, Sagar A Patel, Sheela Hanasoge, Joseph W Shelton, Pretesh R Patel, Bruce W Hershatter, Olayinka A Abiodun-Ojo, Ismaheel O Lawal, Ashesh B Jani","doi":"10.1016/j.prro.2025.07.003","DOIUrl":"https://doi.org/10.1016/j.prro.2025.07.003","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluated changes in radiation (XRT) target volume & acute toxicity using ⁶⁸Ga-prostate specific membrane antigen (PSMA) vs ¹⁸F-Fluciclovine fluciclovine PET/CT in post-prostatectomy patients with biochemical recurrence. We hypothesized that both fluciclovine and PSMA guided XRT would a) significantly change pre-PET XRT volumes and b) show similar toxicity.</p><p><strong>Methods and materials: </strong>We performed an IRB-approved, randomized trial comparing fluciclovine (Arm 1) and PSMA (Arm 2)-guided post-prostatectomy XRT in patients with detectable PSA after prostatectomy. Treatment volumes were rigidly defined based on PET and simultaneous integrated boosts (SIB) to PET uptake in the prostate bed (70.2-76.0Gy) or pelvis (54.0-56.0Gy) were allowed. Volumes included: prostate bed (CTV_PB); pelvic lymph nodes (CTV_PLV); and volumetric constraints for bladder(-CTV) & rectum. Acute CTCAE v5.0 genitourinary (GU) and gastrointestinal (GI) toxicity was assessed <90 days from treatment.</p><p><strong>Results: </strong>140 patients were enrolled with 70 randomized to each Arm; 11 Arm 1 and 10 Arm 2 patients did not receive radiation on study and were excluded. Fluciclovine & PSMA incorporation increased both CTV_PB and CTV_PLV (p<0.01). More fluciclovine pts received prostate bed boosts (45/59 pts vs 26/60 pts, p<0.01), there was no difference in proportion receiving pelvic nodal boosts (10/15 pts vs 9/16 pts, fluciclovine vs PSMA; p=0.97). Dose constraints were met for most patients. Rates of G2 GU (17.0% vs 6.7%, fluciclovine vs PSMA; p=0.15) and GI (5.1% vs 1.7%, fluciclovine vs PSMA; p=0.47) toxicity were low with no G3+ events. Higher rectal and bladder dose metrics correlated with GI toxicity (p<0.05), but use of SIB was not associated with acute toxicity.</p><p><strong>Conclusions: </strong>Though both PSMA and fluciclovine use modestly increased target volumes, significantly more fluciclovine patients received prostate bed boosts. Planning directives were met for most patients and acute toxicity was mild in both Arms. Analysis of biochemical control, late toxicity and patient reported outcomes are forthcoming.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Hydrogel Spacer Intravasation of the Internal Iliac Vein and Associated Thrombus Formation During Preparation for Prostate Cancer External Beam Radiotherapy.","authors":"Jacob Eckstein, Mina S Makary, Spero R Cataland, Rebekah Young, Russel Palm, Dayssy A Diaz Pardo, Therese Andraos, Doug Martin, Shang Jui Wang","doi":"10.1016/j.prro.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.prro.2025.07.001","url":null,"abstract":"<p><p>Use of rectal spacer gel has been associated with decreased risk of radiation therapy (RT)-related rectal toxicity in clinical trials and has been increasingly adopted. Optimal management of spacer-related toxicities, such as rectal wall and vascular infiltration, remains poorly defined. To address this gap, we present a case of extensive hydrogel intravasation of the periprostatic venous plexus with development of associated bland thrombus extending to the level of the common iliac vein. The patient was evaluated for placement of an inferior vena cava (IVC) filter and anticoagulation by a multidisciplinary team. After undergoing 6 months of anticoagulation without IVC filter placement, both the hydrogel and the associated thrombus resolved asymptomatically. We review the timeline of these events, their associated symptomatology, our rationale in management of this clinical scenario, and propose a treatment paradigm.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Body Radiotherapy for the Treatment of Adrenal Metastases - A Case-Based Radiosurgery Society Practice Guide and Review.","authors":"Felix Ehret, Daniel K Ebner, Tugce Kutuk, Aria Shakeri, Sabi Shrestha, Karin A Skalina, Fatemeh Fekrmandi, Simon S Lo, John L Gore, Rupesh Kotecha, Percy Lee, Ben J Slotman, Christoph Fürweger, Alexander Muacevic, Shankar Siva, Krishna Reddy","doi":"10.1016/j.prro.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.prro.2025.06.011","url":null,"abstract":"<p><strong>Purpose: </strong>Adrenal metastases are frequently diagnosed in patients with common solid tumors. Surgical adrenalectomy has historically been used for their management. However, stereotactic body radiotherapy (SBRT) has emerged as a safe and effective alternative. Careful treatment planning is essential, considering multiple factors such as tumor size and location, motion management, dose and fractionation, and proximity to adjacent organs at risk. This case-based practice guide and review provides an overview of SBRT for the management of adrenal tumors, with a particular focus on adrenal metastases.</p><p><strong>Methods and materials: </strong>Three clinical scenarios were selected to illustrate the use of SBRT in managing adrenal tumors. These include a small right-sided metastasis treated with single-fraction, fiducial-based SBRT, a large left-sided metastasis treated with fractionated SBRT under magnetic resonance imaging guidance, and a case of bilateral metastases, which emphasizes the potential risk of adrenal insufficiency. We also address the limited evidence available regarding the management of primary adrenal gland tumors with SBRT.</p><p><strong>Results: </strong>SBRT is an effective treatment modality for most adrenal tumors, demonstrating a favorable safety profile. Thoughtful treatment planning and an understanding of potential pitfalls, limitations, and risks are essential to ensure the appropriate use of SBRT.</p><p><strong>Conclusions: </strong>This case-based guide and review provides a comprehensive overview of SBRT for treating adrenal tumors, specifically metastases. We present and discuss clinical cases and relevant literature, highlighting key considerations specific to adrenal SBRT.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Stereotactic Radiosurgery for Resected Brain Metastases: Targeting of the Surgical Tract.","authors":"Charlotte I Rivers, Michael D Mix, Kyle Wang, William Godwin, Istvan Takacs, Bhisham Chera","doi":"10.1016/j.prro.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.prro.2025.02.012","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Radiation Therapy for Early Stage Glottic Cancer Using a 4-Field Technique.","authors":"Jeffrey V Brower, Colin M Harari, John R Matte, Michael J Lawless, Adam R Burr, Tera Kruser, Paul M Harari","doi":"10.1016/j.prro.2025.06.008","DOIUrl":"10.1016/j.prro.2025.06.008","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Recommendations for the Radiation Dose in Patients with Mycosis Fungoides and Localized Lesional Disease Based on a Retrospective Analysis of Treatment Outcomes.","authors":"Juliette M Kersten, Rosanne Ottevanger, Saskia E Rademakers, Maarten H Vermeer, Koen D Quint, Karen J Neelis","doi":"10.1016/j.prro.2025.06.006","DOIUrl":"10.1016/j.prro.2025.06.006","url":null,"abstract":"<p><strong>Purpose: </strong>Primary cutaneous T-cell lymphomas are a rare and heterogeneous group of non-Hodgkin lymphomas predominantly affecting the skin. Treatment strategies are guided by diagnosis and disease stages. In patients with classical mycosis fungoides (MF) or folliculotropic mycosis fungoides, low-dose multiple fraction radiation therapy (RT) is a common approach for localized lesions, but optimal dose regimens are still to be defined. This study aimed to compare the efficacy of single-fraction low-dose RT (1 × 6 Gy) vs the well-accepted 2-fraction regimen (2 × 4 Gy) in patients with localized MF.</p><p><strong>Methods and materials: </strong>A cohort of 54 patients with confirmed diagnoses of classical MF or folliculotropic MF received low-dose RT with either 1 × 6 Gy or 2 × 4 Gy between January 2017 and December 2022. Outcomes assessed included complete response (CR) rates, freedom from treatment failure, and toxicity.</p><p><strong>Results: </strong>The CR rate for 311 treated fields was 86%. There was no significant difference observed in complete response rate between the 88 fields treated with 1 × 6 Gy (88% CR) and the 223 fields treated with 2 × 4 Gy (86% CR) (P = .87). The freedom from treatment failure at 3 years furthermore showed similar outcomes for both regimens (71% for 2 × 4 Gy and 79% for 1 × 6 Gy; P = .18). There were no significant treatment-related toxicities reported.</p><p><strong>Conclusions: </strong>In this study, a single-fraction low-dose RT regimen (1 × 6 Gy) was shown to be comparable to the two-fraction regimen (2 × 4 Gy) in achieving CR for localized disease in patients with MF, offering a more convenient and patient-friendly option without compromising efficacy or safety. These findings support the incorporation of 1 × 6 Gy into clinical guidelines for the palliative management of MF.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Assist Device, Implantable Cardioverter Defibrillator, and Radiation Therapy: A Technical Report, Review of Literature, and Recommendations.","authors":"Alexander Bennassi, Tony Truong, Nhu Hanh To, Chahrazed Boukhobza, Wassim Ksouri, Lahcène Belaïdi, Fatimah-Zara Bellefkih, Hanan Rida, Kamel Debbi, Yazid Belkacémi","doi":"10.1016/j.prro.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.prro.2025.05.013","url":null,"abstract":"<p><p>Recent advancements in cardiology have significantly improved survival and quality of life for patients with severe heart conditions, including those requiring implantable cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs). Radiation therapy (RT) using either conventional or advanced techniques, such as stereotactic body RT, remains a cornerstone treatment for cancer. However, managing patients with both ICDs and LVADs during RT presents unique challenges caused by potential device malfunctions and interactions with radiation. In this report, we present a case of a patient with both a triple-chamber ICD and an electronically equipped LVAD undergoing RT. The study explores the dosimetric considerations, device interactions, and adapted simulations required to minimize risks. This work aimed to bridge the knowledge gap and provide recommendations for the safe and effective integration of RT delivery in patients with advanced cardiac devices.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Key Anatomic Structures on Magnetic Resonance Imaging During Prostate Stereotactic Body Radiation Therapy for Dose Avoidance to Reduce Erectile Dysfunction Risk.","authors":"Sungmin Woo, Anton S Becker, Angela Tong, Hebert Alberto Vargas, Peter B Schiff, David J Byun, Michael J Zelefsky","doi":"10.1016/j.prro.2025.06.005","DOIUrl":"10.1016/j.prro.2025.06.005","url":null,"abstract":"<p><p>Postradiation therapy erectile dysfunction can significantly impact the quality of life of patients with prostate cancer (PCa). Critical anatomic structures, such as the neurovascular bundles (NVBs), internal pudendal arteries (IPAs), penile bulb, and corporal tissues track near the prostate, making them susceptible to radiation-related damage. This study aimed to evaluate the anatomic patterns of these structures and their relationship with the prostate and to provide comprehensive illustrative examples on magnetic resonance imaging (MRI) scans. Consecutive patients with PCa who underwent MRI-linear accelerator-based stereotactic body radiation therapy from January 2024 until December 2024 were included. NVB patterns were classified into 3 categories: (1) \"classical\" with discrete NVB elements, (2) \"adherent,\" dispersed and adherent to prostatic capsule, and (3) \"absent.\" The smallest distance between the IPA and the prostate capsule and the membranous urethral length, serving as a surrogate for the distance between corporal tissue and prostatic apex, were also measured. These MRI scan findings were compared between prostate volumes >40 and <40 mL and between MRI scan findings and pathologic features of the dominant intraprostatic lesion. A total of 160 men (median age 70 years, interquartile range [IQR], 64-76) were included. The most common NVB pattern was \"classic\" (80.0%-85.0%), followed by the \"adherent\" NVB pattern (13.8%-18.1%). The median smallest distance between the IPA and prostate was 2.3 cm (IQR, 1.8-2.8 cm), with 3.1% to 3.8% <1.0 cm. The median membranous urethral length was 1.5 cm (IQR, 1.2-1.8 cm), with 2.5% of patients <1.0 cm. No significant association was found between these MRI scan features and prostate volume or other variables (P = .09-.99). In conclusion, most patients with PCa demonstrated favorable anatomy for potential dose sparing of critical structures. Comprehensive MRI scan illustrations are provided to help radiation oncologists recognize the location, trajectory, and relationship of these structures, facilitating their contouring and ultimately aiding in achieving meaningful dose reductions to these erectile function structures.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography Guided Brachytherapy With Hybrid Applicators: An Effective Curative Treatment for Vaginal Cuff Recurrences.","authors":"Evrim Duman, Sinem Karahan, Busra Tavli, Huseyin Sertel, Merdan Fayda","doi":"10.1016/j.prro.2025.06.004","DOIUrl":"10.1016/j.prro.2025.06.004","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the clinical feasibility of hybrid brachytherapy and the benefits of computed tomography (CT) guidance for optimizing applicator position and needle placement via Utrecht or Venezia applicators in the curative treatment of vaginal cuff recurrence.</p><p><strong>Methods and materials: </strong>Sixteen previously operated patients with gynecological cancer treated with hybrid brachytherapy for vaginal cuff recurrence from 2018 to 2022 were included. The applicators were selected according to vaginal diameter and tumor location. CT scans were conducted before and after needle insertion. The high-risk clinical target volume (CTV-HR), including residual disease and suspicious regions, as well as normal tissues, was contoured. The dosimetry goal was to ensure that the reference isodose (100%) adequately covered the CTV-HR while minimizing overlap with organs at risk. The needle shifts were assessed according to their locations. Outcome measures, including disease-free survival and overall survival, were analyzed.</p><p><strong>Results: </strong>A total of 64 fractions were administered, with Utrecht applicators used for 62.5% (n = 40). The median equivalent doses in 2 Gy fractions (EQD2 D90) for 90% of the CTV-HR and intermediate-risk CTV were 87.64 Gy (57.45-97.78 Gy) and 69 Gy (31.33-76.73 Gy), respectively. Among the 696 possible needle positions, 419 interstitial needles (60%) were successfully inserted. The median number of needles per fraction was 6 (range, 1-12). Needle shifts occurred in 93% of the patients, predominantly in the anteromedial direction, with a mean magnitude of 0.21 ± 0.14 cm. The median follow-up was 14 months, with a 90% local tumor control rate and an 85% overall survival rate over 2 years, without severe side effects.</p><p><strong>Conclusions: </strong>Despite challenges in treating vaginal cuff recurrence in patients with gynecological cancers, hybrid brachytherapy provides an effective and personalized approach. Although needle shifts are common, they do not significantly impact dosimetric outcomes, highlighting the method's adaptability and reliability.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}