Practical Radiation Oncology最新文献

{"title":"Radiosurgery Society Case-Based Guide to Stereotactic Body Radiation Therapy for Challenging Cases of Spinal Metastases.","authors":"Khaled Aziz, Daniel Koffler, April Vassantachart, Abbas Rattani, Nii-Kwanchie Ankrah, Emile Gogineni, Therese Y Andraos, Arjun Sahgal, Balamurugan Vellayappan, Emma M Dunne, Shankar Siva, Fabio Y Moraes, Matthias Guckenberger, Daniel Lubelski, Samuel Chao, Stephanie Combs, Eric Chang, Anubhav G Amin, Matthew Foote, Iris Gibbs, Minsun Kim, Joshua Palmer, Simon Lo, Kristin J Redmond","doi":"10.1016/j.prro.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.prro.2024.08.004","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal stereotactic body radiation therapy (SBRT) has become the standard of care in management of patients with limited sites of metastatic disease, radio-resistant histologies, painful vertebral metastases with long life expectancy and cases of reirradiation. Our case-based guidelines aim to assist radiation oncologists in the appropriate utilization of SBRT for common, yet challenging, cases of spinal metastases.</p><p><strong>Materials and methods: </strong>Cases were selected to include scenarios of large volume sacral disease with nerve entrapment, medically inoperable disease abutting the thecal sac, and local failure after prior SBRT. Relevant literature was reviewed, and areas requiring further investigation were discussed to offer a framework for evidence-based clinical practice.</p><p><strong>Results: </strong>Spinal SBRT can be effectively delivered in challenging cases following multidisciplinary discussion by utilizing a methodical approach to patient selection, appropriate dose selection, and adherence to evidence-based dose constraints.</p><p><strong>Conclusions: </strong>The Radiosurgery Society's case-based practice review offers guidance to practicing physicians treating technically challenging SBRT candidate patients with spinal metastases.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134432","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":"Comprehensive Clinical Usability-oriented Contour Quality Evaluation for Deep learning Auto-segmentation: Combining Multiple Quantitative Metrics through Machine Learning.","authors":"Ying Zhang, Asma Amjad, Jie Ding, Christina Sarosiek, Mohammad Zarenia, Renae Conlin, William A Hall, Beth Erickson, Eric Paulson","doi":"10.1016/j.prro.2024.07.007","DOIUrl":"https://doi.org/10.1016/j.prro.2024.07.007","url":null,"abstract":"<p><strong>Purpose: </strong>The current commonly-used metrics for evaluating the quality of auto-segmented contours have limitations and do not always reflect the clinical usefulness of the contours. This work aims to develop a novel contour quality classification (CQC) method by combining multiple quantitative metrics for clinical usability-oriented contour quality evaluation for deep learning-based auto-segmentation (DLAS).</p><p><strong>Methods: </strong>The CQC was designed to categorize contours on slices as acceptable, minor edit, or major edit based on the expected editing effort/time with supervised ensemble tree classification models using seven quantitative metrics. Organ-specific models were trained for five abdominal organs (pancreas, duodenum, stomach, small and large-bowels) using 50 MRI datasets. Twenty additional MRI and nine CT datasets were employed for testing. Inter-observer variation (IOV) was assessed among six observers and consensus labels were established through majority vote for evaluation. The CQC was also compared with a threshold-based baseline approach.</p><p><strong>Results: </strong>For the five organs, the average AUC was 0.982±0.01 and 0.979±0.01, the mean-accuracy was 95.8±1.7% and 94.3±2.1%, and the mean risk-rate was 0.8±0.4% and 0.7±0.5% for MRI and CT testing dataset, respectively. The CQC results closely matched the IOV results (mean-accuracy of 94.2±0.8% and 94.8±1.7%) and were significantly higher than those obtained using the threshold-based method (mean-accuracy of 80.0±4.7%, 83.8±5.2%, and 77.3±6.6% using one, two, and three metrics).</p><p><strong>Conclusion: </strong>The CQC models demonstrated high performance in classifying the quality of contour slices. This method can address the limitations of existing metrics and offers an intuitive and comprehensive solution for clinically oriented evaluation and comparison of DLAS systems.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134431","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":"Centralized Quality Assurance of Stereotactic Body Radiation Therapy for the Veterans Affairs Cooperative Studies Program Study Number 2005: A Phase 3 Randomized Trial of Lung Cancer Surgery or Stereotactic Radiotherapy for Operable Early-Stage Non-Small Cell Lung Cancer (VALOR).","authors":"Timothy A Ritter, Robert D Timmerman, Hena I Hanfi, Hairong Shi, Matthew K Leiner, Hua Feng, Vicki L Skinner, Lisa M Robin, Cheryl Odle, Gabriella Amador, Tom Sindowski, Amanda J Snodgrass, Grant D Huang, Domenic J Reda, Christopher Slatore, Catherine Sears, Lorraine D Cornwell, Tomer Karas, David H Harpole, Jatinder Palta, Drew Moghanaki","doi":"10.1016/j.prro.2024.07.010","DOIUrl":"https://doi.org/10.1016/j.prro.2024.07.010","url":null,"abstract":"<p><strong>Background: </strong>The phase III Veterans Affairs Lung cancer surgery Or stereotactic Radiotherapy (VALOR) study implemented centralized quality assurance (QA) to mitigate risks of protocol deviations. This report summarizes quality and compliance for the first 100 participants treated with SBRT in this study.</p><p><strong>Methods: </strong>A centralized QA program was developed to credential and monitor study sites to ensure standard-of-care lung stereotactic body radiation therapy (SBRT) treatments are delivered to participants. Requirements were adapted from protocols established by the National Cancer Institute's Image and Radiation Oncology Core, which provides oversight for clinical trials sponsored by the NCI's National Clinical Trials Network.</p><p><strong>Results: </strong>The first 100 lung SBRT treatment plans were reviewed from April 2017 to October 2022. Tumor contours were appropriate in all submissions. PTV expansions were less than the minimum 5 mm requirement in 2% of cases. Critical organ-at-risk (OAR) structures were contoured accurately for the proximal bronchial tree, trachea, esophagus, spinal cord, and brachial plexus in 75%, 92%, 100%, 100%, and 95% of cases. Prescriptions were appropriate in 98% of cases; two central tumors were treated using a peripheral tumor dose prescription while meeting OAR constraints. PTV V100% values were above the protocol-defined minimum of 94% in all but one submission. The median Dmax within the PTV was 125.4% (105.8% - 149.0%, standard deviation ±8.7%). High-dose conformality (<1.2) and intermediate-dose compactness (R50% and D2cm) indices were acceptable or deviation acceptable in 100% and 94% of cases, respectively.</p><p><strong>Conclusions: </strong>The first 100 participants randomized to SBRT in this study were appropriately treated without safety concerns. A response to the incorrect prescriptions led to preventative measures without further recurrences. The program was developed in a healthcare system without prior experience with a centralized RT QA program and may serve as a reference for other institutions.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134430","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":"Masthead/Sub page","authors":"","doi":"10.1016/S1879-8500(24)00168-1","DOIUrl":"10.1016/S1879-8500(24)00168-1","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096577","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":"The Impact of Radiation Therapy in Patients with Systemic Sclerosis and Head and Neck Cancer","authors":"","doi":"10.1016/j.prro.2024.04.015","DOIUrl":"10.1016/j.prro.2024.04.015","url":null,"abstract":"<div><h3>Objective</h3><p>Systemic sclerosis (SSc) is considered a relative, or in some cases, absolute contraindication for radiation therapy for various cancers; however, radiation is the standard of care and the best option for tumor control for locally advanced head and neck (H&amp;N) cancer. We present a case series to document postradiation outcomes in patients with SSc and H&amp;N cancer.</p></div><div><h3>Methods</h3><p>Patients with SSc and H&amp;N cancer treated with radiation were identified from the Johns Hopkins Scleroderma<span><span> Center and the University of Pittsburgh Scleroderma Center research registries. Through chart review, we identified whether patients developed predetermined acute and late side effects or changes in SSc activity from radiation. We further describe therapies used to prevent and treat radiation-induced </span>fibrosis.</span></p></div><div><h3>Results</h3><p><span>Thirteen patients with SSc who received radiation therapy for H&amp;N cancer were included. Five-year survival was 54%. Nine patients (69%) developed local radiation-induced skin thickening, and 7 (54%) developed reduced neck range of motion. Two patients required long-term percutaneous endoscopic gastrostomy<span> use due to radiation therapy complications. No patients required respiratory support<span> related to radiation therapy. Regarding SSc disease activity among the patients with established SSc before radiation therapy, none experienced interstitial lung </span></span></span>disease progression<span><span><span> in the postradiation period. After radiation, one patient had worsening skin disease outside the radiation field; however, this patient was within the first year of SSc, when progressive skin disease is expected. Treatment strategies to prevent radiation fibrosis included </span>pentoxifylline<span>, amifostine, and </span></span>vitamin E, while intravenous immunoglobulin (IVIG) was used to treat it.</span></p></div><div><h3>Conclusion</h3><p>Although some patients with SSc who received radiation for H&amp;N cancer developed localized skin thickening and reduced neck range of motion, systemic flares of SSc were uncommon. This observational study provides evidence to support the use of radiation therapy for H&amp;N cancer in patients with SSc when radiation is the best treatment option.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140864403","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 Radiation Therapy Contouring Atlas for Delineation of the Level I and II Axillae in the Prone Position: A Single-Institution Experience","authors":"","doi":"10.1016/j.prro.2024.04.016","DOIUrl":"10.1016/j.prro.2024.04.016","url":null,"abstract":"<div><h3>Purpose</h3><p><span>With transition from supine to prone position, tenting of the pectoralis major occurs, displacing the muscle from the chest wall and shifting the level I and II axillary spaces. For patients for whom we aim to treat the level I and II </span>axillae<span><span> using the prone technique, accurate delineation of these nodal regions is necessary. Although different consensus guidelines exist for delineation of nodal anatomy in </span>supine position, to our knowledge, there are no contouring guidelines in the prone position that account for this change in nodal anatomy.</span></p></div><div><h3>Methods and Materials</h3><p>The level I and II nodal contours from the Radiation Therapy Oncology<span> Group (RTOG) breast cancer supine atlas were adapted for prone position by 2 radiation oncologists and a breast radiologist based on anatomic changes observed from supine to prone positioning on preoperative diagnostic imaging. Forty-three patients from a single institution treated with prone high tangents from 2012 to 2018 were identified as representative cases to delineate the revised level I and II axillae on noncontrast computed tomography (CT) scans obtained during radiation simulation. The revised nodal contours were reviewed by an expanded expert multidisciplinary panel including breast radiologists, radiation oncologists, and surgical oncologists for consistency and reproducibility.</span></p></div><div><h3>Results</h3><p>Consensus was achieved among the panel in order to create modifications from the RTOG breast atlas for CT–based contouring of the level I and II axillae in prone position using bone, muscle, and skin as landmarks. This atlas provides representative examples and accompanying descriptions for the changes described to the caudal and anterior borders of level II and the anterior, posterior, medial, and lateral borders of level I. A step-by-step guide is provided for properly identifying the revised anterior border of the level I axilla.</p></div><div><h3>Conclusions</h3><p>The adaptations to the RTOG breast cancer atlas for prone positioning will enable radiation oncologists to more accurately target the level I and II axillae when the axillae are targets in addition to the breast.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905189","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":"To pass away on leap day","authors":"","doi":"10.1016/j.prro.2024.01.008","DOIUrl":"10.1016/j.prro.2024.01.008","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121335","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":"PROshot: Immunotherapy for Cervical Cancer, Epidermal Growth Factor Receptor-Mutated Stage III Lung Cancer, Perioperative Chemotherapy for Esophageal Cancer, Salvage Postprostatectomy Radiation and Androgen Deprivation Therapy, and Immunotherapy for Head and Neck Cancer","authors":"","doi":"10.1016/j.prro.2024.06.001","DOIUrl":"10.1016/j.prro.2024.06.001","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096505","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":"Radiation Therapy Dose Response in Bulky Relapsed/Refractory Large B-Cell Lymphoma","authors":"","doi":"10.1016/j.prro.2024.06.003","DOIUrl":"10.1016/j.prro.2024.06.003","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess whether a radiation therapy (RT) dose affects response in bulky tumors in relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL).</p></div><div><h3>Methods and Materials</h3><p>Data from patients with r/r DLBCL treated with salvage- or palliative-intent RT (2008-2020) at a single institution were examined. Index lesion size ≥7.5 cm was defined as bulky. Equivalent doses in 2-Gy fractions (EQD2) were calculated to compare doses between conventional and hypofractionated (≥2.5 Gy/fraction) schemes. Objective response rates (ORRs) were compared using nonparametric Mann-Whitney <em>U</em> test or Kruskal-Wallis test with Dunn's multiple comparison corrections. Freedom from local progression (FFLP) was assessed using Kaplan-Meier and Cox proportional hazard regression analyses.</p></div><div><h3>Results</h3><p>One hundred eighty-three courses of 151 unique patients were included (salvage: 37% and palliative: 63%). Nonbulky and bulky tumors were irradiated in 109 (60%) and 74 (40%) courses, respectively. Median EQD2 was 33 Gy (IQR, 23-39 Gy) with hypofractionation in 84 (46%) cases. Of those with post-RT imaging (80%), the ORR was 59%, with a trend toward worsened ORR in bulky tumors (50% vs 65%, <em>P</em> = .077). For bulky tumors, RT regimens with EQD2s &gt;30 Gy were associated with better ORR (≤30 Gy vs &gt;30 Gy: 27% vs 64%, <em>P</em> = .0073), whereas a lower EQD2 cutoff was sufficient for nonbulky tumors (≤20 Gy vs &gt;20 Gy: 38% vs 75%, <em>P</em> = .0011). On multivariable regression analysis, bulky tumor size was associated with worsened FFLP (hazard ratio, 2.07; 95% CI, 1.16-3.68; <em>P</em> = .014), whereas high EQD2s &gt;30 Gy were associated with better FFLP (hazard ratio, 0.48; 95% CI, 0.25-0.93; <em>P</em> = .031). Bulky tumors treated with EQD2s ≤30 Gy had the lowest median FFLP (4.0 months), whereas EQD2s &gt;30 Gy had an unreached median FFLP (<em>P</em> = .0047).</p></div><div><h3>Conclusions</h3><p>Bulky r/r DLBCL tumors were associated with less favorable tumor control outcomes in the salvage and palliative settings. RT regimens with higher EQD2s (&gt;30 Gy) should be considered if durable local control of bulky tumors is desired.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1879850024001449/pdfft?md5=ac6e17b19f8078cd07b21353a719072b&pid=1-s2.0-S1879850024001449-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase II Trial of Stereotactic Body Radiation Therapy and Androgen Deprivation for Oligometastases in Prostate Cancer (SBRT-SG 05)","authors":"","doi":"10.1016/j.prro.2024.04.022","DOIUrl":"10.1016/j.prro.2024.04.022","url":null,"abstract":"<div><h3>Purpose</h3><p><span>SBRT-Spanish Group-05 (ClinicalTrials.gov.Identifier: NCT02192788) is a collaborative (SBRT-SG, Grupo de Investigación Clínica en Oncología Radioterápica, and Sociedad Española de Oncología Radioterápica) prospective multicenter phase II trial testing stereotactic body radiation therapy (SBRT) and androgen deprivation therapy (ADT) in patients with oligorecurrent </span>prostate cancer.</p></div><div><h3>Methods and Materials</h3><p><span><span><span>Two cohorts of patients with prostate cancer in an oligorecurrent stage (hormone-sensitive in the principal cohort and castration-resistant in the exploratory cohort) were assigned to receive ADT and </span>SBRT for at least 24 months from the time of the enrollment. Concomitant treatment with chemotherapy, </span>abiraterone, or </span>enzalutamide was not allowed. Oncologic outcomes were assessed in both cohorts. Toxicity was prospectively analyzed.</p></div><div><h3>Results</h3><p>From 2014 to 2019, 81 patients with a total of 126 lesions from 14 centers met the inclusion criteria, 14 of whom were castration-resistant. With a median follow-up of 40 months (12-58 months), 3-year local recurrence-free survival was 92.5% (95% CI, 79.9%-96.3%) and 85.7% (95% CI, 48.2%-95.6%) in the principal and exploratory cohorts, respectively. In the principal cohort, biochemical relapse-free survival and metastasis progression-free survival at 1, 2, and 3 years were 91% (95% CI, 81%-95.8%), 73.7% (95% CI, 61.1%-82.8%), 50.6% (95% CI, 36.2%-63.3%), and 92% (95% CI, 83%-97%), 81% (95% CI, 70%-89%), and 67% (95% CI, 53%-77%), respectively. In the exploratory cohort, metastasis progression-free survival at 1, 2, and 3 years was 64% (95% CI, 34%-83%), 43% (95% CI, 18%-66%), and 26% (95% CI, 7%-51%), respectively. None of the patients developed grade III or higher toxicity or symptoms related to local progression, and only 2 (2.4%) patients developed grade II toxicity.</p></div><div><h3>Conclusions</h3><p>The combination of SBRT and ADT is safe and shows favorable clinical outcomes in patients with hormone-sensitive and castration-resistant prostate cancer. Validation studies are needed in patients with castration-resistant prostate cancer.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472584","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}