Practical Radiation Oncology最新文献

{"title":"Radiation Therapy for Heterotopic Ossification: A Systematic Review","authors":"Christine Bang MD ,&nbsp;Eric Jutkowitz PhD ,&nbsp;Eduardo Caputo PhD ,&nbsp;Sherry X. Yan MD ,&nbsp;Htun Ja Mai MBBS, MPH ,&nbsp;Ghid Kanaan MD ,&nbsp;Tayler Leonard ,&nbsp;Taylor Rickard MS ,&nbsp;Thomas Trikalinos MD ,&nbsp;James L. Rudolph MD ,&nbsp;Katherine Rieke PhD","doi":"10.1016/j.prro.2024.10.013","DOIUrl":"10.1016/j.prro.2024.10.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Heterotopic ossification (HO) is a benign disorder characterized by ectopic bone formation in soft tissues that can lead to functional loss in patients. We conducted a systematic review of the evidence on the use of radiation therapy (RT) for the prevention or treatment of HO.</div></div><div><h3>Methods and Materials</h3><div>Literature searches were conducted using Medline (via PubMed), Embase, and ClinicalTrials.gov until April 1_, 2023. Medical subject headings and free text terms relevant to HO and RT were used. In brief, eligible study participants were ≥18 years of age with HO and were treated with low-dose external RT. Two reviewers screened relevant abstracts and extracted full-text data for analysis. The review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.</div></div><div><h3>Results</h3><div>Ten studies evaluating the effect of RT for either the prevention or treatment of HO met the inclusion for evidence synthesis. Nine randomized controlled trials did not clearly report their methods and had a medium risk of bias. The studies were conducted between 1988 and 2008, with follow-up ranging on average from 3 to 59 months posttreatment. A total of 1530 participants were analyzed, and 566 were treated with RT following fracture fixation, total hip arthroplasty, or total hip replacement. In pooled data from 8 randomized controlled trials, there was a nonsignificant but clinically meaningful reduction in the presence of HO at follow-up for patients who received RT versus comparators (pooled odds ratio, 0.47; 95% CI, 0.19, 1.17). There was minimal evidence of adverse events.</div></div><div><h3>Conclusions</h3><div>This systematic review found a clinically, but not statistically, significant benefit of prophylactic RT for HO at follow-up. These findings are tempered by a moderate risk of bias. While practice patterns vary, RT for HO prophylaxis in high-risk patients may have benefits that outweigh the risks.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages 228-247"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632541","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 Margin Expansions on Local Control and Radionecrosis Following Stereotactic Radiosurgery for Brain Metastases: A Systematic Review and Meta-Analysis","authors":"Raj Singh MD ,&nbsp;John G. Roubil MD ,&nbsp;Eric J. Lehrer MD, MS ,&nbsp;Gael Muanamputu BS ,&nbsp;Evan M. Thomas MD, PhD ,&nbsp;Sasha J. Beyer MD, PhD ,&nbsp;Raju R. Raval MD, DPhil ,&nbsp;Rupesh Kotecha MD ,&nbsp;Joshua D. Palmer MD","doi":"10.1016/j.prro.2025.01.012","DOIUrl":"10.1016/j.prro.2025.01.012","url":null,"abstract":"<div><h3>Purpose</h3><div>The implications of margin expansions on local control (LC) and radionecrosis (RN) for treating brain metastases (BMs) with stereotactic radiosurgery (SRS) remain unclear. We performed a systematic review and meta-analysis to compare LC and RN between patients with BMs treated with SRS planned with no margin versus a margin.</div></div><div><h3>Methods and Materials</h3><div>We used the Population, Intervention, Control, Outcomes, Study Design; the Preferred Reporting Items for Systematic Reviews; and Meta-analyses, and the Meta-analysis of Observational Studies in Epidemiology selection inclusion criteria for studies of patients with BMs treated with SRS with no margin or a margin. Primary outcomes were 1-year LC and radiographic and symptomatic RN incidences. Weighted random effects meta-analyses were performed to compare effect sizes.</div></div><div><h3>Results</h3><div>Across 17 studies, we identified 5015 lesions treated with SRS (1360 lesions with no margin and 3684 with a margin). The median total margin was 1.5 (range, 1-3) mm. Single-fraction SRS was most common with a median prescription dose of 21 Gy (range, 15-24 Gy). The estimated 1-year LC rate was similar with a margin (88.4% [95% CI, 83.7%-92.4%]) versus without (83.0% [95% CI, 69.3-93.2%; <em>P</em> = 0.28]). The estimated incidences of radiographic RN after SRS with or without a margin were 9.2% (95% CI, 0.2%-29.6%) and 7.0% (95% CI, 4.1%-10.7%; <em>P</em> = 0.56), respectively. The estimated incidences of symptomatic RN after SRS without or with a margin were 8.6% (95% CI, 5.2%-12.7%) and 4.1% (95% CI, 0.9%-9.3%), respectively (<em>P</em> = .24).</div></div><div><h3>Conclusions</h3><div>We did not note a significant difference in LC or RN between patients treated with or without margin expansions. Prospective evaluations are warranted to further assess this question while controlling for other relevant treatment planning and metastasis considerations.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages e245-e257"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426615","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":"Patient Positional Uncertainty and Margin Reduction in Lung Stereotactic Ablative Radiation Therapy Using Pneumatic Abdominal Compression","authors":"Yohan A. Walter MS ,&nbsp;Chiachien J. Wang MD, PhD ,&nbsp;Daniel B. Speir RT ,&nbsp;William E. Burrell MSRS, RT ,&nbsp;Carlos D. Palomeque CMD ,&nbsp;James C. Henry CMD ,&nbsp;Megan M. Rodrigues CMD ,&nbsp;Troy D. Jacobs MS ,&nbsp;Bethany L. Broekhoven MS ,&nbsp;Joseph P. Dugas PhD ,&nbsp;Anne N. Hubbard MS ,&nbsp;Philip F. Durham MS ,&nbsp;Hsinshun T. Wu PhD","doi":"10.1016/j.prro.2024.12.001","DOIUrl":"10.1016/j.prro.2024.12.001","url":null,"abstract":"<div><h3>Purpose</h3><div>Motion management presents a significant challenge in thoracic stereotactic ablative radiation therapy (SABR). Currently, a 5.0-mm standard planning target volume (PTV) margin is widely used to ensure adequate dose to the tumor. Considering recent advancements in tumor localization and motion management, there is merit to reassessing the necessary PTV margins for modern techniques. This work presents a large-scale analysis of intrafraction repositioning for lung SABR under forced shallow breathing to determine the margin requirements for modern delivery techniques.</div></div><div><h3>Methods and Materials</h3><div>Treatment data for 124 lung SABR patients treated in 607 fractions on a linear accelerator were retrospectively collected for analysis. All patients were treated using pneumatic abdominal compression and intrafraction 4-dimensional (4D) cone beam computed tomography (4D CBCT)-guided repositioning halfway through treatment. Executed repositioning shifts were collected and used to calculate margin requirements using the 2-SD method and an analytical model which accounts for systematic and random errors in treatment.</div></div><div><h3>Results</h3><div>A total of 85.7% of treated fractions had 3-dimensional repositioning shifts under 5.0 mm. Fifty-three fractions (8.7%) had shifts ≥ 5.0 mm in at least 1 direction. Margins in the right-left, inferior-superior, and posterior-anterior directions were 3.62 mm, 4.34 mm, and 3.50 mm, respectively, calculated using the 2-SD method. The analytical approach estimated that 4.01 mm, 4.37 mm, and 3.95 mm margins were appropriate for our workflow. Executing intrafraction repositioning reduced margin requirements by 0.73 ± 0.07 mm.</div></div><div><h3>Conclusions</h3><div>Clinical data suggest that the uniform 5.0-mm margin is conservative for our workflow. Using modern techniques such as 4D CT, 4D CBCT, and effective motion management can significantly reduce required margins, and therefore necessary healthy tissue dose. However, the limitations of margin calculation models must be considered, and margin reduction must be approached with caution. Users should conduct a formal risk assessment prior to adopting new standard PTV margins.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages 253-261"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903455","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":"Management of Continuous Glucose Monitors in Radiation Oncology Patients","authors":"Johnathan Zeng MD ,&nbsp;Tara Kosak MEd ,&nbsp;Samir Malkani MD ,&nbsp;Julie C. Hudson MS ,&nbsp;Neil E. Martin MD, MPH ,&nbsp;Roy B. Tishler MD, PhD ,&nbsp;Itai M. Pashtan MD","doi":"10.1016/j.prro.2024.06.016","DOIUrl":"10.1016/j.prro.2024.06.016","url":null,"abstract":"<div><div>Continuous glucose monitors (CGMs) are an increasingly prevalent electronic medical device used by patients with diabetes, offering several advantages over “finger sticks.” There is a resulting rise in patients with CGMs seen in radiation oncology clinics. Manufacturers specify that CGMs should not be exposed to radiation (both diagnostic and therapeutic) due to the risk of device damage, creating challenges for patients and providers. We present a workflow for the management of CGMs in radiation oncology patients, beginning with systematic screening by providers and staff. We propose options for CGM management together with the device prescriber, including removal of the CGM or keeping it in place with periodic finger sticks to confirm the accuracy and offer guidance to radiation oncology providers and staff.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages e295-e299"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983919","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":"Neurostimulators and Radiation Therapy: Is There Any Risk?","authors":"Hanan Rida MD ,&nbsp;Alexander Bennassi MD ,&nbsp;Chahrazed Boukhobza MD ,&nbsp;Fatima Zahra Bellefkih MD ,&nbsp;Kamel Debbi MD ,&nbsp;Yazid Belkacemi MD, PhD","doi":"10.1016/j.prro.2024.09.013","DOIUrl":"10.1016/j.prro.2024.09.013","url":null,"abstract":"<div><div>The use of neurostimulators has increased in recent decades. However, safety guidelines in patients undergoing radiation therapy (RT) are lacking. We report 2 cases of pelvic RT for prostate cancer in patients with spinal cord neurostimulators. The implantable pulse generator was placed close to the irradiated volume in the gluteal region and received a median and maximal dose of 2.8 and 5.68 Gy, respectively for patient 1; and 3.65 and 5.15 Gy, respectively for patient 2. During and after RT, No dysfunction of the device was recorded. Based on the similarity with the cardiac implantable electric devices, we recommend similar safety procedures, this include the following: (i) a cumulative dose &lt;5 Gy, (ii) avoiding neutron-producing RT, (iii) ensuring the implantable pulse generator positioning outside the direct beams, (iv) switching the device to “off-mode” during treatment delivery, and (v) in vivo verification in case of implantable pulse generator close to irradiation volume. The final decision should involve neurology specialist.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages e300-e303"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607410","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 for Graves’ Ophthalmopathy: When Is the Optimal Timing of Treatment and Evaluation","authors":"Ji Hyun Hong MD, MPH ,&nbsp;Kyu Hye Choi MD, PhD ,&nbsp;Ji Sang Kim MD ,&nbsp;Suk Woo Yang MD, PhD ,&nbsp;Yeon-Sil Kim MD, PhD","doi":"10.1016/j.prro.2024.10.012","DOIUrl":"10.1016/j.prro.2024.10.012","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the decades of using radiation therapy (RT) for Graves’ ophthalmopathy, the effects and optimal timing remain unclear. We retrospectively analyzed to evaluate the overall efficacy and response, predictive factors, and the effective timing of RT by assessing steroid requirement after RT in patients without prior surgery.</div></div><div><h3>Methods and Materials</h3><div>Between 2008 and 2022, we analyzed 74 patients with Graves’ ophthalmopathy who received RT to both orbits. Concurrent steroid therapy was administered to 51 patients. Symptoms were evaluated using a modified clinical activity score (CAS), defining responders as those with a ≥2 score improvement in CAS, diplopia, or a significant reduction in exophthalmos asymmetry. Common symptoms included eye swelling (81.1%), and conjunctival edema (81.1%). Diplopia observed in 48 patients (64.9%).</div></div><div><h3>Results</h3><div>Median follow-up was 44.5 months (range, 4.8-169.6). CAS significantly improved in the early-immediate phase, 1 month after RT (<em>P</em> &lt; .001). However, diplopia showed significant improvement at a relatively late phase, 4 months after RT (<em>P</em> = .039). Patients treated with steroids concurrently showed a faster response compared to those without steroids. Initiating RT within 12 months of symptom onset resulted in a shorter duration of steroid use after RT compared with later initiation (65 vs 286 days, <em>P</em> = .011).</div></div><div><h3>Conclusions</h3><div>Our study suggests an evaluation period of at least 4 months after RT regardless of concurrent steroid treatment, recognizing the prolonged improvement timeline for diplopia. Additionally, for reducing steroid use after RT, our study suggests optimal timing of RT within 12 months of symptom onset.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages e221-e229"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632542","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 Potential of Diffusion-weighted Magnetic Resonance Imaging for the Definition of Patient-specific Patterns of Tumor Infiltration in Sacral Chordoma","authors":"Nadya Shusharina PhD ,&nbsp;Evangelia Kaza PhD ,&nbsp;Miranda B. Lam MD, MBA","doi":"10.1016/j.prro.2024.09.002","DOIUrl":"10.1016/j.prro.2024.09.002","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages 219-220"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525163","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":"In Regard to Mechalakos et al.","authors":"Hinpetch Daungsupawong PhD,&nbsp;Viroj Wiwanitkit MD","doi":"10.1016/j.prro.2024.11.013","DOIUrl":"10.1016/j.prro.2024.11.013","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Page 308"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906894","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":"In Regard to Alcorn and Baldoni","authors":"Dimitri Alex Dimitroyannis PhD, MBA","doi":"10.1016/j.prro.2024.10.016","DOIUrl":"10.1016/j.prro.2024.10.016","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Page e304"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906879","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":"In Reply to Dimitroyannis","authors":"Sara Alcorn MD, MPH, PhD ,&nbsp;Tracy Balboni MD, MPH","doi":"10.1016/j.prro.2024.12.010","DOIUrl":"10.1016/j.prro.2024.12.010","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 3","pages":"Pages e305-e306"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906880","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}