Practical Radiation Oncology最新文献

{"title":"Excluding Upper Axillary Level 1 in Regional Nodal Irradiation Does Not Increase Axillary Recurrence Risk in Patients With Breast Cancer","authors":"Hwa Kyung Byun MD, PhD ,&nbsp;Hyung Seok Park MD, PhD ,&nbsp;Seo Hee Choi MD ,&nbsp;Seho Park MD, PhD ,&nbsp;Jee Suk Chang MD, PhD ,&nbsp;Ik Jae Lee MD, PhD ,&nbsp;Yong Bae Kim MD, PhD","doi":"10.1016/j.prro.2024.08.010","DOIUrl":"10.1016/j.prro.2024.08.010","url":null,"abstract":"<div><h3>Purpose</h3><div>The optimal extent of regional nodal irradiation (RNI) in postoperative radiation therapy for breast cancer, particularly regarding axillary level 1 (AXL1), remains uncertain. This study aimed to compare clinical outcomes between extensive RNI including the entire axilla and limited RNI excluding the upper AXL1 in patients with breast cancer.</div></div><div><h3>Methods and Materials</h3><div>A retrospective analysis included 1780 women with nonmetastatic unilateral breast cancer who underwent RNI during postoperative radiation therapy between 2007 and 2018. Patients were classified into extensive and limited RNI groups based on the upper AXL1 inclusion in the radiation field. Propensity-score matching yielded a cohort of 1020 patients. Noninferiority of limited RNI compared with extensive RNI was assessed with a defined margin of ≤2% in the 5-year axillary recurrence rate.</div></div><div><h3>Results</h3><div>After a median follow-up of 67.9 months, the 5-year axillary recurrence rates were similar between extensive and limited RNI groups (1.2% vs 1.6%; <em>P</em>_log-rank= .790). Limited RNI demonstrated noninferiority with a 0.4% difference (95% confidence interval, –1.1% to 1.9%; <em>P</em>_{noninferiority}= .019). Disease-free survival (87.9% vs 91.5%; <em>P</em>_log-rank= .122) and overall survival (94.1% vs 96.9%; <em>P</em>_log-rank= .260) at 5 years were not significantly different between extensive and limited RNI groups. Multivariable analysis revealed that lymphovascular invasion (hazard ratio [HR], 5.17; <em>P</em> = .02) and negative hormone receptor status (HR, 11.73; <em>P</em> = .002) were associated with a higher risk of axillary recurrence, whereas limited RNI showed no significant association (HR, 1.35; <em>P</em> = .652). Subgroup analysis demonstrated that extensive RNI did not improve axillary control in patients with lymphovascular invasion, hormone receptor negativity, positive lymph node metastasis, or a small number of nodes removed.</div></div><div><h3>Conclusions</h3><div>Limited RNI, excluding the upper AXL1 from the radiation field, demonstrated axillary recurrence rates comparable with those of extensive RNI in patients with breast cancer. The study suggests that extensive RNI may not provide additional therapeutic benefits, whereas limited RNI appears to be a valid option for regional control.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 144-154"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373571","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 Pathologic Tumor Necrosis of Conventional Versus Ultrahypofractionated Preoperative Radiation Therapy in Localized Extremity Soft Tissue Sarcoma and Its Correlation With Clinical Outcomes","authors":"Hanis Hanafi MD ,&nbsp;Carolyn R. Freeman MD ,&nbsp;James Tsui MD ,&nbsp;Paul Ramia MD ,&nbsp;Robert Turcotte MD ,&nbsp;Ahmed Aoude MD ,&nbsp;Anthony Bozzo MD ,&nbsp;Fabio L. Cury MD","doi":"10.1016/j.prro.2024.10.008","DOIUrl":"10.1016/j.prro.2024.10.008","url":null,"abstract":"<div><h3>Purpose</h3><div>We aimed to determine if ultrahypofractionated radiation therapy (UHYPO-RT) delivering 6 Gy x 5 fractions yields similar tumor necrosis compared with conventional radiation therapy (CONV-RT) with 2 Gy x 25 fractions in soft tissue sarcoma. The clinical significance of tumor necrosis on loco-regional recurrence-free survival (LRFS), distant disease-free survival (DDFS), and overall survival (OS) were assessed.</div></div><div><h3>Methods and Materials</h3><div>Patients with localized soft tissue sarcoma treated with CONV-RT or UHYPO-RT followed by surgery were included. Good response was defined as tumor necrosis ≥90%, and poor response as &lt;90%. The Mann-Whitney <em>U</em> test compared median tumor necrosis. χ² analysis was used for categorical variables. The Kaplan-Meier function estimated LRFS, DDFS, and OS.</div></div><div><h3>Results</h3><div>A total of 64 patients received CONV-RT, and 45 received UHYPO-RT. The median tumor size was 7.0 cm, with the lower extremity being the most common site (55%). Myxofibrosarcoma (39%) and undifferentiated pleomorphic sarcoma (16%) were the most frequent histologies. The median time from radiation therapy to surgery was 35 days. There was a significant difference in median tumor necrosis between CONV-RT and UHYPO-RT, with rates of 40% and 60%, respectively (<em>P</em> = .022). Patients receiving UHYPO-RT had a higher percentage of tumor necrosis at the 90% cutoff, achieving 27% compared with 6% for CONV-RT (<em>P</em> = .003). At a median follow-up of 32 months, 12 patients (9%) experienced loco-regional recurrence, 24 patients (19%) faced distant failure, and 19 patients (15%) died of metastatic disease. Patients with &lt;90% necrosis had higher rates of loco-regional (13% vs 0%, <em>P</em> = .207) and distant failure (25% vs 0%, <em>P</em> = .021). Three-year LRFS was 86% for &lt;90% necrosis and 100% for ≥90% necrosis (<em>P</em> = .160). DDFS was 75% for &lt;90% necrosis versus 100% for ≥90% (<em>P</em> = .036). OS rates were 79% and 93%, respectively (<em>P</em> = .290).</div></div><div><h3>Conclusions</h3><div>Preoperative RT with UHYPO-RT was associated with a higher rate of tumor necrosis ≥90% than CONV-RT. Our data suggest that more extensive necrosis is associated with better clinical outcomes.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e189-e197"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559466","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(25)00023-2","DOIUrl":"10.1016/S1879-8500(25)00023-2","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Page A1"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705177","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: Dose Escalation for Non-small Cell Lung Cancer, 5-year Outcomes for Prostate Stereotactic Body Radiation Therapy, Optimal Chemotherapy for Oligodendroglioma, and Omitting Sentinel Lymph Node Biopsy in Early Breast Cancer","authors":"Caleb Dulaney MD ,&nbsp;Laura Dover MD, MSPH","doi":"10.1016/j.prro.2025.01.007","DOIUrl":"10.1016/j.prro.2025.01.007","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 113-116"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705178","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":"Unplanned Emergency Department or Inpatient Acute Care Within 1 Week After Administration of Peptide Receptor Radionuclide Therapy: Frequency of Occurrence and Standard Operating Procedures for Radioprotection in These Situations","authors":"Roshan S. Prabhu MD, MS ,&nbsp;Rachel Russek MPH ,&nbsp;James E. McBride MSN ,&nbsp;Karen B. Price BSN ,&nbsp;Danielle N. Garland BSN ,&nbsp;Elizabeth Franklin MS ,&nbsp;Derek R. McHaffie MD ,&nbsp;Matthew C. Ward MD ,&nbsp;Chelsea L. Rowland MSN ,&nbsp;Courtney E. Huffstetler MSN ,&nbsp;Amy S. Hicks DNP","doi":"10.1016/j.prro.2024.07.002","DOIUrl":"10.1016/j.prro.2024.07.002","url":null,"abstract":"<div><div>Peptide receptor radionuclide therapy (PRRT) is a rapidly developing treatment modality. These treatments are indicated for patients who are either heavily pretreated and/or may have neurohormonal active disease, increasing the risk of acute adverse effects and the need for unplanned acute care. The goals of this report were to characterize the frequency of unplanned acute care utilization after PRRT infusion and detail a comprehensive standard operating procedure (SOP) for radioprotection during unplanned post-PRRT acute care. The records of patients treated with PRRT were reviewed. The event of interest was emergency department (ED) utilization and/or inpatient admission within 7 days of PRRT infusion. A multidisciplinary group developed a radioprotection SOP for all phases of unplanned acute care including the clinical infusion space and emergency medical services transport to the ED, within the ED, and on the inpatient floor. A total of 232 patients received 814 infusions of PRRT, with 134 (58%) receiving Lutathera and 98 (42%) receiving Pluvicto. Nineteen patients received unplanned acute care at an ED within 7 days of PRRT infusion (8% of patients, 2% of infusions), of which 10 received Lutathera (8% of patients, 2% of infusions). Two patients (2% of patients, 0.5% of infusions) experienced carcinoid crises within 24 hours of Lutathera infusion. The median and average intervals between infusion and ED visit were 0.5 days and 1.3 days, respectively. Nine patients received Pluvicto (9% of patients, 3% of infusions). The median and average intervals between infusion and ED visit were 4 and 4.7 days, respectively. Emergency room utilization and/or inpatient admission after PRRT administration are relatively infrequent events, but not unexpected. Centers that administer PRRT should have a comprehensive SOP in place to effectively care for radioactive patient emergencies while maximizing medical staff protection.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e109-e114"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762639","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 Case of Radiotherapy During Pregnancy for Oropharyngeal Cancer: Long-Term Pediatric Outcome Evaluation and Literature Review","authors":"Chiara Lucrezia Deantoni MD ,&nbsp;Claudio Fiorino MSc ,&nbsp;Anna Chiara MD ,&nbsp;Miriam Torrisi MD ,&nbsp;Laura Giannini MD ,&nbsp;Alessandro Loria MSc ,&nbsp;Andrei Fodor MD ,&nbsp;Sara Broggi MSc ,&nbsp;Marcella Pasetti MD ,&nbsp;Nadia Di Muzio MD ,&nbsp;Italo Dell'Oca MD","doi":"10.1016/j.prro.2024.06.018","DOIUrl":"10.1016/j.prro.2024.06.018","url":null,"abstract":"<div><div>Oropharyngeal cancer (OphC) is extremely rare during pregnancy, although its incidence is expected to increase in the years to come. Any delay in treatment can heavily affect cancer control and survival. Information regarding radiation therapy during pregnancy and long-term pediatric outcomes is lacking. In this article, we discuss a case of OphC in a pregnant woman, treated with surgery and radiation therapy, offering also an updated review with respect to the limited current evidence of the feasibility and clinical results of radiation therapy during pregnancy. A 39-year-old pregnant woman (through assisted fertilization) with locally advanced OphC underwent surgery and subsequent radiation therapy. A special fetal shielding device and a modified planning optimization strategy were used to reduce the dose to the fetus as much as possible. Phantom and in vivo dosimetry were performed to estimate the dose to the fetus and the related risks, according to International Commission on Radiological Protection (ICRP) publication 90. Thanks to the actions taken, the mean dose to the fetus was estimated to be around 50 mSv. A healthy baby was born at 33 weeks of gestation + 6 days. After a 10-year follow-up, the patient is in complete remission, and her 16-year-old daughter is healthy with good school performance. Adjuvant radiation therapy in OphC during pregnancy may be optimized to reduce the dose to the fetus, and the measures taken represent a realistic option to ensure the mother and baby's health.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e95-e99"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057228","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 Dose Accumulation Routine (RADAR)-A Novel Dose Accumulation Script With Built-In Uncertainty","authors":"James G. Mechalakos PhD,&nbsp;Yu-Chi Hu PhD,&nbsp;Licheng Kuo MS,&nbsp;Lei Zhang PhD,&nbsp;Niral Shah MS,&nbsp;Ase Ballangrud PhD,&nbsp;Laura Cervino PhD,&nbsp;Ellen Yorke PhD,&nbsp;Yilin Liu PhD,&nbsp;Pengpeng Zhang PhD","doi":"10.1016/j.prro.2024.10.006","DOIUrl":"10.1016/j.prro.2024.10.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To incorporate uncertainty into dose accumulation for reirradiation.</div></div><div><h3>Methods and Materials</h3><div>The RAdiotherapy Dose Accumulation Routine (RADAR) script for the Eclipse treatment planning system (Varian Medical Systems) is described, and the voxel-wise ellipsoid search algorithm is introduced as a means of incorporating uncertainty. RADAR is first demonstrated on a test patient reirradiated to the spine, illustrating the effect of the uncertainty algorithm. A summary of initial evaluation testing conducted by 11 users, each of whom ran a separate spine reirradiation case, follows. Finally, RADAR run times are reported for various conditions.</div></div><div><h3>Results</h3><div>In the demonstration case in which a 3-mm ellipsoid search was used, the maximum RADAR 2-Gy equivalent (EQD2) accumulated spinal cord dose increased from 7244 to 12,689 cGy because the ellipsoid search pulled dose from closer to the adjacent target structure. When the ellipsoid search was restricted to voxels within the spinal cord, the maximum accumulated cord dose was reduced to 6523 cGy and did not exceed the sum of the maximum EQD2 spinal cord doses of the individual plans (6730 cGy). In the evaluation cases, the RADAR EQD2 maximum dose for the spinal cord increased by an average of 31.6% with uncertainty applied compared to a conventional dose accumulation and decreased by an average of 16.7% compared to a conventional dose accumulation when the uncertainty calculation was restricted to voxels within the spinal cord. RADAR run times vary depending on the number of plans added and the type of uncertainty used.</div></div><div><h3>Conclusions</h3><div>RADAR offers a novel way to directly account for uncertainty in dose accumulation through a voxel-wise ellipsoid search algorithm. EQD2 dose accumulation with and without dose discounts is also available.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 187-195"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512855","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":"Survival and Patterns of Relapse of Cutaneous Squamous Cell Carcinoma With Large Nerve Perineural Spread After Skull Base Surgery and/or Radiation Therapy","authors":"Megan Anna Carroll FRANZCR ,&nbsp;Ryan Sommerville FRACS ,&nbsp;Karen Hay BVSc, MEpi, PhD ,&nbsp;Abigail Walker MBBS ,&nbsp;Sarah Grigg MBBS ,&nbsp;Lizbeth Kenny FRANZCR ,&nbsp;Benjamin Chua FRANZCR ,&nbsp;Jason Papacostas FRACS ,&nbsp;Hamish Alexander FRACS ,&nbsp;Charles Lin FRANZCR","doi":"10.1016/j.prro.2024.09.007","DOIUrl":"10.1016/j.prro.2024.09.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of our study was to evaluate survival and patterns of relapse for patients with perineural spread (PNS) of cutaneous squamous cell carcinoma (cSCC), who have undergone curative intent skull base surgery and/or radiation therapy. In addition, we modified the classification of zone 2 disease into 2a and 2b and reported the respective outcome.</div></div><div><h3>Methods and Materials</h3><div>A review of a prospective database of patients who received diagnoses of PNS of cSCC and were treated with curative intent skull base surgery and/or radiation therapy between the years of 2013 and 2020 was conducted. Kaplan-Meier methods were used to estimate relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). Cox proportional hazard modeling was performed to test associations between patient factors and survival outcomes.</div></div><div><h3>Results</h3><div>Eighty patients with a median follow-up of 36 months were included in the study. The 5-year RFS was 61% (95% CI, 48%-71%), the DSS was 77% (95% CI, 63%-86%), and OS was 67% (95% CI, 53%-78%). In multivariable modeling, involvement of 2 or more nerves was strongly associated with worse 5-year RFS (HR, 4.0; <em>P</em> ≤ .001), DSS (HR, 4.5; <em>P</em> = .004), and OS (HR, 4.3; <em>P</em> = .002). Age group (≥65 years) (HR, 5.1; <em>P</em> = .010) and immune compromise (HR, 10.7; <em>P</em> = .001) were strongly associated with worse OS but not DSS or RFS. The majority of relapses (60%) occurred at the local skin sites.</div></div><div><h3>Conclusions</h3><div>Our study demonstrated surgery followed by radiation therapy was safe and effective in the management of cSCC with PNS. We did not detect a difference in outcome between zones 2a and 2b though further study is required. The most common mode of relapse was at the skin epidermis and/or adjacent dermis highlighting the importance of adequate local skin dose delivery.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e198-e210"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512856","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":"Erratum to: Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus. Yanagihara TK, Tepper JE, Moon AM, et al. Pract Radiat Oncol. 2024 Mar-Apr;14(2):134-145","authors":"Ted K. Yanagihara MD, PhD ,&nbsp;Joel E. Tepper MD ,&nbsp;Andrew M. Moon MD ,&nbsp;Aisling Barry MD ,&nbsp;Meritxell Molla MD ,&nbsp;Jinsil Seong MD, PhD ,&nbsp;Ferran Torres MD, PhD ,&nbsp;Smith Apisarnthanarax MD ,&nbsp;Michael Buckstein MD, PhD ,&nbsp;Higinia Cardenes MD, PhD ,&nbsp;Daniel T. Chang MD ,&nbsp;Mary Feng MD ,&nbsp;Chandan Guha MBBS, PhD ,&nbsp;Christopher L. Hallemeier MD ,&nbsp;Maria A. Hawkins MD ,&nbsp;Morten Hoyer MD, PhD ,&nbsp;Hiromitsu Iwata MD, PhD ,&nbsp;Salma K. Jabbour MD ,&nbsp;Lisa Kachnic MD ,&nbsp;Jordan Kharofa MD ,&nbsp;Laura A. Dawson MD","doi":"10.1016/j.prro.2025.01.002","DOIUrl":"10.1016/j.prro.2025.01.002","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 214-215"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143705175","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":"Radiation Therapy for Rectal Cancer: An ASTRO Clinical Practice Guideline Focused Update","authors":"Jennifer Y. Wo MD ,&nbsp;Jonathan B. Ashman MD, PhD ,&nbsp;Nishin A. Bhadkamkar MD ,&nbsp;Lisa Bradfield BA ,&nbsp;Daniel T. Chang MD ,&nbsp;Nader Hanna MD ,&nbsp;Maria Hawkins MD ,&nbsp;Michael Holtz BS ,&nbsp;Edward Kim MD ,&nbsp;Patrick Kelly MD, PhD ,&nbsp;Diane C. Ling MD ,&nbsp;Jeffrey R. Olsen MD ,&nbsp;Manisha Palta MD ,&nbsp;Ann C. Raldow MD, MPH ,&nbsp;Erika Ruiz-Garcia MD, PhD ,&nbsp;Arshin Sheybani MD ,&nbsp;Karyn B. Stitzenberg MD, MPH ,&nbsp;Prajnan Das MD, MS, MPH","doi":"10.1016/j.prro.2024.11.003","DOIUrl":"10.1016/j.prro.2024.11.003","url":null,"abstract":"<div><h3>Purpose</h3><div>With the results of several recently published clinical trials, this guideline focused update provides evidence-based recommendations for the indications and dose-fractionation regimens for neoadjuvant radiation therapy (RT), optimal sequencing of RT and systemic therapy in the context of total neoadjuvant therapy (TNT), and considerations for selective omission of RT and surgery for rectal cancer.</div></div><div><h3>Methods</h3><div>The American Society for Radiation Oncology convened a multidisciplinary task force to update 3 key questions that focused on the role of RT for patients with operable rectal cancer. The key questions addressed (1) indications for neoadjuvant RT, (2) selection of neoadjuvant regimens, and (3) indications for consideration of a nonoperative management (NOM) or local excision approach after definitive/preoperative chemoradiation. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation.</div></div><div><h3>Results</h3><div>For patients with stage II-III rectal cancer, neoadjuvant RT was strongly recommended; however, among patients deemed at lower risk of locoregional recurrence, consideration of omission of neoadjuvant RT was conditionally recommended in favor of neoadjuvant chemotherapy with a favorable treatment response or upfront surgery. For patients with T3-T4 and node-positive rectal cancer undergoing neoadjuvant RT, a TNT approach was strongly recommended. Among patients with higher risk of locoregional recurrence, TNT with chemotherapy before or after long-course chemoradiation was strongly recommended, whereas TNT with short-course RT followed by chemotherapy was conditionally recommended. For patients with rectal cancer for whom NOM is a priority, concurrent chemoradiation followed by consolidation chemotherapy was strongly recommended. Selection of RT dose-fractionation regimen, sequencing of therapies, and consideration of NOM should be determined by multidisciplinary consensus and based on disease extent, disease location, patient preferences, and quality of life considerations.</div></div><div><h3>Conclusions</h3><div>The task force proposed recommendations to inform best clinical practices on the use of RT for rectal cancer with strong emphasis on multidisciplinary care. Future studies should focus on further addressing optimal treatment regimens to allow for more personalized recommendations based on individual risk stratification and patient priorities regarding quality of life.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages 124-143"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741178","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}