Advances in Radiation Oncology最新文献

{"title":"The Empty Bladder is Preferred in Some Cases of Radiation Therapy for Rectal Cancer","authors":"Inna Ospovat MD, Albert Schlocker MSc, Natan Shtraus MSc, Ravit Geva MD, Shani Hazan BSc, Tatyana Shevchuk MSc, Alexander Barenboim MD, Ido Wolf MD, Orit Gutfeld MD, Viacheslav Soyfer MD","doi":"10.1016/j.adro.2025.101872","DOIUrl":"10.1016/j.adro.2025.101872","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101872"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HyperArc Automated Stereotactic Radiosurgery Planning Enables Accurate a Priori Fractionation Scheme Selection via Adherence to HyTEC Toxicity Thresholds","authors":"Joel A. Pogue PhD ,&nbsp;John Fiveash MD ,&nbsp;Rex Cardan PhD ,&nbsp;Christopher Willey MD, PhD ,&nbsp;Natalie Viscariello PhD ,&nbsp;Rodney Sullivan PhD ,&nbsp;Samuel Marcrom MD ,&nbsp;Luke Moradi MD ,&nbsp;Philip Schmalz MD ,&nbsp;James Markert MD, MPH ,&nbsp;Richard Popple PhD","doi":"10.1016/j.adro.2025.101893","DOIUrl":"10.1016/j.adro.2025.101893","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiosurgery plan safety is commonly estimated by volumes receiving specific doses (ie, 12 Gy/1 fraction [fx]), which are evaluated postplan generation. However, automated treatment planning can produce highly consistent and thus predictable plans. Thus, we hypothesized that HyperArc (HA) automated stereotactic radiosurgery (SRS) planning enables clinical decision-making prior to plan generation, such as selecting the appropriate SRS fractionation scheme.</div></div><div><h3>Methods and Materials</h3><div>All previously treated single-isocenter HA plans at our institution were queried, totaling 3361 marginless targets without bridging at the 50% isodose level (1495 plans), making this the largest single-institutional SRS dosimetry study to the authors’ knowledge. Eight isodose volumes (IDVs; 50.00%-97.60%) were calculated for all HA targets, each corresponding to the ratio of a High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic (HyTEC) brain toxicity dose level and a common prescription dose (eg, 50.00% = 12 Gy/24 Gy). Power law relationships of IDV and target volume (<span><math><mrow><mi>I</mi><mi>D</mi><mi>V</mi><mo>=</mo><mi>a</mi><msup><mrow><msub><mi>V</mi><mrow><mi>t</mi><mi>a</mi><mi>r</mi><mi>g</mi><mi>e</mi><mi>t</mi></mrow></msub></mrow><mi>b</mi></msup></mrow></math></span>) were generated from a training data set of 361 targets (10.7%) and validated on the remaining 3000 targets (89.3%), allowing grade 1 to 3 brain toxicity rates to be predicted from target volume.</div></div><div><h3>Results</h3><div>Models resulted in high R² values when applied to the validation cohort (≥0.982), allowing targets to be classified as either above or below the HyTEC thresholds (IDV = 5 cm³, 10 cm³, and 20 cm³) with high accuracy (≥97.6%) and precision (≥99.3%). As an example, the 50.0% IDV model predicted that target volumes/diameters of 1.00 cm³/1.24 cm, 2.34 cm³/1.65 cm, and 5.51 cm³/2.19 cm correlate with 3.6%, 4.8%, and 8.6% grade 1 to 3 brain toxicity rates, respectively, when prescribing 24 Gy/1 fx.</div></div><div><h3>Conclusion</h3><div>The resulting models enabled accurate and precise prediction of target volumes/diameters, resulting in 3.6%, 4.8%, and 8.6% brain grade 1 to 3 toxicity rates, according to HyTEC toxicity estimates. Leveraging relative IDVs rather than prescription doses enabled all 3361 targets to be used for modeling 9 common SRS prescriptions (1 fx: 24 Gy, 20 Gy, 18 Gy, 16 Gy, and 15 Gy; 3 fx: 27 Gy and 24 Gy; 5 fx: 30 Gy and 25 Gy), enabling clinicians to estimate brain toxicity a priori via an open-source calculator.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101893"},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric Performance of Orthogonal Dual-Layer Multi-Leaf Collimator System on Locally Advanced Lung Cancer: Cardiac Substructures Sparing Plans","authors":"AiHui Feng MS ,&nbsp;YanHua Duan MS ,&nbsp;ZhangRu Yang MD ,&nbsp;Hao Wang PhD ,&nbsp;Hua Chen PhD ,&nbsp;HengLe Gu MS ,&nbsp;Ying Huang MS ,&nbsp;ZhenJiong Shen MS ,&nbsp;XuFei Wang PhD ,&nbsp;ZhiYong Xu PhD","doi":"10.1016/j.adro.2025.101891","DOIUrl":"10.1016/j.adro.2025.101891","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to reduce the risk of cardiovascular incidents and radiation pneumonia (RP) by improving the dose distribution to cardiac substructures through the use of a dual-layer multileaf collimator (MLC) accelerator- VenusX.</div></div><div><h3>Methods and Materials</h3><div>Eighteen patients with advanced-stage lung cancer were selected for this study. The total lung, spinal cord, whole heart, and specific cardiac substructures (including the left ventricle [LV], pulmonary artery, left anterior descending artery, left circumflex artery [LCX], and coronary artery) were delineated as organs at risk and incorporated into the optimization process of the avoidance plan. Single-layer MLC plans optimized for the whole heart, referred to as S-WH plans (where WH denotes whole heart), were developed alongside single-layer MLC plans specifically designed to avoid cardiac substructures, known as S-CS plans (where CS denotes cardiac substructures). Additionally, dual-layer MLC avoidance plans, designated as D-CS plans, were created for each patient. We evaluated the relative risk of coronary artery disease, chronic heart failure, acute cardiac events, and RP, as well as the effective dose to the immune system.</div></div><div><h3>Results</h3><div>D-CS plans significantly reduced the dose metrics of LV, pulmonary artery, left anterior descending artery, LCX, and the coronary, while maintaining target coverage and achieving comparable conformity index to the S-WH plans. Additionally, the D-CS plans significantly decreased the volume receiving 5 Gy (V_5Gy) for the LV and V_15Gy of LCX, with other substructures also experiencing a notable degree of dose reduction. Furthermore, the relative risk of coronary artery disease, chronic heart failure, acute cardiac event, and RP is ranked as follows: D-CS &lt; S-CS &lt; S-WH plans. Effective dose to the immune system of the D-CS plans indicated the lowest risk among the 3 plans.</div></div><div><h3>Conclusions</h3><div>The dual-layer MLC system demonstrated superior performance compared to the single-layer MLC system in CS-avoidance plans, providing new opportunities for subsequent immunotherapy in patients with locally advanced lung cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101891"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of the Augsburg Nasopharyngeal Applicator: Enhancing Efficacy in Nasal Route Brachytherapy","authors":"Jerome Jean-Joseph MSc ,&nbsp;Christoph Westerhausen PhD ,&nbsp;Johannes Doescher MD ,&nbsp;Bruno Maerkl MD ,&nbsp;Zoha Roushan MSc ,&nbsp;Maria Neu MD ,&nbsp;Tilman Janzen PhD ,&nbsp;Klaus-Henning Kahl MD ,&nbsp;Georg Stueben MD ,&nbsp;Nikolaos Balagiannis MD","doi":"10.1016/j.adro.2025.101896","DOIUrl":"10.1016/j.adro.2025.101896","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the Augsburg Nasopharyngeal Applicator (ANA), a novel nasal brachytherapy device designed for early-stage nasopharyngeal carcinoma (T1–T2 stages). ANA leverages nasal anatomy to overcome limitations of oral applicators, optimizing tumor targeting while sparing adjacent tissues, such as the soft palate and oral mucosa.</div></div><div><h3>Methods and Materials</h3><div>ANA was developed using sagittal computed tomography-based anatomic measurements and computer-aided design modeling. Structural integrity was validated through nonlinear finite-element analysis, mechanical stress testing (including Euler buckling tests), and displacement testing (30 min vibration at 5 Hz with 2 cm amplitude). Dosimetry was verified using radiochromic film with 3%/3 mm gamma analysis criteria, following the TG-43 formalism for dose calculation. Insertion feasibility was assessed in a postmortem model under institutional autopsy protocols.</div></div><div><h3>Results</h3><div>ANA (with nylon 6/6 catheter) withstood displacements up to 30 mm without failure. Simulated motion tests demonstrated positional stability (&lt;1 mm displacement). Dosimetry achieved a 97.5% gamma pass rate (clinical acceptability threshold: 95%), with the 20 mm curvature configuration reducing soft palate doses by &gt;50% compared to standard oral applicators (eg, Rotterdam design). Postmortem insertion was completed in 10 min, with endoscopic confirmation of positioning accuracy within 1 mm.</div></div><div><h3>Conclusions</h3><div>ANA demonstrates precise positioning, mechanical stability under simulated physiologic motion (&lt;1 mm displacement), and clinically significant dose sparing (&gt;50% reduction to the soft palate with the 20 mm curvature configuration). Its nasal approach and anatomic adaptability position it as a promising alternative to oral applicators. These proof-of-concept findings support the need for phase 1/2 clinical trials to evaluate safety and efficacy in patients.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101896"},"PeriodicalIF":2.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Benefit of Combined Chemoimmunotherapy and Radiation Therapy in Patients with Recurrent or Metastatic Esophageal Cancer","authors":"Xueru Wang MD ,&nbsp;Danyu Guo MD ,&nbsp;Xiaoyang Li PhD ,&nbsp;Yuan He PhD ,&nbsp;Jieyong Tian MD ,&nbsp;Dong Qian PhD ,&nbsp;Jingjing Cheng PhD","doi":"10.1016/j.adro.2025.101890","DOIUrl":"10.1016/j.adro.2025.101890","url":null,"abstract":"<div><h3>Purpose</h3><div>Chemotherapy combined with immune checkpoint inhibitors (ICIs) has become the standard first-line treatment for recurrent or metastatic esophageal cancer, but its efficacy remains suboptimal. This study aimed to evaluate whether the addition of radiation therapy (RT) to ICIs can improve patients’ survival.</div></div><div><h3>Methods and Materials</h3><div>This retrospective cohort study analyzed clinical data from 178 patients with recurrent or metastatic esophageal cancer who were treated at the First Affiliated Hospital of USTC between December 2019 and October 2023. Based on their actual treatment regimens, patients were stratified into 2 groups: the chemoimmunotherapy-alone group (ICIs group) and the chemoimmunotherapy combined with RT group (ICIs + RT group). To minimize selection bias, propensity score matching was used to balance baseline characteristics between the groups before comparative analysis. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival and safety.</div></div><div><h3>Results</h3><div>After propensity score matching, 128 patients were selected for the final analysis, with 64 patients in the ICIs + RT group and 64 patients in the ICIs group. The median follow-up time was 11.26 months (95% CI, 7.02-15.32). The median overall survival was 23.71 months in the ICIs + RT group and 13.00 months in the ICIs group (hazard ratio, 0.53; 95% CI, 0.31-0.88; <em>P</em> = .013). The median progression-free survival was 10.43 months in the ICIs + RT group and 7.27 months in the ICIs group (hazard ratio, 0.61; 95% CI, 0.39-0.94; <em>P</em> = .024). Combination of chemoimmunotherapy and RT was safe and tolerable. No treatment-related deaths occurred in either group.</div></div><div><h3>Conclusions</h3><div>Adding RT can significantly improve survival in patients with recurrent or metastatic esophageal cancer who are treated with chemoimmunotherapy, but further prospective trials are needed for validation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101890"},"PeriodicalIF":2.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Proton Radiation Treatment Exclusion Volume Because of Inconsistent Location of Breast Expander Titanium Port","authors":"Emily T. Tran BS ,&nbsp;Patrick Newbury MD ,&nbsp;Mark Newpower PhD ,&nbsp;Heather Ortega CMD ,&nbsp;Timothy D. Malouff MD ,&nbsp;Christina Henson MD","doi":"10.1016/j.adro.2025.101876","DOIUrl":"10.1016/j.adro.2025.101876","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101876"},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Cutaneous Ecchymosis with Bruton’s Tyrosine Kinase Inhibitors and Breast Radiation: A Case Report","authors":"Jinah Kim MD ,&nbsp;Diego Adrianzen Herrera MD ,&nbsp;Puyao C. Li MD","doi":"10.1016/j.adro.2025.101878","DOIUrl":"10.1016/j.adro.2025.101878","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101878"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145045572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Efficacy of Hydrogen Therapy on Acute Radiation Enteritis and Inflammatory Response in Patients with Cervical Cancer Undergoing Concurrent Chemoradiation Therapy","authors":"Bo Liu PhD ,&nbsp;Yao Bao MD ,&nbsp;Jinan Ma PhD ,&nbsp;Xiaodong Wang PhD ,&nbsp;Yeqian Feng PhD","doi":"10.1016/j.adro.2025.101879","DOIUrl":"10.1016/j.adro.2025.101879","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute radiation enteritis (ARE) is a common toxic inflammatory reaction in patients with cervical cancer undergoing concurrent chemoradiation therapy (CCRT). Molecular hydrogen, as a novel antioxidant and anti-inflammatory agent, may alleviate treatment-related toxicity. This study aimed to evaluate the efficacy of inhaled hydrogen in preventing ARE and modulating systemic inflammation.</div></div><div><h3>Methods</h3><div>Eligible patients with cervical cancer undergoing CCRT were prospectively enrolled and randomized into an experimental group (n = 28) or a control group (n = 30). The experimental group received inhalation therapy with a hydrogen-oxygen gas mixture (66.6% hydrogen, 33.3% oxygen; 3 L/min, 2 h/d) on each radiation therapy day. Inflammatory biomarkers—including C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and interleukin 6—as well as hemogram parameters, fecal occult blood, Late Effects Normal Tissue Task Force—Subjective, Objective, Management, and Analytic scores; Patient-Generated Subjective Global Assessment scores; and Radiation Therapy Oncology Group enteritis grades were monitored during treatment and Response Evaluation Criteria in Solid Tumors scores.</div></div><div><h3>Results</h3><div>Baseline characteristics (age, tumor stage, pathology, and surgical history) were balanced between groups (<em>P</em> &gt; .05). Compared with the control group, the experimental group showed significantly lower levels of C-reactive protein, neutrophil-to-lymphocyte ratio, interleukin 6, and fecal occult blood positivity rates (<em>P</em> &lt; .05). Clinical assessments also indicated lower Late Effects Normal Tissue Task Force–Subjective, Objective, Management, and Analytic and Patient-Generated Subjective Global Assessment scores and milder Radiation Therapy Oncology Group enteritis grading in the hydrogen group (<em>P</em> &lt; .05). Importantly, no significant difference in tumor response was observed between groups based on the Response Evaluation Criteria in Solid Tumors, suggesting that hydrogen therapy did not interfere with the antitumor efficacy of CCRT. No adverse events related to hydrogen inhalation were reported.</div></div><div><h3>Conclusion</h3><div>Hydrogen inhalation is a safe and effective adjunctive therapy that significantly alleviates inflammation and mitigates clinical symptoms of ARE in patients with cervical cancer who are undergoing CCRT, without compromising antitumor treatment outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101879"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging Radiomic Analysis of Radiation-Induced Morphea of the Breast: A Proof-of-Concept Study","authors":"Jieying Wu MD ,&nbsp;Joseph Bae MS ,&nbsp;Chao Chen PhD ,&nbsp;Samuel Ryu MD ,&nbsp;Daniel Lozeau MD ,&nbsp;Alexander Stessin MD, PhD ,&nbsp;Prateek Prasanna PhD","doi":"10.1016/j.adro.2025.101881","DOIUrl":"10.1016/j.adro.2025.101881","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation-induced morphea (RIM) is a very rare but devastating side effect of breast radiation therapy, characterized by progressive skin induration, pain, and discoloration, with no effective treatments currently available. This is a proof-of-concept study that aims to identify radiomic features from pretreatment magnetic resonance imaging (MRI) scans associated with the development of RIM in patients with breast cancer undergoing radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>This is a retrospective analysis of a single institutional registry of patients who received diagnosis of RIM following breast radiation therapy from 2008 to 2022. Clinical and histopathological data were reviewed. Pretreatment MRI scans of these patients and matched controls were analyzed. Radiomic features were extracted from whole breast and fibroglandular tissue regions of interest. A total of 528 radiomic features were compared between patients who developed RIM and those who did not, using the Wilcoxon rank-sum test to identify statistically significant differences.</div></div><div><h3>Results</h3><div>We evaluated 10 patients who received clinical diagnosis of RIM, with a mean age of 63 years (range, 44-75 years). Among these, 7 patients had biopsy-proven RIM. Both clinical and histologic findings were correlated with radiomic analyses. Forty percent of the patients had a history of autoimmune disorders, including hypothyroidism, Graves’ disease, systemic sclerosis, and systemic lupus erythematosus. Radiomic analysis identified 11 significant features, primarily related to tissue structure and texture. Nine of these features were from the contralateral breast, and 2 were from the ipsilateral breast.</div></div><div><h3>Conclusions</h3><div>This is a pilot study on a small sample that demonstrates that radiomic features extracted from pretreatment MRI scans can serve as potential predictors for the development of RIM in patients with breast cancer. The integration of clinical and histopathological data with radiomic analysis highlights the distinct changes in breast tissue architecture that precede RIM onset. These findings pave the way for the early identification of patients at risk, allowing for more personalized surveillance and management strategies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101881"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interim Analysis of Pro-Grid: A Phase 1 Proton Spatially Fractionated Radiation Therapy Trial","authors":"Khadija Sheikh PhD ,&nbsp;Anh Tran MSc ,&nbsp;Heng Li PhD ,&nbsp;Anna W. LaVigne MD ,&nbsp;Jean L. Wright MD ,&nbsp;Aditya Halthore MD","doi":"10.1016/j.adro.2025.101857","DOIUrl":"10.1016/j.adro.2025.101857","url":null,"abstract":"<div><h3>Purpose</h3><div>Spatial fractionation (SFRT) is a radiation therapy technique that targets bulky tumors by delivering alternating high and low doses within the tumor. Here, we report an interim analysis of a phase 1 trial examining the feasibility and safety of a novel proton SFRT approach.</div></div><div><h3>Methods and Materials</h3><div>Ten patients with unresectable tumors of varying histopathology measuring at least 7 cm in the palliative setting were enrolled in a prospective phase 1 trial. Robust pencil-beam scanning proton SFRT plans were created using cylindrical (grid) targets within gross tumor treated to a prescription dose of 18 Gy in a single fraction. Quality assurance computed tomography imaging (qCT) was performed before treatment delivery.</div></div><div><h3>Results</h3><div>Four patients had breast primaries, 3 patients had lung primaries, and 3 patients had pelvic primaries. Five patients had prior photon treatment to a different site. Eight patients received additional planned normofractionated radiation therapy totaling an average dose of 30 Gy. Median time from SFRT treatment to last follow-up was 25 weeks (range, 4-60 weeks). Gross tumor volume ranged from 151 cm³ to 1638 cm³. All qCTs maintained robustness, with no re-planning needed. At last follow-up, 40% showed partial response, 20% had stable disease, and 40% experienced disease progression, with half progressing in the treated area. One patient with pelvic treatment developed grade 3 small bowel obstruction, followed by late grade 2 obstructions. No other patients had grade 3 or higher acute or late toxicities attributable to the proton SFRT.</div></div><div><h3>Conclusions</h3><div>Spatial fractionation using a novel pencil-beam scanning SFRT technique was technically feasible to deliver and reliable on robust evaluation of qCT in this small prospective cohort of patients with difficult-to-manage bulky tumors. Proton SFRT appears safe even when additional normofractionated radiation therapy is delivered. Some bulky tumors exhibited significant response to proton SFRT; thus, further work elucidating which patients most benefit from this technique is warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101857"},"PeriodicalIF":2.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}