Advances in Radiation Oncology最新文献

{"title":"Monitoring of Early Skin Reactions by Optical Coherence Tomography and Dermatoscopy in Patients Receiving Radiation Therapy for Head and Neck Cancer","authors":"Bettina Heise PhD ,&nbsp;Peter Schlagnitweit MSc ,&nbsp;Robert Pollak DI ,&nbsp;Karoline Felbermayer DI ,&nbsp;Elisabeth Silberberger Mag ,&nbsp;Lukas Kocik MD ,&nbsp;Leonhard Trinkl BSc ,&nbsp;David Weinzinger DI ,&nbsp;Philipp Anderlik DI ,&nbsp;Andreas Springer PhD ,&nbsp;Marija Geroldinger-Simic MD, PhD ,&nbsp;Georg Gruber MD, PhD ,&nbsp;Maximilan Hartl MD ,&nbsp;Hans Geinitz MD","doi":"10.1016/j.adro.2025.101793","DOIUrl":"10.1016/j.adro.2025.101793","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with head and neck cancer undergoing radiation therapy (RT) may experience pronounced acute skin reactions. We tested whether optical coherence tomography (OCT) and dermatoscopy could detect and monitor early subclinical RT-induced skin changes and might be used as a noninvasive prediction tool for higher-grade acute toxicity.</div></div><div><h3>Methods and Materials</h3><div>Handheld OCT and dermatoscopy were used to monitor skin conditions during RT in head and neck cancer patients. Images were reviewed for typical and suspicious features facilitated by electronic image analyses. Radiation toxicity was graded weekly by a radiation oncologist. Machine learning was used to analyze the recorded data and to extract features, patterns/anomalies, and risk prediction values for high-grade radiation toxicity.</div></div><div><h3>Results</h3><div>The most common skin features during RT observed by OCT were expressions of hyperkeratosis, blister formation, and in selected cases, formation of extensive microvascular structures or stratification disorder. Dermatoscopy revealed an almost linear increase in skin redness and saturation over the course of RT. By integrating all imaging and clinical data from RT weeks 1 to 3, it was possible to predict an increased risk of severe radiation toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or higher) in the second half of RT. A prediction accuracy of 72%, 75%, and 77% was achieved with OCT and clinical assessment, dermatoscopy and clinical assessment, and all 3 modes combined, respectively.</div></div><div><h3>Conclusions</h3><div>OCT and dermatoscopy can detect early radiation-induced skin changes at a subclinical level. Dermatoscopy is more accessible, whereas OCT requires training and further electronic processing to interpret images. Dermatoscopy, but not OCT, can quantify skin color changes, whereas OCT is able to deliver unique information on epidermal suspicious microstructural changes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101793"},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254879","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":"Local Control After Adjuvant Radiosurgery for Spinal Metastasis Treated With Decompression and Posterior Segmental Stabilization: A Comparison Between Carbon Fiber/Polyetheretherketone-Based and Metallic Implants","authors":"Romulo A. Andrade-Almeida MD ,&nbsp;Francisco Call-Orellana MD ,&nbsp;Juan P. Zuluaga-Garcia MD, MSc ,&nbsp;Esteban Ramirez-Ferrer MD ,&nbsp;Gil Kimchi MD ,&nbsp;Brian S. De MD ,&nbsp;Alexandre B. Guimaraes MD ,&nbsp;Christopher A. Alvarez-Breckenridge MD, PhD ,&nbsp;Jing Li MD, PhD ,&nbsp;Amol J. Ghia MD ,&nbsp;Laurence Rhines MD ,&nbsp;Martin C. Tom MD ,&nbsp;Chenyang Wang MD, PhD ,&nbsp;Thomas H. Beckham MD, PhD ,&nbsp;Behrang Amini MD, PhD ,&nbsp;Robert Y. North MD, PhD ,&nbsp;Claudio E. Tatsui MD","doi":"10.1016/j.adro.2025.101806","DOIUrl":"10.1016/j.adro.2025.101806","url":null,"abstract":"<div><h3>Purpose</h3><div>Carbon fiber-reinforced polyetheretherketone (CFRP) spinal implants are gaining popularity in the surgical management of spinal metastasis because of their physical and radiographic properties, which facilitate adjuvant radiation planning and tumor surveillance. Their impact on clinical outcomes is still under investigation. We evaluated the role of hardware material (CFRP vs titanium) in local control and hardware durability in metastatic cases receiving decompressive surgery and adjuvant spinal stereotactic radiosurgery (SSRS).</div></div><div><h3>Methods and Materials</h3><div>This single-institution, retrospective cohort study was approved by the local institutional review board. Patients who underwent decompressive surgery with posterior segmental instrumentation followed by treatment with SSRS for metastatic spine disease were included. Exclusion criteria were as follows: (1) cervical implants, (2) mixed-type hardware, (3) SSRS greater than 60 days after surgery, and (4) less than 3 months magnetic resonance imaging follow-up. Only tumor progression occurring inside or at the margins of the irradiated field was considered.</div></div><div><h3>Results</h3><div>Eighty-three spinal segments (55 titanium, 28 CFRP; from 82 patients) were evaluated. Except for the number of radiation fractions, proportion of single-fraction 24 Gy cases, and radiation equivalent dose in 2-Gy fractions, no significant differences were found between groups. The median follow-up time was 14.5 months (range, 3.0-70.4 months). Sixteen local progressions were identified, with 15 in the titanium group (<em>P</em> = .009). Using death as a competing factor, local progression-free survival was longer in the CFRP group (HR, 0.127; 95% CI, 0.017-0.945; <em>P</em> = .044). The median time to progression was 9.27 months (IQR, 4.5-15.65 months). Higher equivalent dose in 2-Gy fractions was the only variable associated with local tumor control in both univariate and multivariate analyses (<em>P</em> = .025 and <em>P</em> = .019, respectively). The titanium cohort experienced 4 hardware adverse events, whereas the CFRP group had 2 adverse events (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>CFRP implants were associated with lower rates of local progression in crude analyses, but did not reach statistical significance in multivariable models. No differences in hardware durability were identified.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101806"},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254707","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":"Electronic Chart Recording for Gamma Knife Stereotactic Radiosurgery","authors":"Sven Ferguson MS ,&nbsp;Gregory Kamal BS ,&nbsp;Nels Knutson PhD ,&nbsp;Timothy Mitchell PhD ,&nbsp;Sreekrishna Murty Goddu PhD ,&nbsp;Eric Filiput BS ,&nbsp;Amanda Schoenberger BS ,&nbsp;Joshua L. Dowling MD ,&nbsp;Jiayi Huang MD ,&nbsp;Yi Huang ScM ,&nbsp;Taeho Kim PhD","doi":"10.1016/j.adro.2025.101777","DOIUrl":"10.1016/j.adro.2025.101777","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation oncology departments are uniquely susceptible to additional challenges when transitioning from paper to electronic chart recording systems. The Gamma Knife stereotactic radiation therapy system has additional complexities stemming from limited network connectivity to other computer systems used within the department. The goal of this project is to transition from paper charting to completely electronic charting.</div></div><div><h3>Methods</h3><div>To accomplish the digital transformation, our department created a detailed mapping of the paper workflow, converted all documents digitally, implemented a paperless printing solution, and established a digital platform for document processing. Throughout each step, we intended to preserve the integrity of the high-quality treatment workflow in our department by focusing on (1) enhancing the multidisciplinary aspects of the treatment workflow; (2) ensuring protected health information security; and (3) maintaining efficient patient care.</div></div><div><h3>Results</h3><div>Electronic signature software and a digital printer were installed to overcome technical hurdles. All paper documents, such as the written directive, stereotactic radiosurgery-frame measurements, and physics consult, were converted to electronic documents mainly using spreadsheet applications. Based on clinical implementation and practice, all goals were met which enhanced the treatment workflow by allowing less time spent on documentation and more time with the patients.</div></div><div><h3>Conclusions</h3><div>With technical planning and coordination from all team members, we demonstrated that the implementation of electronic chart recording systems can be achieved for Gamma Knife radiosurgery treatments that enhance the treatment workflow, provide flexibility for staff, and allow for greater multidisciplinary communication.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101777"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263473","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":"Long-Term Outcomes of Multimodality Accelerated Partial Breast Irradiation for Ductal Carcinoma In Situ","authors":"Silpa Raju-Salicki MD ,&nbsp;Hayley B. Stowe MD, MSCI ,&nbsp;Alden D’Souza MD ,&nbsp;Yi Huang MS ,&nbsp;Mustafaa Mahmood MD ,&nbsp;William R. Kennedy MD ,&nbsp;Randall J. Brenneman MD, PhD ,&nbsp;Julie Margenthaler MD ,&nbsp;Katherine Glover-Collins MD, PhD ,&nbsp;Amy Cyr MD ,&nbsp;Carmen Bergom MD, PhD ,&nbsp;Joanna Yang MD ,&nbsp;Maria A. Thomas MD, PhD ,&nbsp;Jacqueline Zoberi PhD ,&nbsp;Imran Zoberi MD","doi":"10.1016/j.adro.2025.101792","DOIUrl":"10.1016/j.adro.2025.101792","url":null,"abstract":"<div><h3>Purpose</h3><div>To report long-term institutional outcomes for ductal carcinoma in situ treated with accelerated partial breast irradiation (APBI) using multiple modalities as a part of breast-conserving therapy.</div></div><div><h3>Methods and Materials</h3><div>From January 2001 to April 2019, 240 patients with stage 0 breast cancer were treated with breast-conserving surgery (BCS) and adjuvant APBI at our institution. Based on the 2024 American Society for Radiology and Oncology (ASTRO) APBI guidelines, 170 patients were “recommended,” 68 were “conditionally recommended,” and 2 were “not recommended” for APBI. A total of 102 patients were treated with linear accelerator-based external beam radiation therapy, 38 with magnetic resonance image-guided external beam radiation therapy (MRgEBRT), 49 with multicatheter interstitial implant (ISI) brachytherapy, and 51 with intracavitary applicator brachytherapy (strut-adjusted volume implant). Patients treated with external beam radiation therapy received 3850 cGy in 10 fractions twice a day. Patients treated with ISI or strut-adjusted volume implant received 3400 cGy in 10 fractions twice a day. Recurrence and survival were calculated using the Kaplan–Meier method. Cosmesis was scored by the Harvard criteria.</div></div><div><h3>Results</h3><div>At a median follow-up of 11.5 years (range, 1.2-17.8 years), the overall and cause-specific survival rates were 94.8% and 100%, respectively. The 10-year ipsilateral breast tumor recurrence rate was 3.8%. There were 9 observed ipsilateral breast tumor recurrences with 1 concurrent ipsilateral regional lymph node recurrence. No other breast failures, regional recurrences, or distant metastases were noted. Breast cancer–specific survival (BCSS) was 99.6% at the time of analysis. There was no statistically significant difference in overall survival or recurrence rates between the different treatment modalities. Cosmesis was excellent or good in 90% of cases without a statistically significant difference between the treatment method, 2024 American Society for Radiology and Oncology APBI criteria, or the 2022 American Brachytherapy Society (ABS) APBI acceptability categories.</div></div><div><h3>Conclusions</h3><div>APBI as a component of breast-conserving therapy for pure ductal carcinoma in situ is associated with excellent survival rates, local control, and cosmetic outcomes regardless of radiation therapy modality.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101792"},"PeriodicalIF":2.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115529","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":"Optimizing Breast Cancer Radiation therapy With Volumetric Modulated Arc Therapy and Skin Flash: A Case Study Using Deep Inspiration Breath Hold and Cherenkov Imaging","authors":"Adi Robinson PhD ,&nbsp;Michael Tallhamer MS ,&nbsp;Amber Orman MD","doi":"10.1016/j.adro.2025.101798","DOIUrl":"10.1016/j.adro.2025.101798","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101798"},"PeriodicalIF":2.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115132","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":"Computed Tomography Scan Planning in Radiation Oncology: Prospective Evaluation of the “Mini-CT Scan” Procedure Prior to a Routine Immediate Planning Computed Tomography Scan Practice. Results of the OPTIMAL Study","authors":"Kamel Debbi ,&nbsp;Sarah Witmeyer ,&nbsp;Alexander Bennassi ,&nbsp;Chahrazed Boukhobza ,&nbsp;Gloria Fonteneau ,&nbsp;Nhu Hanh To ,&nbsp;Gabriele Coraggio ,&nbsp;Wassim Ksouri ,&nbsp;Noémie Grellier ,&nbsp;Mohamed Aziz Cherif ,&nbsp;Gokoulakrichenane Loganadane ,&nbsp;Yazid Belkacemi ,&nbsp;AROME (Association of Radiotherapy and Oncology of the Mediterranean Area; www.aromecancer.org) and Transatlantic Radiation Oncology Network (TRONE)","doi":"10.1016/j.adro.2025.101808","DOIUrl":"10.1016/j.adro.2025.101808","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the benefit/risk in terms of radioprotection of performing a mini-computed tomography (CT) scan prior to the planning CT scan in patients requiring pelvic irradiation. The study population included patients who received curative intent external beam radiation therapy for pelvic malignancies. The results are applicable to all supine pelvic external beam radiation therapy patients.</div></div><div><h3>Methods and Materials</h3><div>Between April 9, 2021, and October 5, 2021, 53 patients were included in the study. A mini-CT scan was performed for each patient to determine whether they were properly prepared with a full bladder and empty rectum for the planning CT scan. Depending on the result, it was decided to either perform the planning CT scan or repeat a mini scan after rectal enema and drinking to better empty the rectum and fill the bladder. Up to 3 mini scans could be performed, after which a new CT appointment was scheduled if the patient was considered not sufficiently prepared.</div></div><div><h3>Results</h3><div>Among the 53 patients included in the study, 64 wide CT scans were performed (average, 1.2 scans per patient). A total of 47, 3, 2, and 1 patients were treated for prostate, rectal, bladder, and anal canal cancers, respectively. The median age was 75 years (range, 57-94), with 51 men and 2 women. For 29 patients, a single mini-CT scan was performed prior to the wide CT scan, corresponding to an additional mean effective dose of 2.3 mSv to the mini-CT scan. For 25 patients, multiple wide CT scans and mini-CT scans were performed. For these patients, the mini-CT scan allowed us to decrease patient exposure by reducing the average effective dose by 22.1 mSv per patient. The systematic use of a mini-CT scan in the whole cohort allowed reducing the mean effective dose by 9.44 mSv based on a paired <em>t</em> test (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>We demonstrated that the effective dose delivered to the patient was significantly lower if we carried out 1 or more mini-CT scans to avoid doing iterative planning CT scans that deliver a higher dose to the patient.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101808"},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254878","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":"Validation of a Novel Data-Driven Algorithm to Detect Atypical Prescriptions in Radiation Therapy","authors":"Connor Thropp MS ,&nbsp;Jaroslaw Hepel MD ,&nbsp;Timothy Leech ,&nbsp;Eric E. Klein PhD ,&nbsp;Qiongge Li PhD","doi":"10.1016/j.adro.2025.101804","DOIUrl":"10.1016/j.adro.2025.101804","url":null,"abstract":"<div><h3>Purpose</h3><div>Erroneous radiation therapy (RT) prescriptions (Rx) can lead to injury or death of patients. A novel data-driven model that uses similarity learning to identify atypical Rx was recently published. In that study, prototype analysis was conducted within a single institution with a single treatment site. The present study sets out to validate the robustness of the model by applying the model to multiple disease sites using a different institution’s data.</div></div><div><h3>Methods and Materials</h3><div>A query was conducted of Brown University Health RT treatment records for thoracic and brain cancer patients from 1995 to 2021 to create historical databases used for training. The query included records containing data on the Rx and patient-specific features. Simulated anomalies were created to mimic potential errors and were used in the training and testing of the model. Model performance was evaluated using F1 score.</div></div><div><h3>Results</h3><div>F1 scores for the brain site are 99% for intensity modulated RT, 90% for stereotactic radiation therapy/ radiosurgery/SRT, and 94% for 3-dimensional RT. F1 scores for the thoracic site are 95%, 90%, and 95% for the 3 techniques, respectively. Statistical analysis shows no significant differences between the model’s prediction and ground truth.</div></div><div><h3>Conclusions</h3><div>The model performance shows feasibility for application to various disease sites across different institutions. This model can be used alongside physicians and physicists during peer review chart rounds to aid in the detection of potential RT Rx errors.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101804"},"PeriodicalIF":2.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239960","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":"Multi-institutional Outcomes after Stereotactic Radiosurgery for Gastrointestinal Brain Metastases","authors":"Jamiluddin J. Qazi MD ,&nbsp;David J. Carpenter MD, MS ,&nbsp;Jim Leng MD ,&nbsp;Christina C. Huang MD, MS ,&nbsp;Steven J. Chmura MD, PhD ,&nbsp;Muzamil Arshad MD, PhD ,&nbsp;Zachary J. Reitman MD, PhD ,&nbsp;John P. Kirkpatrick MD, PhD ,&nbsp;Julian C. Hong MD, MS ,&nbsp;Scott R. Floyd MD, PhD ,&nbsp;Trey C. Mullikin MD ,&nbsp;Joseph K. Salama MD","doi":"10.1016/j.adro.2025.101795","DOIUrl":"10.1016/j.adro.2025.101795","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare outcomes between gastrointestinal and nongastrointestinal patients with brain metastases after radiosurgery.</div></div><div><h3>Methods and Materials</h3><div>Retrospective cohort study identifying patients completing an initial course of radiosurgery between January 2015 and December 2020, with follow-up data collected through November 2022. Multi-institutional, academic referral centers. The primary outcomes were overall survival and intracranial progression-free survival, calculated by the Kaplan–Meier method. Progression was defined as concern on postradiosurgery imaging for recurrence determined by clinical multidisciplinary consensus. Cox proportional hazard models were used to assess associations between outcomes and covariates.</div></div><div><h3>Results</h3><div>This study included 1281 nongastrointestinal patients and 102 gastrointestinal patients, of which 45.1% were colorectal, 33.3% esophageal, and the remaining 21.6% comprising other sites. Gastrointestinal patients were more likely to be younger (mean 59.1 vs 63.5 years, <em>P</em> = .001), male (56.9% vs 44.3%, <em>P</em> = 0.014), have received systemic therapy (73.5% vs 63.9%, <em>P</em> = .049), and have resection of brain metastases (45.1% vs 25.0%, <em>P</em> &lt; .001) prior to radiosurgery. Median overall survival was lower for gastrointestinal patients at 5.4 months (95% CI, 3.8-7.7) versus nongastrointestinal patients at 10.6 months (95% CI, 9.3-11.6, <em>P</em> &lt; 0.0001). In a multivariate model, gastrointestinal patients had worse overall survival compared to nongastrointestinal patients (hazard ratio, 1.92; <em>P</em> &lt; .0001; 95% CI, 1.53-2.41). Median intracranial progression-free survival was lower for gastrointestinal patients at 6.2 months (95% CI, 4.0-9.6) versus nongastrointestinal patients at 12.3 months (95% CI, 10.8-13.9; <em>P</em> = 0.0002). In a multivariate model, gastrointestinal patients had worse intracranial progression-free survival compared to nongastrointestinal patients (hazard ratio, 1.60; 95% CI, 1.20-2.14; <em>P</em> = 0.0013). There were no significant differences between colorectal primary patient or esophageal primary patient outcomes compared to all other gastrointestinal primary patients.</div></div><div><h3>Conclusions</h3><div>Across a multi-institutional stereotactic radiosurgery cohort, brain metastases of gastrointestinal origin demonstrated inferior overall survival and intracranial progression-free survival to those of nongastrointestinal origin. These data may help inform treatment decisions and postradiosurgery surveillance.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101795"},"PeriodicalIF":2.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239962","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":"Spinal Instability Neoplastic Score as a Predictor of Vertebral Fracture in Patients Undergoing Radiation Therapy for Spinal Metastases: A Single-Institution Study","authors":"Patrick Doyle MS ,&nbsp;Sarah Caplan MS ,&nbsp;Neil Klinger MD ,&nbsp;Kee-Young Shin MS ,&nbsp;Michael Groff MD ,&nbsp;Maeve Dillon-Martin BS ,&nbsp;Thomas Johnson MS ,&nbsp;Heejoo Kang BS ,&nbsp;Teresia Perkins BS ,&nbsp;Claire Novack BS ,&nbsp;Alexander Spektor MD ,&nbsp;Mai Anh Huynh MD, PhD ,&nbsp;Ellen Kim MPH ,&nbsp;Shyam Tanguturi MD ,&nbsp;Cara Richards MSPAS, PA-C ,&nbsp;Wenxin (Vincent) Xu MD ,&nbsp;David Kozono MD, PhD ,&nbsp;Ron Alkalay PhD ,&nbsp;David Hackney MD ,&nbsp;Tracy Balboni MD, MPH","doi":"10.1016/j.adro.2025.101803","DOIUrl":"10.1016/j.adro.2025.101803","url":null,"abstract":"<div><h3>Purpose</h3><div>The Spinal Instability Neoplastic Score (SINS) is the most common method of assessing spine stability in the setting of spinal metastases. We sought to assess (1) the SINS score as a predictor of vertebral compression fracture (VCF), (2) the risk contributions of the 6 SINS individual factors, and (3) other contributors to fracture risk.</div></div><div><h3>Methods and Materials</h3><div>In total, 194 patients with 391 spinal lesions that had not previously been treated with vertebroplasty/kyphoplasty, radiation therapy (RT), or surgery were enrolled before RT and followed for new or worsened fracture.</div></div><div><h3>Results</h3><div>A total of 187 patients who were treated to 361 vertebral levels underwent post-RT follow-up. Average follow-up time for patients on study was 9.4 months (range, 0.2-38.8 months). A total of 33 new or worsened fractures (9.1% of lesions followed) were observed, with an average time to fracture of 4.4 months (range, 0.1-27.8 months). Of all 6 SINS factors, 3 were found to be individually significantly associated with increased risk of fracture, these were: lesion location in L2-L4 [hazard ratio (HR) = 2.78, <em>P</em> = .04], mixed or lytic appearance on computed tomography (mixed HR = 3.87, <em>P</em> = .01, lytic HR = 2.68, <em>P</em> = .02), and &lt;50% vertebral collapse (HR = 3.52, <em>P</em> &lt; .01). SINS as a summated score was significantly associated with increased risk of fracture on multivariable analysis (<em>P</em> &lt; .01). Use of bone-strengthening medications such as bisphosphonates was also significantly associated with decreased risk of fracture in multivariable analysis in stable (SINS ≤6) (HR = 0.10, <em>P</em> = .03) and potentially unstable (SINS, 7-12) lesions (HR: 0.18, <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>These findings support that SINS is a useful tool for estimating VCF risk, with lesion location, metastasis bone morphology, and presence of &lt;50% collapse being the strongest predictors. Additionally, findings suggest that bone-strengthening medications such as bisphosphonates may mitigate the risk of developing VCF after RT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101803"},"PeriodicalIF":2.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239961","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":"Screening Colonoscopy Association With Gastrointestinal Toxicity and Quality of Life After Prostate Stereotactic Body Radiation Therapy","authors":"Jonathan W. Lischalk MD ,&nbsp;Vianca F. Santos MPH ,&nbsp;Brianna Vizcaino BA ,&nbsp;Astrid Sanchez MS ,&nbsp;Christopher Mendez MA ,&nbsp;Kathleen Maloney-Lutz RN ,&nbsp;Sam Serouya MD ,&nbsp;Seth R. Blacksburg MD, MBA ,&nbsp;Todd Carpenter MD ,&nbsp;Moses Tam MD ,&nbsp;Scott Niglio MD ,&nbsp;William Huang MD ,&nbsp;Samir Taneja MD ,&nbsp;Michael J. Zelefsky MD ,&nbsp;Jonathan A. Haas MD","doi":"10.1016/j.adro.2025.101747","DOIUrl":"10.1016/j.adro.2025.101747","url":null,"abstract":"<div><h3>Purpose</h3><div>Screening colonoscopies (CS) performed before prostate stereotactic body radiation therapy (SBRT) allow for identifying synchronous malignancies and comorbid gastrointestinal (GI) conditions. Performing these procedures prior to radiation precludes the necessity of post-SBRT pelvic instrumentation, which may lead to severe toxicity and fistulization. We review compliance of CSs, incidence of GI pathology, and the impact of pretreatment CS findings on subsequent physician-reported toxicity and patient-reported quality of life (QoL).</div></div><div><h3>Methods and Materials</h3><div>We reviewed an institutional database of patients treated for prostate cancer with SBRT including toxicity and QoL outcomes. A detailed review of pretreatment CS findings was reviewed including identification of diverticulosis, location of polyp resection, and presence of hemorrhoids. Pretreatment CS findings were then correlated with outcomes following SBRT.</div></div><div><h3>Results</h3><div>Identification of comorbid GI conditions was a common event, with the presence of diverticulosis in 49.5% (n = 100), hemorrhoids in 67% (n = 136), and polyps in 48% (n = 98). More than half of patients with polyps removed had at least 1 removed from the rectosigmoid. Pretreatment CS did not introduce a delay in SBRT start date. Grade 1 toxicity was significantly lower in patients who underwent CS closer to the initiation of SBRT. There was no increased risk of physician-graded toxicity in the presence of diverticulosis, hemorrhoids, or polyps. Patient-reported GI QoL pattern in our screening cohort mimicked that seen in the previously published nonscreened population. There was no overt QoL detriment observed in patients who had GI pathology identified before SBRT.</div></div><div><h3>Conclusions</h3><div>GI pathology identified in our elderly patient population was commonly identified on pretreatment CS. Screening CS may optimize bowel health for patients heading into radiation therapy. Toxicity and QoL for patients with GI pathologies identified on pretreatment CS do not preclude the delivery of prostate SBRT. We advocate for pretreatment CS in patients eligible prior to SBRT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101747"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941146","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}