Advances in Radiation Oncology最新文献

{"title":"Planning Automation for Treatment Techniques Comparison and Robustness Analysis: Tangential Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Whole Breast Irradiation","authors":"Livia Marrazzo MSc ,&nbsp;Deborah Chilà MSc ,&nbsp;Immacolata Vanore MSc ,&nbsp;Roberto Pellegrini MSc ,&nbsp;Peter Voet PhD ,&nbsp;Vanessa Di Cataldo MD ,&nbsp;Icro Meattini MD ,&nbsp;Margherita Zani MSc ,&nbsp;Chiara Arilli MSc ,&nbsp;Silvia Calusi PhD ,&nbsp;Marta Casati MSc ,&nbsp;Antonella Compagnucci MSc ,&nbsp;Cinzia Talamonti PhD ,&nbsp;Lorenzo Livi MD ,&nbsp;Stefania Pallotta MSc","doi":"10.1016/j.adro.2025.101719","DOIUrl":"10.1016/j.adro.2025.101719","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the use of the mCycle automated planning system integrated into the Monaco Treatment Planning System for step-and-shoot intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in whole breast irradiation (WBI). The aim was to assess whether automation can standardize plan quality across a diverse patient cohort and compare dosimetric outcomes and robustness of the 2 techniques against setup errors and anatomical variations.</div></div><div><h3>Methods and Materials</h3><div>A total of 65 patients with breast cancer who underwent postoperative WBI were selected for the study. Treatment plans were generated using mCycle, which employs multicriteria optimization with no manual intervention. Two automated planning techniques—IMRT and VMAT—were implemented and evaluated based on dosimetric outcomes, physician review, planning time, and plan robustness. The plan deliverability was verified through γ index and point dose measurements.</div></div><div><h3>Results</h3><div>The mCycle system produced clinically acceptable plans for both IMRT and VMAT across all patient cohorts. VMAT showed superior target coverage (V95% = 97.9%) and better sparing of ipsilateral organs at risks (OARs), whereas IMRT demonstrated enhanced sparing of contralateral OARs and greater robustness to anatomical changes such as breast swelling. Planning times were reduced with VMAT because of complete automation. Plan deliverability was confirmed with high γ passing rates and acceptable point dose deviations.</div></div><div><h3>Conclusions</h3><div>The use of mCycle in WBI planning successfully standardized plan quality and improved workflow efficiency. VMAT provided superior target coverage and ipsilateral OAR sparing but was more sensitive to anatomical changes. IMRT showed better contralateral OAR sparing and robustness. Both techniques are viable, with advantages depending on clinical scenarios.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101719"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Therapy for Isolated Central Nervous System Progression Among Patients Receiving Antibody-Drug Conjugate Therapy","authors":"Emily S. Lebow MD ,&nbsp;Jordan Eichholz MS ,&nbsp;Zhigang Zhang PhD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Brandon Imber MD, MA ,&nbsp;Linda Chen MD ,&nbsp;Quincey LaPlant MD, PhD ,&nbsp;Josh Yamada MD ,&nbsp;Luke R.G. Pike MD, DPhil ,&nbsp;Shanu Modi MD ,&nbsp;Andrew D. Seidman MD ,&nbsp;Kathryn Beal MD ,&nbsp;Nelson S. Moss MD ,&nbsp;Yao Yu MD","doi":"10.1016/j.adro.2025.101714","DOIUrl":"10.1016/j.adro.2025.101714","url":null,"abstract":"<div><h3>Purpose</h3><div>Antibody drug conjugates (ADCs) are an increasingly important class of therapeutics among patients with breast, lung, urothelial, and other malignancies. Guidelines recommend local therapy and continuation of current systemic therapy among patients with isolated brain relapse. We describe the clinical outcomes of this approach among patients receiving ADCs.</div></div><div><h3>Methods and Materials</h3><div>We queried our institutional database for patients receiving radiation therapy (RT) in the setting of isolated brain progression on ADCs with a plan to continue same-line therapy after radiation. Patients with ≤3 brain metastases at the time of recurrence were categorized as oligoprogressive. Study endpoints included overall survival, progression-free survival (PFS), and the cumulative incidence of next therapy from the start of local therapy.</div></div><div><h3>Results</h3><div>We identified 17 patients receiving ADC therapy with isolated brain progression treated with radiation (stereotactic radiosurgery [SRS]: n = 13, whole brain radiation: n = 4). All patients received concurrent ADC and RT. The median follow-up from local therapy was 29.5 months (95% CI, 21.4-not reached). The median overall survival was 19 months (95% CI, 16-not reached), and the median PFS was 8.1 months (range, 6.7-19 months). One lesion treated with SRS had local failure 21 months after treatment, and the 24-month cumulative incidence of local failure across the entire cohort was 1.6% (95% CI, 0.13%-7.7%). The 6-month cumulative incidence of radiation necrosis was 12% (95% CI, 1.8%-32%). The cumulative incidence of next therapy at 6 and 12 months was 47% (95% CI, 22%-69%) and 71% (95% CI, 41%-87%), respectively, and was significantly lower among patients with oligoprogressive brain recurrence. After SRS, 2 patients were without evidence of disease, discontinued systemic therapy, and were stable on observation at last follow-up.</div></div><div><h3>Conclusions</h3><div>To the best of our knowledge, this is the first clinical report of outcomes using the guideline-recommended approach of local therapy for isolated brain relapse among patients receiving ADCs. Local therapy may delay the need for next line systemic therapy, particularly among patients with oligoprogressive brain relapse.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101714"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma","authors":"Jennifer K. Matsui MD, PhD ,&nbsp;Scott Jackson MS ,&nbsp;Judy Fang MS ,&nbsp;David G. Mohler MD ,&nbsp;Robert J. Steffner MD ,&nbsp;Raffi S. Avedian MD ,&nbsp;Gregory W. Charville MD, PhD ,&nbsp;Matt van de Rijn MD ,&nbsp;Lynn Million MD ,&nbsp;Alexander L. Chin MD, MBA ,&nbsp;Susan M. Hiniker MD ,&nbsp;Anusha Kalbasi MD ,&nbsp;Everett J. Moding MD, PhD","doi":"10.1016/j.adro.2025.101718","DOIUrl":"10.1016/j.adro.2025.101718","url":null,"abstract":"<div><h3>Purpose</h3><div>Synovial sarcoma (SS) is a rare, aggressive soft tissue malignancy that is divided into biphasic and monophasic histologic subtypes. In addition to surgical resection, radiation therapy (RT) improves local control in patients at higher risk of recurrence. This study aimed to investigate the impact of histologic subtype on radiation response and survival outcomes in patients treated with RT as part of definitive management.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively identified patients with SS treated with RT and surgical resection from 1997 to 2020 at Stanford Medical Center. We assessed the association between histologic subtypes (biphasic vs monophasic) and response to preoperative RT based on imaging and pathology. Volumetric response was calculated using the pre-RT and post-RT/preoperative postcontrast T1-weighted magnetic resonance imaging images. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariable and multivariable analyses were conducted using Cox regression models. Variables for univariable and multivariable analyses included age, histologic subtypes, tumor location, tumor size, margin status, chemotherapy, and performance status.</div></div><div><h3>Results</h3><div>In our study, 50 patients met the inclusion criteria. The median age was 34.8 years at diagnosis, and 36% (n = 18) received concurrent chemotherapy. Biphasic (n = 18, 36%) and monophasic (n = 32, 64%) tumors exhibited significant differences in negative margin status (94% vs 66%, <em>P</em> = .036). Of the 22 patients who underwent preoperative RT, 15 patients had pre-RT and post-RT imaging to assess volumetric changes. Biphasic tumors demonstrated less necrosis at the time of surgical resection but a significantly greater volumetric decrease with preoperative RT (42% vs 5%, <em>P</em> = .004). PFS and OS were superior in biphasic tumors (<em>P</em> = .003 and <em>P</em> = .009, respectively). Multivariable analyses identified histologic subtypes (monophasic vs biphasic) as a significant factor impacting PFS (HR, 5.65; 95% CI, 1.78-17.91; <em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>Biphasic tumors exhibit an improved volumetric response to preoperative RT and improved outcomes. These findings underscore the importance of considering histology when tailoring treatment for patients with SS.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101718"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Analysis of Treatment Approaches in Chest Wall Ewing Sarcoma: The Impact of Tumor Volume on Oncologic Outcomes","authors":"Brady S. Laughlin MD ,&nbsp;Aaron Bogan MA ,&nbsp;Wendy A. Allen-Rhoades MD, PhD ,&nbsp;Peter S. Rose MD ,&nbsp;Stephanie F. Polites MD, MPH ,&nbsp;Jonathan B. Ashman MD, PhD ,&nbsp;Ivy Petersen MD ,&nbsp;Michael G. Haddock MD ,&nbsp;Anita Mahajan MD ,&nbsp;Nadia N. Laack MD ,&nbsp;Safia K. Ahmed MD","doi":"10.1016/j.adro.2025.101729","DOIUrl":"10.1016/j.adro.2025.101729","url":null,"abstract":"<div><h3>Purpose</h3><div>Local treatment with surgery (S) and radiation therapy (RT) for chest wall Ewing sarcoma (cwES) is often challenging given the extent of the tumor and the aggressiveness of local treatments needed for cure. We report tumor and treatment characteristics, oncologic outcomes, and toxicities of patients with cwES at 2 centers of a single institution.</div></div><div><h3>Methods and Materials</h3><div>Consecutive patients with cwES treated from 1997 to 2022 were retrospectively reviewed. All patients were treated with standard 5-drug chemotherapy (vincristine, doxorubicin, cyclophosphamide, alternating with ifosfamide and etoposide) before initiation of local therapy. Local treatment was S, RT, or both. The decision on modality and timing was determined by a multidisciplinary sarcoma group or by consensus between sarcoma experts regarding patient preferences.</div></div><div><h3>Results</h3><div>The cohort consisted of 39 patients. The median age at diagnosis was 19.2 years (range, 3.5-53.6 years). Median tumor volume (TV) was 235.5 mL (range, 5.3-6761.9 mL). The local control (LC) modality was S in 18 patients (46%), RT in 4 (10%), and S + RT in 17 (44%). Four (10%) patients treated with S + RT had R1 margins. The median follow-up was 3.2 years (range, 0.1-21.6 years). Grade 3 radiation-associated toxicity relative to the RT modality was 16.7% and 7.1% for photons (n = 6) and protons (n = 14), respectively. The 2-year LC by modality was 100% for RT (95% CI, 100%-100%), 88.2% (95% CI, 74.2%-100%) for S, and 73.3% (95% CI, 54.0%-99.5%) for S + RT. The 5-year LC, failure-free survival, and overall survival for all patients were 79.7% (95% CI, 67.3%-94.4%), 52.3% (95% CI, 38.1%-71.9%), and 64.2% (95% CI, 49.6%-83.1%), respectively. In univariate and multivariate analysis, TV ≥ 130 mL was associated with a significantly worse 5-year failure-free survival (31.8% TV ≥ 130 mL vs 80.8% TV &lt; 130 mL; hazard ratio, 4.94, <em>p</em> = .013 and adjusted hazard ratio, 5.43; 95% CI, 1.28-22.98; <em>p</em> = .022). The multivariate model was adjusted for age, metastatic disease at diagnosis, and S.</div></div><div><h3>Conclusions</h3><div>Outcomes for cwES tumors are highly dependent on tumor size, even with the use of combined modality local therapy. With early follow-up, smaller tumors may be well controlled with either S or RT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101729"},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Domain-Adaptive and Per-Fraction Guided Deep Learning Framework for Magnetic Resonance Imaging-Based Segmentation of Organs at Risk in Gynecologic Cancers","authors":"Reza Kalantar PhD ,&nbsp;Manasi Ingle FRCR ,&nbsp;Romelie Rieu BA, BmBCh ,&nbsp;Sebastian Curcean MD ,&nbsp;Jessica Mary Winfield PhD ,&nbsp;Gigin Lin MD, PhD ,&nbsp;Christina Messiou MD, MRCP, FRCR ,&nbsp;Susan Lalondrelle FRCR ,&nbsp;Dow-Mu Koh MD, FRCP, FRCR ,&nbsp;Matthew David Blackledge PhD","doi":"10.1016/j.adro.2025.101745","DOIUrl":"10.1016/j.adro.2025.101745","url":null,"abstract":"<div><h3>Purpose</h3><div>The integration of magnetic resonance imaging into radiation therapy (RT) treatment necessitates automated segmentation algorithms for fast and accurate adaptive interventions, particularly in magnetic resonance imaging-integrated linear accelerator (MR-linac or MRL) treatment systems. However, the scarcity of data hampers the training of these models. This study aimed to address this shortcoming by developing a synthetic MRL-assisted deep learning framework to establish a robust baseline for organ at risk segmentation on MRL images and enable domain adaptation for automatic delineations during adaptive RT treatments.</div></div><div><h3>Methods and Materials</h3><div>We used a retrospective data set, comprising 158 patients diagnosed with various gynecologic cancers who underwent computed tomography scanning for RT planning and 25 patients with T₂-weighted MRL scans for model fine-tuning, adaptation, and evaluation. A patch-based cycle-consistent generative adversarial network was developed to synthesize MRL images from computed tomography data. Subsequently, a domain-adaptive segmentation network was trained to segment the 6 organs at risk on acquired MRL images. In addition, we employed per-fraction adaptation to enhance anatomical conformity guided by prior treatment fractions of individual patients. A quantitative evaluation and blinded human reader assessment were conducted to establish contour acceptance rates.</div></div><div><h3>Results</h3><div>The synthetic MRL-assisted model improved organ at risk segmentation accuracy on MRL images, with fraction-adapted contours displaying high anatomical fidelity. Two radiation oncologists reported contour acceptance rates of 100% and 98% for treatment planning after adaptation.</div></div><div><h3>Conclusions</h3><div>This novel framework holds promise to bridge the semantic gap between computed tomography and magnetic resonance imaging databases, potentially facilitating adaptive RT treatments and reducing treatment times as well as clinician burden. The utility of this framework can extend beyond gynecologic and pelvic cancers.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101745"},"PeriodicalIF":2.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Survival Following Chemoradiation in Locoregional Recurrent Germline ATM Mutated Pancreatic Ductal Adenocarcinoma","authors":"Rachael A. Safyan MD ,&nbsp;Keven Zhang MD ,&nbsp;Smith Apisarnthanarax MD ,&nbsp;Jonathan G. Sham MD ,&nbsp;Venu G. Pillarisetty MD, PhD ,&nbsp;Sita Kugel PhD ,&nbsp;Marianne Dubard-Gault MD, MS ,&nbsp;Colin C. Pritchard MD, PhD ,&nbsp;Eric Q. Konnick MD, MS ,&nbsp;Dushyant Sahani MD ,&nbsp;E. Gabriela Chiorean MD","doi":"10.1016/j.adro.2025.101742","DOIUrl":"10.1016/j.adro.2025.101742","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101742"},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Study of Patients Treated with Palliative Radiation Therapy While on Immunotherapy","authors":"Georgia Harris MBBS, MPH ,&nbsp;Andrew Bang MD ,&nbsp;Rebecca K.S. Wong MB ChB, MSc ,&nbsp;Jolie Ringash MD ,&nbsp;Andrea Bezjak MD ,&nbsp;Bernard Cummings MB ChB ,&nbsp;Barbara-Ann Millar MB ChB ,&nbsp;Zhihui A. Liu PhD ,&nbsp;Laura A. Dawson MD","doi":"10.1016/j.adro.2025.101741","DOIUrl":"10.1016/j.adro.2025.101741","url":null,"abstract":"<div><h3>Purpose</h3><div>To prospectively document the outcomes of patients treated with palliative radiation therapy (RT) who are receiving immunotherapy.</div></div><div><h3>Methods and Materials</h3><div>Patients with advanced cancer receiving or planning to commence immunotherapy within 28 days who were referred for palliative RT at our center between January 2017 and September 2019 were screened for participation in this prospective observational study. Demographic and treatment data, along with patient-reported outcomes (PROs) using the Edmonton Symptom Assessment Scale for cancer, were collected at baseline, after 1 month, and then every 3 months for up to 1 year or until death. RT dose and fractionation were at the discretion of the treating radiation oncologist. Immunotherapy was given as per the standard of care protocol. The primary outcome was 3-month toxicity. Secondary outcomes included response evaluation criteria in solid tumors version 1.1 (RECIST v1.1) response on computed tomography scan performed 1, 3, and 6 months post-RT. The feasibility of enhancing PRO compliance using caregiver-aided PROs and virtual PRO collection was explored.</div></div><div><h3>Results</h3><div>Thirty-nine patients who received 50 courses of palliative RT (most often for pain) and who also received immunotherapy within 28 days of RT were evaluated for toxicity at 3 months post-RT. The most common primary cancer was non-small cell lung cancer (38%), followed by melanoma (36%). The most common RT dose was 20 Gy in 5 fractions (42%). 87% of patients (34/39) received a programmed cell death protein 1 inhibitor alone. An interval of &lt;14 days between RT and immunotherapy. No grade 3 or higher toxicity was attributable to combined treatment. The median survival for the cohort was 11 months. At 3 months, 26 patients had imaging available for RECIST v1.1; 14 of 26 (54%) had an in-field response, and 3 of 26 (12%) had stable disease (with mixed out-of-field response). Compliance with PROs was 79% (31/39) at 1 month and 69% (27/39) at 3 months. Ten of the 31 patients (32%) and 11 of 31 patients (41%) used caregiver-aided PRO collection.</div></div><div><h3>Conclusions</h3><div>Palliative RT appears safe in patients receiving immunotherapy with no apparent increase in toxicity because of the combination. Responses out of irradiated volumes were no better than expected than with immunotherapy alone. Caregiver-aided PROs improved compliance with PRO data collection and were feasible.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101741"},"PeriodicalIF":2.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Dosimetric Benefits of Cone Beam Computed Tomography-Guided Online Adaptive Radiation Treatment Frequencies for Lung Cancer","authors":"Jingwei Duan PhD ,&nbsp;Joseph Harms PhD ,&nbsp;Drexell H. Boggs MD ,&nbsp;Adam J. Kole MD, PhD ,&nbsp;Richard A. Popple PhD ,&nbsp;Dennis N. Stanley PhD ,&nbsp;Michael H. Soike MD ,&nbsp;Natalie N. Viscariello PhD ,&nbsp;Rex Cardan PhD ,&nbsp;Carlos E. Cardenas ,&nbsp;Joel A. Pogue PhD","doi":"10.1016/j.adro.2025.101740","DOIUrl":"10.1016/j.adro.2025.101740","url":null,"abstract":"<div><h3>Purpose</h3><div>Online adaptive radiation therapy (oART) has shown the ability to diminish interfraction variations. However, oART is a time- and labor-intensive process, and the optimal adaptation frequency remains to be determined for lung cancer oART. The purpose of this study was to quantify and assess dosimetric benefits associated with various adaptive frequencies in patients with lung cancer receiving oART.</div></div><div><h3>Methods and Materials</h3><div>This study included 8 patients with lung cancer receiving oART treated on the Ethos platform in 30 or 33 fractions (n = 7 /1). For a total of 243 fractions, daily contours on cone-beam computed tomography (CT) and adaptive/nonadaptive plans on synthetic CT scan were used to simulate 4 different adaptation frequencies: none, single, weekly, and daily adaptation, resulting in 972 unique dose distributions. Dose-volume-histograms of targets and organs-at-risk (OARs) were compared between adaptation frequencies. Besides Dose-volume-histogram analysis, 3 radiation oncologists reviewed and scored 185 total plans, evenly sampling plans from the various adaptive frequencies. A comprehensive plan scorecard was fine-tuned to correlate with physician reviews and subsequently used for interplan comparison.</div></div><div><h3>Results</h3><div>Compared with no adaptation, daily adaptation improved the median clinical target volume V100% by 0.2% (IQR, 0.0-1.0) and the planning target volume D98% by 0.5% (IQR, −2.2 to 3.83). It also reduced the planning target volume D0.03cc by 2.1% (IQR, 0.7-3.2), the lungs-internal target volume V20 Gy by 2.5% (IQR, 1.0-4.5), the heart D_mean by 0.9 Gy (IQR, 0.4-2.6), and the esophagus D_mean by 1.6 Gy (IQR, 0.3-4.3). Single and weekly adaptation presented fewer benefits in OAR sparing and led to target undercoverage compared with daily adaptation. The PlanScoreCard effectively quantified plan quality, showing a positive monotonic correlation to physician scores (R = 0.57-0.87). It revealed that daily adaptation significantly improved total plan quality for 7 out of 8 patients, with improvements exceeding 5% of the plan score compared with no adaptation. In contrast, weekly and single adaptations led to improvements in only 2 and 1 patients, respectively.</div></div><div><h3>Conclusions</h3><div>Online kilovoltage cone-beam CT scan-guided daily adaptation may lead to dosimetric benefits in both target coverage and OAR sparing in patients with lung cancer. Other adaptation frequencies are effective for some patients but tend to lead to target undercoverage compared with daily adaptation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101740"},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Estimation of Late Rectal Toxicity Using a Convolutional Neural Network-based Dose Prediction in Prostate Cancer Radiation Therapy","authors":"Seiya Takano MD, PhD ,&nbsp;Natsuo Tomita MD, PhD ,&nbsp;Taiki Takaoka MD, PhD ,&nbsp;Machiko Ukai MD ,&nbsp;Akane Matsuura MD ,&nbsp;Masanosuke Oguri MD ,&nbsp;Nozomi Kita MD, PhD ,&nbsp;Akira Torii MD, PhD ,&nbsp;Masanari Niwa MD, PhD ,&nbsp;Dai Okazaki MD, PhD ,&nbsp;Takahiro Yasui MD, PhD ,&nbsp;Akio Hiwatashi MD, PhD","doi":"10.1016/j.adro.2025.101739","DOIUrl":"10.1016/j.adro.2025.101739","url":null,"abstract":"<div><h3>Purpose</h3><div>The present study investigated the feasibility of our automatic plan generation model based on a convolutional neural network (CNN) to estimate the baseline risk of grade ≥2 late rectal bleeding (G2-LRB) in volumetric modulated arc therapy for prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>We built the 2-dimensional U-net model to predict dose distributions using the planning computed tomography and organs at risk masks as inputs. Seventy-five volumetric modulated arc therapy plans of prostate cancer, which were delivered at 74.8 Gy in 34 fractions with a uniform planning goal, were included: 60 for training and 5-fold cross-validation, and the remaining 15 for testing. Isodose volume dice similarity coefficient, dose-volume histogram, and normal tissue complication probability (NTCP) metrics between planned and CNN-predicted dose distributions were calculated. The primary endpoint was the goodness-of-fit, expressed as a coefficient of determination (<em>R</em>²) value, in predicting the percentage of G2-LRB-Lyman-Kutcher-Burman-NTCP.</div></div><div><h3>Results</h3><div>In 15 test cases, 2-dimensional U-net predicted dose distributions with a mean isodose volume dice similarity coefficient value of 0.90 within the high-dose region (doses ≥ 50 Gy). Rectum V_50Gy, V_60Gy, and V_70Gy were accurately predicted (<em>R</em>² = 0.73, 0.82, and 0.87, respectively). Strong correlations were observed between planned and predicted G2-LRB-Lyman-Kutcher-Burman-NTCP (<em>R</em>² = 0.80, <em>P</em> &lt; .001), with a small percent mean absolute error (mean ± 1 standard deviation, 1.24% ± 1.42%).</div></div><div><h3>Conclusions</h3><div>A risk estimation of LRB using CNN-based automatic plan generation from anatomic information was feasible. These results will contribute to the development of a decision support system that identifies priority cases for preradiation therapy interventions, such as hydrogel spacer implantation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101739"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143592395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Toxicity after Non-Myeloablative Conditioning Regimens Using Total Body Irradiation","authors":"Pranalee Patel MD ,&nbsp;Zihan Wan MS ,&nbsp;Mairead Dillon BS ,&nbsp;Donna Niedzwiecki PhD ,&nbsp;Kerri-Anne Crowell MPH ,&nbsp;Mitchell E. Horwitz MD ,&nbsp;Edina Wang MD ,&nbsp;Chris R. Kelsey MD","doi":"10.1016/j.adro.2025.101738","DOIUrl":"10.1016/j.adro.2025.101738","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate long-term health risks after allogeneic hematopoietic stem cell transplantation (HSCT) using non-myeloablative total body irradiation (TBI).</div></div><div><h3>Methods and Materials</h3><div>All adult patients undergoing non-myeloablative allogeneic HSCT using TBI-based conditioning from 1995 to 2020 at our institution were included. Long-term toxicities, defined as events persisting beyond or occurring after 6 months from the date of transplant, were graded per the National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0. A competing risk analysis was performed to assess the risk of developing long-term toxicities within major organ systems using the Fine-Gray model. Outcomes were compared with a cohort of patients undergoing myeloablative TBI.</div></div><div><h3>Results</h3><div>A total of 174 patients undergoing nonmyeloablative HSCT were assessed along with 378 myeloablative patients. Nonmyeloablative recipients were older (58 vs 43 years, <em>P</em> &lt; .001), less likely to be transplanted for acute leukemia (35% vs 64%, <em>P</em> &lt; .001), more likely to be transplanted for non-malignant conditions (33% vs 11%, <em>P</em> &lt; .001), and were more likely to have used tobacco (33% vs 22%, <em>P</em> = .009). The median follow-up was 7.4 years. The cumulative incidences of long-term toxicities at 5 years for nonmyeloablative and myeloablative patients, taking into account the competing risk of death, were pulmonary (4% vs 4.8%, <em>P</em> &gt; .9), cardiac (6.8% vs 3.3%, <em>P</em> = .11), renal (4.3% vs 4.1%, <em>P</em> = .9), thyroid (3.6% vs 1.5%, <em>P</em> = .2), other endocrine (3.1% vs 8.8%, <em>P</em> = .04), and cataracts (2.5% vs 2.8%, <em>P</em> = .7). The risk of developing a secondary malignancy was 3.5% vs 1.1% (<em>P</em> = .2) between the 2 cohorts. The proportion of all toxicities that were high-grade (3-5) for nonmyeloablative and myeloablative regimens, respectively, were pulmonary (60% and 69%), cardiac (17% and 45%), renal (27% and 21%), and other endocrine (4% and 2%).</div></div><div><h3>Conclusions</h3><div>Recipients of nonmyeloablative conditioning regimens, despite receiving much lower doses of TBI and chemotherapy, are at risk of developing significant, long-term medical conditions comparable with those undergoing myeloablative HSCT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101738"},"PeriodicalIF":2.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}