Advances in Radiation Oncology最新文献

{"title":"Impact of Normal Lung Volume Choices on Radiation Pneumonitis Risk Prediction in Locally Non-small Cell Lung Cancer Radiation Therapy","authors":"Alyssa Gadsby MS,&nbsp;Tian Liu PhD,&nbsp;Robert Samstein MD,&nbsp;Jiahan Zhang PhD,&nbsp;Yang Lei PhD,&nbsp;Kenneth E. Rosenzweig MD,&nbsp;Ming Chao PhD","doi":"10.1016/j.adro.2025.101825","DOIUrl":"10.1016/j.adro.2025.101825","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the impact of varying definitions of normal lung volume on the prediction of radiation pneumonitis (RP) risk in patients with locally advanced non-small cell lung cancer undergoing radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>Dosimetric variables V20, V5, and mean lung dose (MLD) were extracted from the treatment plans of 442 patients enrolled in the NRG Oncology Radiation Therapy Oncology Group 0617 trial. Three different definitions of lung volume were evaluated: total lung excluding gross tumor target, total lung excluding clinical target volume, and total lung excluding planning target volume (TL-PTV). Patients were grouped as “no-RP2” (<em>N</em> = 377, grade ≤1 RP) and “RP2” (<em>N</em> = 65, grade ≥2 RP). Statistical analyses were performed to assess the effect of lung volume definition on RP2 prediction. Three supervised machine learning models—logistic regression, k-nearest neighbor (kNN), and eXtreme Gradient Boosting—were used to evaluate predictive performance. Model performance was quantified using the area under the receiver operating characteristic curve, and statistical significance was tested via a bootstrap analysis. Shapley Additive Explanations (SHAP) were applied to interpret feature contributions to model predictions.</div></div><div><h3>Results</h3><div>Statistical analyses showed that V20 and MLD were significantly associated with RP2, while differences among the lung volume definitions were not statistically significant. Both k-nearest neighbor and eXtreme Gradient Boosting classifiers consistently yielded higher area under the receiver operating characteristic curve values for the TL-PTV definition compared to the other definitions, a finding supported by bootstrap analysis. SHAP analysis further indicated that V20 and MLD were the most influential predictors of RP2.</div></div><div><h3>Conclusions</h3><div>In line with previous studies, both statistical analysis and SHAP interpretation confirmed that V20 and MLD were associated with RP2. The machine learning models indicated that defining normal lung volume as TL-PTV yielded the highest predictive performance for RP2 risk. Further validation using external data sets are warranted to confirm these findings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101825"},"PeriodicalIF":2.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536247","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":"A Radiogenomic Deep Ensemble Learning Model for Identifying Radionecrosis Following Brain Metastases (BM) Stereotactic Radiosurgery in Patients With Non-small Cell Lung Cancer BM","authors":"Jingtong Zhao MS ,&nbsp;Eugene Vaios MD, MBA ,&nbsp;Evan Calabrese MD, PhD ,&nbsp;Zhenyu Yang PhD ,&nbsp;Scott Robertson PhD ,&nbsp;John Ginn PhD ,&nbsp;Ke Lu PhD ,&nbsp;Fang-Fang Yin PhD ,&nbsp;Zachary Reitman MD, PhD ,&nbsp;John Kirkpatrick MD, PhD ,&nbsp;Scott Floyd MD, PhD ,&nbsp;Peter Fecci MD, PhD ,&nbsp;Chunhao Wang PhD","doi":"10.1016/j.adro.2025.101826","DOIUrl":"10.1016/j.adro.2025.101826","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic radiosurgery (SRS) is widely used for brain metastases (BM), but the risk of radionecrosis poses a challenge in post-SRS management. Given the lack of noninvasive imaging methods for distinguishing radionecrosis from recurrence, we aimed to design a deep ensemble learning model that integrates patient clinical features and genomic profiles to identify radionecrosis in patients with BM with post-SRS radiographic progression.</div></div><div><h3>Methods and Materials</h3><div>We studied 90 BMs from 62 patients with non-small cell lung cancer, with 27 biopsy-confirmed post-SRS local recurrences. Clinical features and molecular features were collected. A deep neural network (DNN) was trained for radionecrosis/recurrence prediction using the 3-month post-SRS T1+c magnetic resonance imaging. Preceding the binary prediction output, latent variables were extracted as 1024 deep features. An ensemble learning model was then developed, comprising 2 submodels that fused deep features with clinical (“<em>D+C”</em>) or genomic (“<em>D+G”</em>) features. We employed our positional encoding method to optimally fuse the low-dimensional clinical/genomic features with the high-dimensional image features. The postfusion feature in each submodel yielded a logit result after traversing fully connected layers. The ensemble's final output was the synthesized result of these 2 submodels’ logits via logistic regression. Model training employed an 8:2 train/test split, and 10 model versions were developed for robustness evaluation. Performance metrics were compared against image-only DNN model and “<em>D+C”</em> and “<em>D+G”</em> submodels.</div></div><div><h3>Results</h3><div>The deep ensemble model showed satisfactory performance on the test set, with the area under the receiver operating characteristic curve (ROC_AUC) = 0.91 ± 0.04, sensitivity = 0.87 ± 0.16, specificity = 0.86 ± 0.08, and accuracy = 0.87 ± 0.04. This significantly outperformed the image-only DNN result (ROC_AUC = 0.71 ± 0.05, sensitivity = 0.66 ± 0.32). Higher average performance was also observed compared to the “D+C” result (ROC_AUC = 0.82 ± 0.03, sensitivity = 0.67 ± 0.17) and “D+G” result (ROC_AUC = 0.83 ± 0.02, sensitivity = 0.76 ± 0.22).</div></div><div><h3>Conclusions</h3><div>The deep ensemble model achieved the best performance among the models evaluated in this study for distinguishing BM radionecrosis from recurrence using 3-month post-SRS T1+c MR images, clinical features, and genomic features. This highlights the potential of artificial intelligence in clinical decision-making for BM management, warranting further investigation into its clinical applications.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101826"},"PeriodicalIF":2.2,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523830","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":"Functional Imaging of Changes in Lung Function Before and After Radiation Therapy of Lung Cancer","authors":"Jonathan L. Percy BSc ,&nbsp;Marrissa J. McIntosh PhD ,&nbsp;Eric Wallat PhD ,&nbsp;Keegan R. Staab MSc ,&nbsp;Andrew D. Hahn PhD ,&nbsp;Katherine J. Carey PhD ,&nbsp;Gregory P. Barton PhD ,&nbsp;Andrew M. Baschnagel MD ,&nbsp;John E. Bayouth MD ,&nbsp;Rodrigo M. Bello MD ,&nbsp;Scott B. Perlman MD ,&nbsp;Sean B. Fain PhD","doi":"10.1016/j.adro.2025.101810","DOIUrl":"10.1016/j.adro.2025.101810","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101810"},"PeriodicalIF":2.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330031","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":"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":"Definitive Radiation Therapy for Ewing Sarcoma: Outcomes Based on Tumor Volume, Dose, and Fractionation","authors":"Taylor M. Weiskittel MD, PhD ,&nbsp;William S. Harmsen MS ,&nbsp;Anita Mahajan MD ,&nbsp;Ivy A. Petersen MD ,&nbsp;Michael G. Haddock MD ,&nbsp;Wendy Allen-Rhoades MD, PhD ,&nbsp;Steven I. Robinson MD ,&nbsp;Nadia N. Laack MD ,&nbsp;Safia K. Ahmed MD","doi":"10.1016/j.adro.2025.101820","DOIUrl":"10.1016/j.adro.2025.101820","url":null,"abstract":"<div><h3>Purpose</h3><div>Dose escalation for definitive radiation therapy (DE-RT) in larger Ewing sarcomas (ESs) is associated with a lower risk of local recurrence. We report treatment and toxicity outcomes in ES tumors treated with DE-RT, including hypofractionated approaches and size stratification of analysis.</div></div><div><h3>Methods and Materials</h3><div>A retrospective review of ES patients treated with DE-RT to doses ≥55.8 Gy was performed. Local failure (LF) with death as a competing risk was assessed. Maximally selected rank statistics were used to determine the optimal stratification of patients by survival using tumor size measurements.</div></div><div><h3>Results</h3><div>In total, 47 patients were analyzed. Twenty-eight patients (59.6%) received DE-RT, of which 6 received hypofractionation. For DE-RT, median equivalent dose in 2 Gy fraction for α/β = 10 was 60 Gy (range, 56.2-62) with conventional fractionation and 62.2 Gy (range, 56.5-67.1) with hypofractionation. Empirically derived size cutoffs identified a subgroup of ultralarge tumors at higher risk of LF defined as &gt;11.8 cm in the longest direction, 569.2 cm³ prechemotherapy volume, or 288.9 cm³ postchemotherapy volume. Five-year cumulative incidence of LF was lower in patients treated with DE-RT at 11.7% (95% CI, 3.16%-43.6%) versus 35.6% for non-DE-RT (95% CI, 17.4%-72.61%; <em>P</em> = .098). Multivariate analysis showed trends toward DE-RT benefiting tumors of all sizes and stages.</div></div><div><h3>Conclusions</h3><div>DE-RT was associated with a trend toward better LF in all tumors without toxicity or plan quality changes. Ultralarge tumors demonstrated poor LF rates and necessitate further study.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101820"},"PeriodicalIF":2.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536246","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":"Excellent Response Following Palliative Radiation for Locally Advanced Epidemic/AIDS-Associated Kaposi Sarcoma of the Lower Extremity: A Case Report","authors":"Anushka S. Mandalapu BS,&nbsp;Alison K. Yoder MD, MPH,&nbsp;Xin Wang PhD,&nbsp;Devarati Mitra MD, PhD,&nbsp;Andrew J. Bishop MD,&nbsp;B. Ashleigh Guadagnolo MD, MPH,&nbsp;Ahsan S. Farooqi MD, PhD","doi":"10.1016/j.adro.2025.101823","DOIUrl":"10.1016/j.adro.2025.101823","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101823"},"PeriodicalIF":2.2,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144549886","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":"Esophageal Circumferential Dose-Length Histogram Parameters to Predict Dysphagia in Patients Receiving Thoracic Radiation Therapy: A Single-Institution Experience","authors":"Andrea Brown MD ,&nbsp;Chen Hu PhD ,&nbsp;Suqi Ke MS ,&nbsp;Peijin Han MS ,&nbsp;Russell Hales MD ,&nbsp;Todd McNutt PhD ,&nbsp;Siyao Li MS ,&nbsp;Claire Snyder PhD ,&nbsp;Shing Lee PhD ,&nbsp;Khinh Ranh Voong MD, MPH","doi":"10.1016/j.adro.2025.101807","DOIUrl":"10.1016/j.adro.2025.101807","url":null,"abstract":"<div><h3>Purpose</h3><div>Chemoradiation for locally advanced non-small cell lung cancer can cause severe esophagitis. Techniques to spare the contralateral esophagus may mitigate toxicity, but traditional dose-volume histograms (DVH) do not capture the degree of circumferential irradiation. We evaluated dose-length histogram (DLH) parameters as predictors of dysphagia compared with DVH metrics.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients treated with definitive thoracic radiation therapy from 2019 to 2023. Descriptive statistics described the cohort. Clinician-reported (National Cancer Institute Common Terminology Criteria for Adverse Events [CTCAE] v.4) and patient-reported outcomes (PRO)-CTCAE v.1 dysphagia within 120 days of treatment start were collected prospectively. The McNemar test compared dichotomized scores. The length of esophageal full-circumferential (L_Fdose) and partial-circumferential irradiation (L_Pdose) was defined as the length of the esophagus with ≥90% and ≥50% circumference exposure to threshold radiation doses, respectively. Spearman correlation examined relationships between L_Fdose, L_Pdose, and volumetric (V_dose) parameters. Associations between L_Fdose, L_Pdose, and V_dose, and grade ≥2 dysphagia were evaluated using univariate logistic regression. Likelihood ratio tests assessed model fit.</div></div><div><h3>Results</h3><div>Of 107 patients, 86.9% (93) had non-small cell lung cancer, all received ≥60 Gy (median, 63 Gy; range, 60-70 Gy), and 94.4% (101) received concurrent chemotherapy. Patients and physicians reported rates of grade ≥2 dysphagia differently: 17 (15.9%) and 6 (5.6%), respectively (<em>P</em> = .0015). Each 0.5 cm increase in the length of partial-circumference esophagus receiving ≥55 Gy (L_P55) and 60 Gy (L_P60) resulted in increased odds of PRO-CTCAE dysphagia by 8% and 9%, respectively. Each 0.5 cm increase in full-circumference esophagus receiving ≥60 Gy (L_F60) resulted in 11% increased odds of PRO-CTCAE dysphagia. Esophageal DLH parameters, L_P55 and L_P60, correlated with the esophageal V₆₀ volumetric parameter strongly (ρ = 0.751 and 0.729, respectively). No DVH or DLH parameter predicted grade ≥2 CTCAE dysphagia.</div></div><div><h3>Conclusion</h3><div>Esophageal DLH metrics assessing partial- or full-circumferential esophageal irradiation, specifically L_P55, L_P60, and L_F60, are associated with patient-reported dysphagia and complement traditional DVH parameters.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101807"},"PeriodicalIF":2.2,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322929","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}