Practical Radiation Oncology最新文献

{"title":"Lung Stereotactic Body Radiation Therapy Using Dynamic Conformal Arc Therapy With or Without Flattening Filter Photon Beam: A French Institutional Experience.","authors":"Mickael Preault, Leonor Chaltiel, Jonathan Khalifa, Audrey Keller, Sarah Zahi, Audrey Rabeau, Laure Parent, Carole Massabeau","doi":"10.1016/j.prro.2025.04.006","DOIUrl":"10.1016/j.prro.2025.04.006","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of the flattening filter-free (FFF) technique compared with the flattening filter (FF) technique in the context of lung tumor stereotactic body radiation therapy (SBRT).</p><p><strong>Methods and materials: </strong>The study included a total of 101 lung SBRT treatments among 82 consecutive patients. Patients were treated with an FF technique (FF group, n = 47) between 2012 and 2014 and with an FFF technique (FFF group, n = 54) between 2014 and 2016. Our risk-adapted SBRT fractionation protocol based on location (3 or 5 fractions) remained unchanged during the entire study. Treatment plans consisted of a dynamic conformal half-arc, and the dose was prescribed to the 80% isodose line. FFF treatments are delivered 2.33 times faster than FF treatments because of the higher dose rate of the machine.</p><p><strong>Results: </strong>The median follow-up for the 82 patients was 55.4 months, and the median overall survival for all patients was 45.9 months. Local control at 2 years post-SBRT of the 101 lesions was excellent and similar in both groups (97.9% in the FF group vs 98.1% in the FFF group). There were no grade 4 or 5 toxicities and only 4 grade 3 lung toxicities (4.1%) in the FF group (vs none in the FFF group). Three patients in the FFF group versus 1 patient in the FF group had a symptomatic rib fracture. Among patients treated free breathing on a single lesion (n = 65), the local recurrence-free survival at 2 years was 85.7% (95% CI, 62.0-95.2) in the FFF group and 71.4% (95% CI, 52-84.1) in the FF group (P = .139).</p><p><strong>Conclusions: </strong>Patient treatment with lung SBRT using the FFF technique is safe and provides an excellent long-term local control and low toxicity compared with the FF technique.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994783","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":"Assessing ChatGPT for Clinical Decision-Making in Radiation Oncology, With Open-Ended Questions and Images","authors":"Wei-Kai Chuang MD ,&nbsp;Yung-Shuo Kao MD ,&nbsp;Yen-Ting Liu MD ,&nbsp;Cho-Yin Lee MD, PhD","doi":"10.1016/j.prro.2025.04.009","DOIUrl":"10.1016/j.prro.2025.04.009","url":null,"abstract":"<div><h3>Purpose</h3><div>This study assesses the practicality and correctness of Chat Generative Pre-trained Transformer (ChatGPT)-4 and 4O’s answers to clinical inquiries in radiation oncology<span>, and evaluates ChatGPT-4O for staging nasopharyngeal carcinoma (NPC) cases with magnetic resonance (MR) images.</span></div></div><div><h3>Methods and Materials</h3><div>A total of 164 open-ended questions covering representative professional domains (Clinical_G: knowledge on standardized guidelines; Clinical_C: complex clinical scenarios; Nursing: nursing and health education; and Technology: radiation technology and dosimetry) were prospectively formulated by experts and presented to ChatGPT-4 and 4O. Each ChatGPT’s answer was graded as 1 (Directly practical for clinical decision-making), 2 (Correct but inadequate), 3 (Mixed with correct and incorrect information), or 4 (Completely incorrect). ChatGPT-4O was presented with the representative diagnostic MR images of 20 patients with NPC across different T stages, and asked to determine the T stage of each case.</div></div><div><h3>Results</h3><div>The proportions of ChatGPT’s answers that were practical (grade 1) varied across professional domains (<em>P</em> &lt; .01), higher in Nursing (GPT-4: 91.9%; GPT-4O: 94.6%) and Clinical_G (GPT-4: 82.2%; GPT-4O: 88.9%) domains than in Clinical_C (GPT-4: 54.1%; GPT-4O: 62.2%) and Technology (GPT-4: 64.4%; GPT-4O: 77.8%) domains. The proportions of correct (grade 1+2) answers (GPT-4: 89.6%; GPT-4O: 98.8%; <em>P</em> &lt; .01) were universally high across all professional domains. However, ChatGPT-4O failed to stage NPC cases via MR images, indiscriminately assigning T4 to all actually non-T4 cases (<em>κ</em> = 0; 95% CI, −0.253 to 0.253).</div></div><div><h3>Conclusions</h3><div>ChatGPT could be a safe clinical decision-support tool in radiation oncology, because it correctly answered the vast majority of clinical inquiries across professional domains. However, its clinical practicality should be cautiously weighted particularly in the Clinical_C and Technology domains. ChatGPT-4O is not yet mature to interpret diagnostic images for cancer staging.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 5","pages":"Pages e412-e423"},"PeriodicalIF":3.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063253","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 Efficacy and Toxicity of Hypofractionated Regional Nodal Irradiation in Breast Cancer Patients.","authors":"Daphna Y Spiegel, Julia Willcox, Josephine Levey, Laura E Dodge, Abram Recht","doi":"10.1016/j.prro.2025.03.014","DOIUrl":"10.1016/j.prro.2025.03.014","url":null,"abstract":"<p><strong>Purpose: </strong>Regional nodal irradiation (RNI) is increasingly used in place of axillary lymph node dissection (ALND) in carefully selected breast cancer patients. Although hypofractioned whole breast irradiation is standard for node-negative disease, long-term data on hypofractionated RNI (HF-RNI) are limited. This study aims to assess the long-term safety and effectiveness of HF-RNI for breast cancer patients.</p><p><strong>Methods and materials: </strong>This retrospective analysis included 154 patients with node-positive or high-risk node-negative breast cancer treated with HF-RNI (>2 Gy/fraction) between 2008 and 2020. Median dose was 40 Gy/16 fractions to the breast, chest wall, or reconstructed breast as well as regional nodes. The primary endpoint was the incidence of chronic toxicity. Secondary endpoints were acute toxicity, local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), disease-free survival (DFS), and overall survival (OS). Acute toxicities were defined as those occurring during radiation therapy or within 90 days post-treatment; chronic toxicities were defined as those persisting or arising at least 180 days after radiation completion.</p><p><strong>Results: </strong>Median follow-up was 65.4 months (range, 4-170 months). Median age was 58 years (interquartile range, 48.3-71.0). Sentinel lymph node biopsy was performed in 49.4% of patients, 47.4% underwent ALND, and 3.2% had no axillary surgery. RNI targets included supraclavicular and axillary level 1 to 3 nodes in 65.6% of patients, whereas 34.4% were treated only to the supraclavicular and level 3 nodes. There were 7 (4.7%) patients that had internal mammary nodes treated. Chronic brachial plexopathy occurred in 2.0% of patients, limited range of motion in 1.3%, and upper extremity lymphedema in 10.5%. Late cardiac and lung toxicity rates were low at 0.7% and 3.3%, respectively. Five-year actuarial rates of LRFS, RRFS, DFS, and OS were 98.0%, 99.3%, 90.1%, and 88.1%, respectively.</p><p><strong>Conclusions: </strong>HF-RNI demonstrates low rates of chronic toxicity and excellent disease control, supporting wider adoption in clinical practice. Long-term results of randomized trials of HF-RNI are needed for definitive evidence.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058295","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":"Real-World Experience Using Proton Versus Photon Craniospinal Irradiation for Leptomeningeal Disease","authors":"Kelsey M. Frechette MD ,&nbsp;Amanda F. Meyer APRN ,&nbsp;Sara B. Leier APRN ,&nbsp;William S. Harmsen PhD ,&nbsp;Sydney D. Pulsipher MPH ,&nbsp;Witold Matysiak PhD ,&nbsp;Thomas B. Bradley CMD ,&nbsp;Ugur T. Sener MD ,&nbsp;Lauren M. Webb MD ,&nbsp;David M. Routman MD ,&nbsp;Elizabeth Yan MD ,&nbsp;Nadia N. Laack MD ,&nbsp;Paul D. Brown MD ,&nbsp;Eric J. Lehrer MD ,&nbsp;William G. Breen MD ,&nbsp;Roman O. Kowalchuk MD ,&nbsp;Anita Mahajan MD","doi":"10.1016/j.prro.2025.03.015","DOIUrl":"10.1016/j.prro.2025.03.015","url":null,"abstract":"<div><h3>Purpose</h3><div>Data demonstrate improved survival with proton craniospinal irradiation (CSI) over involved field radiation therapy for leptomeningeal disease (LMD). It is unknown how photon CSI compares in the treatment of LMD. We report our institution’s real-world experience using proton versus photon CSI for LMD.</div></div><div><h3>Methods and Materials</h3><div>We performed a retrospective review of LMD patients treated with photon or proton CSI from January 2021 to February 2024. All histologies were included. Patient characteristics and complete blood counts were collected before and after CSI. The primary endpoint was serious cytopenia likely caused by CSI. The median overall survival was estimated using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Thirty-six patients with LMD treated with CSI (27 proton and 9 photon) were included. Across all major cell lines (hemoglobin, platelets, leukocytes, neutrophils, and lymphocytes), the rate of serious (grade 3 or higher) cytopenia likely caused by CSI was not different between the proton and photon groups (<em>p</em> &gt; .21). The median overall survival in the proton and photon groups was 3.0 months and 1.7 months, respectively (hazard ratio, 1.49; <em>p</em> = .47).</div></div><div><h3>Conclusions</h3><div>In a single-institutional experience treating LMD, acute cytopenias likely caused by CSI were not different between proton and photon CSI across all major cell lines. Survival was also similar between modalities; therefore, photon CSI may be a safe, efficacious option for LMD.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 5","pages":"Pages 472-480"},"PeriodicalIF":3.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040574","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":"Partial Breast Radiation Therapy in Low-Risk Breast Cancer Using a Magnetic Resonance Imaging–Guided Adaptive Approach; Results of the Phase 2 PARLOB Study","authors":"Claire van Vliet MD ,&nbsp;Shyama U. Tetar MD, PhD ,&nbsp;H.J.G. Desirée van den Bongard MD, PhD ,&nbsp;Tamara Fraikin BSc ,&nbsp;Marloes Jeulink BSc ,&nbsp;Miguel A. Palacios PhD ,&nbsp;M. Petrousjka van den Tol MD, PhD ,&nbsp;Ben J. Slotman MD, PhD ,&nbsp;Anna M.E. Bruynzeel MD, PhD","doi":"10.1016/j.prro.2025.03.011","DOIUrl":"10.1016/j.prro.2025.03.011","url":null,"abstract":"<div><h3>Purpose</h3><div>The majority of patients with breast cancer are treated with breast-conserving surgery followed by postoperative whole or partial breast irradiation (PBI). Previous studies on PBI demonstrated similar ipsilateral breast tumor recurrences compared with whole breast irradiation, however, conflicting data on toxicity and cosmetic outcomes were reported. This study investigates the feasibility of stereotactic magnetic resonance imaging-guided adaptive radiation therapy (SMART) for PBI, with emphasis on toxicity and cosmetic outcomes.</div></div><div><h3>Methods and Materials</h3><div>Patients with low-risk breast cancer suitable for PBI as defined by European Society for Radiotherapy and Oncology guidelines were included. SMART was delivered in supine position in a 2-week course of 5 fractions of 6 Gy, or 6.5 Gy in case of high risk characteristics. Patient- and physician-reported toxicity and cosmetic outcomes were scored at 3, 9, 18, and 36 months postoperatively.</div></div><div><h3>Results</h3><div>Between 2017 and 2020, 50 patients were included and 45 patients were treated with SMART. Median age was 66 years, median tumor size was 1.2 cm. Most tumors were Bloom Richardson grade 1 (55.6%) and estrogen receptor positive (95.6%). The majority did not receive adjuvant systemic therapy (80%). The highest grade acute toxicity was grade 2 in 20%, mostly fatigue. At 18 months, 4 patients (9%) reported grade 2 toxicity, consisting of fibrosis and fatigue. No grade ≥3 toxicity was recorded. At 9 and 18 months, 86.4% of patients were (very) satisfied with the cosmetic outcome. The cosmetic outcome was good-excellent compared with the contralateral breast at 18 months in 90.9% and 73.8% as scored by patients and physicians, respectively.</div></div><div><h3>Conclusions</h3><div>Stereotactic magnetic resonance imaging-guided adaptive PBI for patients with low-risk breast cancer was feasible and resulted in low rates of toxicity. Good cosmetic outcomes were reported by patients after a follow-up of 18 months.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 5","pages":"Pages e434-e443"},"PeriodicalIF":3.5,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021339","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":"Practice Patterns of Reirradiation for Brain and Spinal Tumors-An International Survey From the Reirradiation Collaborative Group (ReCOG).","authors":"Xuguang Scott Chen, Lei Zhang, Thankamma Ajithkumar, Anish A Butala, Michelle M Kim, Charles Mayo, Benjamin S Rosen, Colette J Shen, Louise Murray","doi":"10.1016/j.prro.2025.04.003","DOIUrl":"10.1016/j.prro.2025.04.003","url":null,"abstract":"<p><strong>Purpose: </strong>An international workshop was convened by the Reirradiation Collaborative Group. We conducted a survey among the invited attendants to assess practice patterns of reirradiation for central nervous system tumors.</p><p><strong>Methods and materials: </strong>A web-based survey regarding central nervous system reirradiation was distributed to an international group of radiation oncologists and medical physicists via email.</p><p><strong>Results: </strong>Sixty-six respondents from 20 countries completed at least one section of the survey. The most important clinical considerations were treatment goal, degree of overlap, and cumulative dose. Among technical challenges, uncertainties in tolerance of organs at risk (OARs), tissue recovery factors (TRFs) and dose accumulation ranked the highest. Most respondents (68%) used a planning OAR volume with 0 to 3 mm margin. Highly conformal radiation techniques were preferred, including stereotactic body radiation therapy for spine (85%), intensity modulated radiation therapy for adult primary brain tumors (93%), and intensity modulated radiation therapy (100%) and proton therapy (83%) for pediatric cases. Most performed dose accumulation (65%) and evaluated cumulative biological (ie, equieffective) dose (88%). Sixty-one percent preferred rigid registration, whereas 35% used deformable registration, most commonly in pediatric cases (67%). The most frequently used α/β value for OARs was 2 Gy (76%). There was no clear consensus on OAR tolerance for any disease site. Different dose metrics were used for evaluation, including Dmax (48%) and D0.1cc (48%). Most (79%) considered time intervals between radiation courses. For adult primary brain tumors and brain metastasis, 50% and 46% recommended against reirradiation within a short interval (3-6 months). Most respondents (52%) used time dependent TRFs.</p><p><strong>Conclusions: </strong>Among respondents, there are substantial variations in approaches to reirradiation (eg, addition of systemic therapy) and uncertainties in technical implementation (eg, OAR tolerance, TRF, and dose accumulation). Future collaborative registry-based and prospective studies should help address these uncertainties.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057952","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":"Pictorial Guide to Delineating the Recurrent Laryngeal Nerve as an Organ at Risk.","authors":"Deepak Gupta, Richa Arunendu, Shikha Goyal, Smriti Ram, Shyam Singh Bisht, Debolina Kabiraj, Sorun Shishak, Susovan Banerjee, Kushal Narang, Mayur Mayank, Tejinder Kataria","doi":"10.1016/j.prro.2025.04.001","DOIUrl":"10.1016/j.prro.2025.04.001","url":null,"abstract":"<p><p>The recurrent laryngeal nerve (RLN) is especially vulnerable in cases of reirradiation, large-volume irradiation, or stereotactic body radiation therapy. Although RLN injury is rarely reported, it can cause hoarseness, swallowing difficulties, and airway obstruction, often with delayed onset. We aimed to map the course of bilateral RLNs on radiation therapy planning computed tomography scans to assess its feasibility as an organ at risk.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055748","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":"Combination Metastasis-Targeted External Beam Radiation Therapy With ¹⁷⁷Lu-PSMA-617 in Patients With Advanced Castration-Resistant Prostate Cancer.","authors":"Sedra Mohammadi, Isabella R Pompa, Veronica Haberman, Bashar Kako, Richard J Lee, Philip J Saylor, Xin Gao, Shadi A Esfahani, Pedram Heidari, Praful Ravi, Mutlay Sayan, Jason A Efstathiou, Heather A Jacene, Sophia C Kamran, Thomas S C Ng","doi":"10.1016/j.prro.2025.03.010","DOIUrl":"10.1016/j.prro.2025.03.010","url":null,"abstract":"<p><strong>Purpose: </strong>¹⁷⁷Lu-PSMA-617 (LuPSMA) is an effective radiopharmaceutical therapy for patients with metastatic castration-resistant prostate cancer. While LuPSMA can treat disseminated disease, additional localized control of metastatic disease may be required. Metastasis-targeted external beam radiation therapy (M-EBRT) can be an effective adjunct. However, the indications, efficacy, and safety/toxicity of combining M-EBRT with LuPSMA are unclear. Here, we report our experience with M-EBRT in patients receiving LuPSMA and assess M-EBRT's ability for local disease control and palliation.</p><p><strong>Methods and materials: </strong>This retrospective institutional review board-exempted study reviewed patients treated with LuPSMA at a multi-institutional academic cancer center within the first 2 years after United States Food and Drug Administration's approval, receiving contemporaneous M-EBRT. Clinical factors driving the use of M-EBRT were analyzed.</p><p><strong>Results: </strong>Treatment courses of 261 patients receiving LuPSMA were reviewed; 52 patients received M-EBRT contemporaneously. M-EBRT was administered for intracranial/epidural disease (n = 22/52; 42%), bone pain palliation (n = 17/52; 33%), prevention of pathological fractures (n = 12/52; 23%), and 12% (n = 6/52) for various other indications. M-EBRT timing varied among patients, with 54% (n = 28/52) receiving M-EBRT before, 27% (n = 14/52) after, and 13% (n = 7/52) during LuPSMA therapy. EBRT was mostly well tolerated, although lymphopenia was commonly experienced. Most patients (n = 32/52; 62%) had symptom relief following M-EBRT. Symptom relief post-M-EBRT was 68%, 85%, and 50%, and mortality rates were 32%, 29%, and 57% for patients receiving EBRT before, during, and after LuPSMA treatment, respectively, albeit not statistically significant (P > .23). Prostate-specific antigen (PSA)50 (decrease in PSA by 50% during treatment) response in this patient population was 41% compared with 50% in the general LuPSMA population, but the magnitude of PSA response was heterogeneous (P = .27).</p><p><strong>Conclusions: </strong>In our experience, M-EBRT was used effectively with LuPSMA therapy for local tumor control and symptom management, especially for localized osseous and central nervous system lesions, and with good tolerability. M-EBRT may be an important adjunct treatment modality that facilitates the initiation and/or continuation of LuPSMA.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060600","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":"Implantable Rectal Spacers in Prostate Cancer Radiation Therapy: A Systematic Review","authors":"Julie Lippens MSc ,&nbsp;Louise Willems MSc ,&nbsp;Oleksandr Boychak MD, PhD ,&nbsp;Michael Pinkawa MD, PhD ,&nbsp;Peter F. Orio 3rd DO, MS ,&nbsp;Michael W.T. Chao MD, PhD ,&nbsp;Suneil Jain MD, PhD ,&nbsp;Daniel Y. Song MD ,&nbsp;Michael Zelefsky MD ,&nbsp;Evert J. Van Limbergen MD, PhD ,&nbsp;Ben G.L. Vanneste MD, PhD","doi":"10.1016/j.prro.2025.03.009","DOIUrl":"10.1016/j.prro.2025.03.009","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review provides an overview of the available literature regarding the efficacy and safety of implantable rectal spacers (IRSs) in reducing rectal dose and gastrointestinal toxicity during prostate cancer radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>A comprehensive literature search was conducted in December 2024. Results included prospective research in humans and were limited to the English language. The 30 included studies, all published between 2007 and 2024, were randomized controlled trials or clinical trials that focused on adverse events, rectal dose reduction, gastrointestinal toxicity, or bowel quality of life. Next, IRS implantation technique, safety, and spacing distance were assessed.</div></div><div><h3>Results</h3><div>Randomized controlled trial data were available for hydrogel, hyaluronic acid, and rectal balloon implant spacers, whereas only one pilot study is available for human collagen. Prospective clinical research on IRS in brachytherapy is limited. One centimeter of spacing between the rectum and prostate sufficed to spare the rectum, the primary dose-limiting organ. Findings indicate a favorable safety profile, with an overall complication rate of 0,96% when using hydrogel spacers. There was no grade 4 to 5 gastrointestinal toxicity reported in clinical trials. The use of an IRS was associated with improved long-term bowel quality of life.</div></div><div><h3>Conclusions</h3><div>The integration of IRS into clinical practice offers the potential to enhance the therapeutic landscape for patients with prostate cancer. However, its use should be guided by careful consideration of individual patient needs to determine those who benefit most from the IRS because not all patients may benefit equally.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 5","pages":"Pages e460-e483"},"PeriodicalIF":3.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058293","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":"Advancements in Prostate Cancer Radiation Therapy: The Role of Prostate-Specific Membrane Antigen Positron Emission Tomography Imaging","authors":"Nataniel H. Lester-Coll MD ,&nbsp;Alan Dal Pra MD ,&nbsp;Vedang Murthy MD, DNB, DipEPP ,&nbsp;Sophia C. Kamran MD","doi":"10.1016/j.prro.2025.03.008","DOIUrl":"10.1016/j.prro.2025.03.008","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 5","pages":"Pages e451-e459"},"PeriodicalIF":3.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059787","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}