Practical Radiation Oncology最新文献

{"title":"Real World Guide for Delivering Immunotherapy with Radiotherapy.","authors":"Denton J Robinson, Hampartsoum B Barsoumian, Ansel P Nalin, Vivek Verma, Joshua S Niedzielski, Nahum Puebla-Osorio, Yun Hu, Mingyo Kang, Shalin J Shah, Jack Phan, James W Welsh","doi":"10.1016/j.prro.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.prro.2025.06.013","url":null,"abstract":"<p><p>Immunoradiotherapy, the combination of radiotherapy (RT) and immunotherapy, represents a promising advancement in cancer treatment by enhancing local and systemic tumor control and improving patient response rates. While RT has long been a cornerstone of oncologic care, its efficacy is often opposed by various tumor resistance mechanisms. Immunotherapy, which leverages the immune system to combat cancer, offers a complementary means to enhance RT's effectiveness. Despite the potential of this combination, integrating immunotherapy into standard RT protocols remains challenging, due to the convoluted interplay between radiation and immune responses. This review provides a real-world guide for optimizing immunoradiotherapy in clinical practice, focusing on four critical areas: pre-treatment factors, immunotherapy sequencing, RT planning, and post-treatment follow-ups. Key considerations include prior patient treatments, the timing of immunotherapy, radiation dosing/fractionation strategies, tumor size, organs at risk, and effective post-RT monitoring, which collectively will help tailor a precise approach. Moreover, with the ever-increasing utilization of artificial intelligence (AI), we will discuss recent methods to integrate AI into RT planning and personalized immunoradiotherapy. By addressing these complexities, this review aims to bridge the gap between research and clinical practice, facilitating the successful application of immunoradiotherapy into the oncology field.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253716","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":"Elective Target Volume Delineation for Locally Advanced Pancreatic Cancer.","authors":"Alexandra K Bennett, Krishan R Jethwa","doi":"10.1016/j.prro.2025.08.007","DOIUrl":"10.1016/j.prro.2025.08.007","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187447","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":"Shakuntala and the Ring of Recollection: A Lesson in the Theater of Memory and Wisdom.","authors":"Varun Kumar Chowdhry","doi":"10.1016/j.prro.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.prro.2025.08.004","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132668","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":"Ultrahypofractionated Whole Breast Radiation Therapy Using a Novel Boost Regimen for Early-Stage Breast Cancer.","authors":"Molly A Chakraborty, Atif J Khan, Audree B Tadros, Charlie White, Zhigang Zhang, Minji Kim, Amy J Xu, Quincey LaPlant, Diana Roth O'Brien, John J Cuaron, Michael B Bernstein, Lior Z Braunstein, Simon N Powell, Jehee Isabelle Choi","doi":"10.1016/j.prro.2025.08.009","DOIUrl":"10.1016/j.prro.2025.08.009","url":null,"abstract":"<p><strong>Purpose: </strong>The 5-year results of the FAST-Forward trial demonstrated noninferiority of local tumor control using a 26 Gy in 5 fraction regimen compared with 40 Gy in 15 fractions for breast cancer patients receiving adjuvant whole breast radiation therapy (WBRT) with or without a sequential conventionally fractionated tumor bed boost (2 Gy per fraction). Here, we reported our institutional experience using the FAST-Forward regimen with a novel sequential boost regimen of 5.2 Gy in 1 fraction or 10.4 Gy in 2 fractions.</p><p><strong>Methods and materials: </strong>Patients with nonmetastatic invasive breast cancer or ductal carcinoma in situ treated with adjuvant WBRT of 26 Gy in 5 fractions from January 7, 2019, to January 6, 2022, were identified from an institutional database. Clinical outcomes, including adverse events, disease control, and patient-reported outcomes, were collected. Survival outcomes were estimated using the Kaplan-Meier method. Associations between toxicities and clinicopathologic and treatment characteristics were assessed using logistic regression.</p><p><strong>Results: </strong>A total of 311 consecutive patients were included; the use of a 1- or 2-fraction boost was left to the discretion of the treating physicians (54% 1-fraction, 8.7% 2-fraction, and 38% no boost). Median follow-up was 32 months. Overall survival and local recurrence-free survival probabilities at 36 months were 96% (95% CI, 94-99) and 93% (95% CI, 90-97), respectively. Acute and late toxicities occurred at a higher rate in the 2-fraction versus 1-fraction and no boost groups (37.4%, 10.8%, and 12.2% [acute] and 22.7%, 8.6%, and 7.9% [late], respectively). Boost receipt, greater boost volume, 15× energy, increasing breast V95%, and bolus use were associated with the risk of acute grade ≥ 2 toxicities.</p><p><strong>Conclusion: </strong>A 5-fraction ultrahypofractionated WBRT regimen for early-stage breast cancer with either no boost or a single-fraction boost of 5.2 Gy resulted in excellent disease control and acceptable toxicity. Increased toxicity was observed with a boost of 10.4 Gy in 2 fractions and is no longer used at our institution.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139498","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":"\"What Would You Do If You Were Me?\" Reflections on Autonomy in Clinic.","authors":"Jamiluddin J Qazi, Brian P Quaranta","doi":"10.1016/j.prro.2025.08.008","DOIUrl":"10.1016/j.prro.2025.08.008","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126520","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":"Long-Term Outcome of Stereotactically Designed Hypofractionated Image Guided Radiation Therapy in Large, Unresectable Hepatocellular Carcinoma.","authors":"Natalie Sean Man Wong, Francis Ann Shing Lee, Venus Wan Yan Lee, Kenneth Sik-Kwan Chan, Cynthia Sin Yu Yeung, Connie Hoi Man Ho, Winnie Wing Ling Yip, Keith Wan Hang Chiu, Mark Ka Heng Chan, Frank Chi Sing Wong, Feng-Ming Spring Kong, Chi Leung Chiang","doi":"10.1016/j.prro.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.prro.2025.05.016","url":null,"abstract":"<p><strong>Purpose: </strong>Large, prevalent hepatocellular carcinomas (HCCs) are associated with poor prognosis and treatment resistance. While stereotactic body radiation therapy is effective against small HCCs, its application in large tumors is limited by technical challenges and dose-limiting toxicities. This study evaluated long-term outcomes of large, locally advanced HCCs treated with stereotactically designed hypofractionated image guided radiation therapy (HIGRT) in the preimmunotherapy era.</p><p><strong>Methods and materials: </strong>This observational study was conducted using a strictly adhered, single-institutional protocol. Patients had HCCs >5 cm, were ineligible for curative intervention at multidisciplinary team meetings with Child-Pugh (CP) scores A5-B7. Participants received stereotactically designed HIGRT 4 weeks after transarterial chemoembolization, if given. Fractional dose was limited to 4 Gy/fraction (fr) in an individualized course of 6-10 frs, 5 fr/wk, aiming for the highest achievable dose delivery while respecting normal tissue constraints. Primary endpoint was local control (LC). Secondary endpoints included overall survival (OS), objective response, surgical conversion and toxicities.</p><p><strong>Results: </strong>Consecutive patients (n = 156) were treated with a median 2 Gy-equivalent dose of 32.7 Gy₁₀ (range, 28-46.7Gy₁₀) during 2006 to 2017. Median tumor size was 12.9 cm (range, 5.1-25.7 cm). One-year and 2-year LC, best-achievable objective response rates reached 85.5% (95% CI, 79.4%-91.6%), 74.1% (95% CI, 64.5%-83.7%), and 65.7% respectively. As median follow-up among survivors reached 76.1 months (range, 59.2-95.8 months), 1-year and 2-year OS rates were 45.4% (95% CI, 37.6%-53.2%) and 26.8% (95% CI, 19.8%-33.8%), respectively. Successful surgical conversion among responders (n = 14, 9.0%) achieved the longest median OS (47.7 months; 95% CI, 25.3-70.1 months). Grade ≥3 gastrointestinal toxicities (5.1%), CP score progression ≥2 at 3 months (18.9%) were manageable, with no significant differences across CP stages.</p><p><strong>Conclusions: </strong>The safety, LC of modest-dose, individualized, stereotactically designed HIGRT regimen in large, unresectable HCCs with adverse disease factors is comparable to the established 5fr-based stereotactic body radiation therapy, with achievable surgical conversion, OS and preserved tolerability in moderately impaired liver function, rendering an attractive option when systemic therapy is otherwise ineligible or inaccessible.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092682","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":"Postmastectomy Radiation Therapy: An ASTRO/ASCO/SSO Clinical Practice Guideline.","authors":"Rachel B Jimenez, Yara Abdou, Penny Anderson, Parul Barry, Lisa Bradfield, Julie A Bradley, Lourdes D Heras, Atif Khan, Cindy Matsen, Rachel Rabinovitch, Chantal Reyna, Kilian E Salerno, Sarah E Schellhorn, Deborah Schofield, Kekoa Taparra, Iman Washington, Jean L Wright, Youssef H Zeidan, Richard C Zellars, Kathleen C Horst","doi":"10.1016/j.prro.2025.05.001","DOIUrl":"10.1016/j.prro.2025.05.001","url":null,"abstract":"<p><strong>Purpose: </strong>This guideline provides evidence-based recommendations on the use of postmastectomy radiation therapy (PMRT) in the treatment of breast cancer. PMRT refers to the treatment of the chest wall and ipsilateral regional nodes, including at-risk axillary, supra/infraclavicular, and internal mammary nodes. Updated recommendations detail indications for PMRT in the upfront surgical setting and after neoadjuvant systemic therapy, and provide guidance on appropriate target volumes, dosing, and treatment techniques.</p><p><strong>Methods: </strong>The American Society for Radiation Oncology, American Society of Clinical Oncology, and the Society of Surgical Oncology convened a multidisciplinary task force to address 4 key questions focused on radiation therapy (RT) in patients with breast cancer who undergo mastectomy including (1) indications for PMRT after upfront surgery, (2) indications for PMRT after neoadjuvant systemic therapy followed by surgery, (3) appropriate PMRT treatment volumes and dose-fractionation regimens, and (4) treatment techniques. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation.</p><p><strong>Results: </strong>After upfront mastectomy, PMRT is indicated for most patients with node-positive breast cancer and select patients with node-negative disease. PMRT is also recommended after neoadjuvant systemic therapy, both for patients presenting with locally advanced disease and for those with residual nodal disease at the time of surgery. PMRT is conditionally recommended for patients with cT1-3N1 or cT3N0 breast cancer with pathologically negative nodes after neoadjuvant systemic therapy (ypN0). When PMRT is delivered, treatment to the ipsilateral chest wall/reconstructed breast and regional lymphatics is recommended, with moderate hypofractionation preferred, but with conventional fractionation approaches acceptable in rare cases. Computed tomography-based volumetric treatment planning with 3-dimensional conformal RT is recommended, with intensity modulated RT advised when 3-dimensional conformal RT is unable to achieve treatment goals. Deep inspiration breath hold techniques are also recommended for normal tissue sparing. For patients with skin involvement, positive superficial margins, and/or lymphovascular invasion, the use of a bolus is recommended, but the routine use of tissue-equivalent bolus is not recommended.</p><p><strong>Conclusions: </strong>These evidence-based recommendations guide clinical practice on the use of PMRT in patients with breast cancer.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071221","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":"PRO Top 20 Reviewers and Reviewer Apprentice Program Graduates in 2023 and 2024.","authors":"Robert Amdur","doi":"10.1016/j.prro.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.prro.2025.08.001","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082346","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":"Urinary organs-at-risk for radiotherapy following radical prostatectomy: contouring guidelines on behalf of the Francophone Group of Urological Radiation Therapy (GFRU).","authors":"Jennifer Le Guevelou, Thomas Zilli, Arthur Peyrottes, Luc Beuzit, Ludovic Ferretti, Mario Terlizzi, Stephane Supiot, Verane Achard, Samuel Palumbo, Geneviève Loos, Jihane Boustani, Carl Salembier, Paul Sargos","doi":"10.1016/j.prro.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.prro.2025.08.005","url":null,"abstract":"<p><strong>Purpose: </strong>Urinary toxicity following radical prostatectomy (RP) and postoperative radiotherapy (RT) includes urinary incontinence and vesicourethral anastomosis (VUA) strictures. With the increasing use of stereotactic body radiotherapy (SBRT), dose-escalation, and reirradiation within the prostate bed (PB), standardization of the definition of urinary organs at risk (OARs) in the post-RP setting is needed. This works aims to provide a comprehensive review of the anatomical and physiopathological changes occurring after RP, as well as to provide a consensus on urinary OARs delineation for prostate cancer (PCa) EBRT in the post-RP setting.</p><p><strong>Methods and materials: </strong>A multidisciplinary task force including three radiation oncologists, one uroradiologist, and two urologists was created in 2024. First, OARs potentially involved in urinary toxicity were identified and discussed. A literature review was performed, addressing several questions relative to surgical procedures and reconstructive strategies. A focus was also given to potential complications following RP and its impact on urinary OARs. Secondly, results were presented and discussed with a panel of radiation oncologists, members of the \"Francophone Group of Urological Radiation Therapy\" (GFRU). Thereafter, GFRU experts were asked to answer a dedicated questionnaire, including 26 questions on the controversial issues related to the delineation of urinary OARs.</p><p><strong>Results: </strong>The following structures were identified as critical for RT in the post-RP setting: bladder, bladder neck, bladder trigone, VUA, membranous urethra, striated sphincter. A consensus was reached for 25 out of 26 items.</p><p><strong>Conclusion: </strong>New clinical scenarios at risk of toxicity in the post-RP setting are arising, including especially PB reirradiation with SBRT, PB SBRT, and dose-escalated RT within the PB. This consensus highlights contemporary urinary structures in the post-RP setting. It also proposes a standardized definition of urinary OARs for the development of future clinical trials.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008543","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":"Long-Term Outcomes After Reirradiation With Spine Stereotactic Body Radiation Therapy: Single-Institutional Retrospective Experience.","authors":"J John Lucido, Trey C Mullikin, W Scott Harmsen, Sydney D Pulsipher, Benjamin A Johnson-Tesch, Jonathan M Morris, Peter S Rose, Brittany L Siontis, Debra H Brinkmann, Dawn Owen, Sean S Park, Anne W Rajkumar, Roman O Kowalchuk, Kenneth W Merrell","doi":"10.1016/j.prro.2025.08.006","DOIUrl":"10.1016/j.prro.2025.08.006","url":null,"abstract":"<p><p>Reirradiation of spinal metastases using stereotactic body radiation therapy (SBRT) presents clinical challenges, with limited patient outcomes data to guide decision-making. We report a retrospective, single-institutional experience of 107 lesions treated in 91 patients. Of these, 88 (72%) lesions were initially irradiated with conventional radiation therapy (median equivalent dose of 33 Gy to the target, IQR, 23-35 Gy) with a median time to reirradiation of 12 months (IQR, 4-21 months). For reirradiation, most lesions received either 1 fraction (18-24 Gy) or 3 fractions (30-36 Gy) of SBRT. The median equivalent dose in 2 Gy fractions was 38 Gy (IQR, 30-41 Gy), 27 Gy (22-36 Gy), and 65 (54-73 Gy) for previous courses, reirradiation, and cumulatively, respectively. At 1 year, overall survival was 61% with a cumulative incidence of local failure at 12% and vertebral compression fracture at 9% considering death as a competing risk. None of the 79 treated lesions at L1 or above developed radiation myelitis, but 5 patients developed chronic peripheral neuropathy. In our analysis, most adverse events or local failures occur within the 2 years after retreatment. These findings demonstrate the safety and effectiveness of spine reirradiation with SBRT.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006879","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}