Practical Radiation Oncology最新文献

{"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, John G Roubil, Eric J Lehrer, Gael Muanamputu, Evan M Thomas, Sasha J Beyer, Raju R Raval, Rupesh Kotecha, Joshua D Palmer","doi":"10.1016/j.prro.2025.01.012","DOIUrl":"10.1016/j.prro.2025.01.012","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods and materials: </strong>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.</p><p><strong>Results: </strong>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%; P = 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%; P = 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 (P = .24).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-13","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":"ONLINE ADAPTIVE FIVE-FRACTION ABLATIVE RADIOTHERAPY FOR PROSTATE CANCER USING A CONVENTIONAL LINEAR ACCELERATOR.","authors":"Juan-Francisco Calvo-Ortega, Coral Laosa-Bello, Sandra Moragues-Femenía, José Torices-Caballero, Miguel Pozo-Massó, Adam Jones, Marcelino Hermida-López","doi":"10.1016/j.prro.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.prro.2025.01.013","url":null,"abstract":"<p><strong>Aim: </strong>To assess the dosimetric results of an online adaptive stereotactic body radiotherapy (SBRT) program to treat patients with prostate cancer using a conventional linear accelerator.</p><p><strong>Methods and materials: </strong>Prostate SBRT with five fractions is performed at the XXXX using an online adaptive method previously described (XXXX). A CBCT based adaptive \"plan-of-the-day\" (POD) is generated for each treatment fraction, which consists of a single volumetric modulated arc therapy. A dosimetric evaluation of the PODs was performed for the first twenty patients and included analysis of the target (prostate), organs-at-risks (OARs), and patient-specific quality assurance (PSQA). Each of the PODs was also compared with the corresponding conventional image-guided radiotherapy (IGRT) method. Finally, the adaptive treatment timing is analyzed for the one hundred PODs in this study RESULTS: The online adaptive treatment method ensured optimal target coverage in all treatment fractions for all patients. However, the simulated IGRT plans did not result in adequate prostate coverage (V40 Gy ≥ 95%) in 70% of fractions. Small average differences between PODs and IGRT plans were found in the OARs. The dose sparing in the rectum and bladder provided by some simulated IGRT plans, was associated with a compromised prostate coverage. The PSQA resulted in an excellent agreement between the online-calculated plans and the independent dose checks performed for all one hundred PODs. The average duration of the plan adaptation was 20.1 ± 6.1 minutes and the average overall session time including adaptation and treatment delivery was 26.4 ± 33.2 minutes.</p><p><strong>Conclusions: </strong>This study demonstrates The online adaptive program using a conventional linac to treat prostate cancer described in this study is clinically feasible and in adherence with the acceptance criteria set by the PACE B.</p><p><strong>Trial: </strong></p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426612","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 Reflection Rounds: A Departmental Initiative for Staff Well-being.","authors":"Benjamin Hopkins, Reshma Jagsi, Sheela Hanasoge","doi":"10.1016/j.prro.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.prro.2024.11.012","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383297","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":"Neoadjuvant SBRT plus Elective Nodal Irradiation with Concurrent Capecitabine for Patients with Resectable Pancreatic Cancer: Survival Analysis of a Prospective Phase 1 Trial.","authors":"Mustafa M Basree, Jacob S Witt, Nataliya V Uboha, Meghan Lubner, Rebecca Minter, Sharon Weber, Sean Ronnekleiv-Kelly, Daniel Abbott, Jeremy Kratz, Monica Patel, Syed Nabeel Zafar, Noelle LoConte, Sam J Lubner, Dustin Deming, Mark A Ritter, Pranshu Mohindra, Michael F Bassetti","doi":"10.1016/j.prro.2025.01.011","DOIUrl":"10.1016/j.prro.2025.01.011","url":null,"abstract":"<p><strong>Background and purpose: </strong>Elective nodal irradiation (ENI) in resectable pancreatic cancer remains undefined, though occult nodal disease is common. This study investigated the use of neoadjuvant stereotactic body radiation therapy (SBRT) to primary disease with ENI, with concurrent capecitabine. Safety data for this protocol were previously reported. In this report, we provide an updated survival analysis.</p><p><strong>Materials and methods: </strong>This is a prospective, single institution, phase IA/B dose-escalation trial that enrolled patients with biopsy-proven, resectable, pancreatic adenocarcinoma between 2014 - 2019 (NCT1918644). Patients were enrolled into one of the 3 cohorts with escalating dose levels. Neoadjuvant SBRT to the primary tumor was delivered in 5 fractions of 5, 6, or 7 Gy with concomitant capecitabine (1650 mg/m2). All patients received ENI 5 Gy x 5 fractions. Our initial report found no dose-limiting toxicities. Clinicopathologic features were summarized using descriptive statistics. Kaplan-Meier (KM) curves were employed for survival analysis.</p><p><strong>Results: </strong>Of 17 enrolled patients, 16 were evaluable (94.1%). Thirteen (76.5%) proceeded to surgery. Median follow up was 28.0 months (1.7 - 71.9). Four patients (25.0%) received neoadjuvant chemotherapy and six (37.5%) received adjuvant chemotherapy. Pathologic nodal involvement (69.2%) was associated with a higher risk of any relapse (p<0.01) and distant metastasis (p=0.02). Local failure occurred in 4 (25%) patients with 2/4 of those failures occurring partially within the 25 Gy elective nodal field and 1/4 occurred in the 25 Gy elective nodal field and partially within the 35 Gy tumor field. The median overall survival (OS) and disease-free survival (DFS) were 31.1 months (range, 2.3 - 73.6) and 12.0 months (range, 0.4 - 71.9), respectively. Three-year OS and DFS were 50% and 31.3% overall, and 61.5% and 38.5% for the surgical cohort. Patients with pN+ had worse median OS (23.9 vs 69.3 months; p=0.002) and DFS (9.9 vs 58.9 months; p=0.002). No further radiation related toxicities were noted since the prior report.</p><p><strong>Conclusion: </strong>Neoadjuvant SBRT to the primary tumor with ENI and radiosensitizing chemotherapy is a feasible approach that may improve outcomes in patients with resectable and borderline pancreatic cancer, despite high rates of pathological nodal involvement. Further investigation of this strategy is warranted in a larger cohort.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384084","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":"Radiotherapy Target Volume Definition for Myxopapillary Ependymoma of the Lumbosacral Spine Without Indication for Craniospinal Irradiation: The Question of Extending the Target Inferiorly to Include the Proximal Nerve Roots and Thecal Sac.","authors":"Anthony Casper, Daniel J Indelicato, Robert J Amdur, Alexandra N De Leo","doi":"10.1016/j.prro.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.prro.2025.01.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Radiosurgery for Vestibular Schwannoma - A Case-Based Practice Guide from the Radiosurgery Society.","authors":"Felix Ehret, Archis R Bhandarkar, Michael Chisam, Victor Goulenko, Ritesh Kumar, Fatemeh Fekrmandi, Karin A Skalina, John Kresl, Simon S Lo, Iris C Gibbs, Scott G Soltys, Jason P Sheehan, Christoph Fürweger, Ben J Slotman, Helen A Shih, Samuel T Chao","doi":"10.1016/j.prro.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.prro.2025.01.010","url":null,"abstract":"<p><strong>Purpose: </strong>Vestibular schwannomas (VS) are the most common benign intracranial nerve sheath tumors. Surgery and radiotherapy - particularly stereotactic radiosurgery (SRS) - are the primary treatment options. SRS is the dominant treatment for small- and medium-sized VS and selected larger tumors due to its excellent local control rates and favorable safety profile compared to surgery. However, careful treatment planning is essential, taking into account patient preferences, tumor location and size, symptoms, and anticipated treatment-related toxicity.</p><p><strong>Methods and materials: </strong>Four clinical VS scenarios have been selected to illustrate the use of SRS, including a unilateral, small intracanalicular VS, a large VS with cystic components, reirradiation with SRS after local tumor recurrence, and bilateral VS in the setting of neurofibromatosis type 2-related schwannomatosis.</p><p><strong>Results: </strong>SRS is an effective and safe treatment modality for the majority of VS cases, requiring careful treatment planning and a thorough understanding of potential limitations and challenges.</p><p><strong>Conclusions: </strong>This case-based practice guide aims to provide a concise overview of the treatment of VS with SRS. We present and discuss four different clinical scenarios of VS to illustrate the pitfalls and best practice recommendations.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257380","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 in the Management of Hidradenitis Suppurativa.","authors":"Bryn Myers, Shauna R Campbell, Chirag Shah","doi":"10.1016/j.prro.2025.01.008","DOIUrl":"10.1016/j.prro.2025.01.008","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257378","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":"Comparison of Acute and Late Toxicities With Daily Versus Every-Other-Day 5-Fraction Partial Breast Radiation Therapy.","authors":"Sean M Parker, Ahmed Halima, Sudha Amarnath, Maria Claudia Moncaliano, Arya Patel, Connor Spera, Elizabeth Obi, Cole Billena, Zahraa Al-Hilli, Sheen Cherian, Rahul Tendulkar, Chirag Shah","doi":"10.1016/j.prro.2025.01.006","DOIUrl":"10.1016/j.prro.2025.01.006","url":null,"abstract":"<p><strong>Purpose: </strong>Partial breast irradiation (PBI) delivered with intensity modulated radiation therapy over 5 fractions every other day represents an attractive, convenient method of delivering adjuvant radiation therapy for well-selected patients without compromising oncologic or toxicity outcomes. Condensing this regimen to a week of treatment through consecutive daily delivery may further increase patient convenience, though a comparison of toxicities between daily and every other day regimens is limited.</p><p><strong>Methods and materials: </strong>We retrospectively reviewed 507 patients from an institutional registry undergoing PBI for ductal carcinoma in situ (DCIS) or early-stage breast cancer (T1-2N0/x) from 2015 to 2022. All patients received 30 Gy in 5 fractions with intensity modulated radiation therapy. Acute (toxicity within 90 days of treatment) and chronic toxicity were recorded.</p><p><strong>Results: </strong>Of the 507 patients, 351 were treated every other day, and 159 were treated daily. Median follow-up was longer in the every-other-day group (2.4 vs 1.9 years, P < .001). With regards to acute toxicity, there was slightly reduced grade 1 to 2 dermatitis with daily treatment (39% every other day vs 35% daily, P = .06), while rates of fatigue (18% every other day vs 20% daily, P = .09) were similar. Rates of chronic toxicities were comparable between the two approaches, with no differences in the rates of chronic hyperpigmentation (14% every other day vs 14% daily, P = .97), telangiectasias (1% every other day vs 1% daily, P = .92), mild fibrosis/induration (13% every other day vs 13% daily, P = .91), and lymphedema (0% every other day vs 1% daily, P = .31).</p><p><strong>Conclusions: </strong>Overall, 5-fraction PBI delivered daily appears to be well tolerated with similar acute and chronic toxicity to every other day fractionation.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054284","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":"Lorlatinib-Induced Blindness: A Rare Entity.","authors":"Neris Dincer, Orcun Can, Gokhan Demir, Enis Ozyar","doi":"10.1016/j.prro.2025.01.004","DOIUrl":"10.1016/j.prro.2025.01.004","url":null,"abstract":"<p><p>Lorlatinib is a central nervous system-penetrant third-generation tyrosine kinase inhibitor approved for the first-line management of metastatic non-small cell lung cancer with anaplastic lymphoma kinase rearrangement,¹ which accounts for 3% to 5% of non-small cell lung cancer cases.² The most commonly reported side effects include hyperlipidemia, edema, peripheral neuropathy, and central nervous system effects.² Whereas ocular side effects such as photopsia, blurred vision, vitreous floaters, and diplopia have been documented with another anaplastic lymphoma kinase-tyrosine kinase inhibitor, crizotinib, there are few reports of such effects with lorlatinib.³ Herein, we present a case of bilateral optic neuropathy, initially misdiagnosed as optic nerve metastases and treated with palliative radiation therapy.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043336","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":"Use of 3D Printing Technology to Improve Lead Shield Fabrication for Electron Therapy of the Face.","authors":"Igor Bundalevski, Amy S Harrison, Michael F Dzeda, Laura A Doyle, Hungcheng Chen","doi":"10.1016/j.prro.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.prro.2024.12.008","url":null,"abstract":"<p><p>Superficial lesions of the face are often treated with an electron beam and surface collimation utilizing a conformal lead shield with an opening around the region of treatment (ROT). To fabricate the lead shield, an imprint of the patient face is needed. Historically, this was achieved using a laborious and time-consuming process that involved a gypsum imprinted model (GIM) of the patient topography. We propose utilization of 3-dimentional (3D) printing technology to create a 3-dimensional printed custom model (3D-PCM) of the patient facial topography as a more accurate and more efficient alternative to GIM. GIM and 3D-PCM were generated for three patients requiring en face electron therapy of the nose. The models for both methods were then CT-scanned and fused rigidly to the CT of the patient. The accuracy of the models was compared with the CT image of the patient via visual inspection and the Sørensen-Dice similarity coefficient (DSC). The efficiency of the two methods was evaluated by the average time needed to complete each process based on user-reported experience. The average DSC between the patient and GIM is 0.95336 (standard deviation (SD) = 0.0099479), while the average DSC of the patient and 3D-PCM is 0.97886 (SD = 0.0037441). With respect to efficiency, the average time to fabricate and dry GIM is 54.5 hours with hands-on time of 2.5 hours, while generation of 3D-PCM takes about 6.5 hours, with hands on time of approximately 2.5 hours. 3D-PCMs based on CT scan images are found to be an excellent substitute for GIMs by exhibiting a higher degree of fidelity with patient's anatomy, requiring significantly less time to complete, being less labor intensive, and allowing for greater patient comfort. The disadvantage of exposing the patient to radiation associated with the CT scan image acquisition for designing a 3D-PCM could be eliminated by employing 3D-camera scanning technology.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016255","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}