Advances in Radiation Oncology最新文献

{"title":"A Simulation-Free Replacement Solution for Radiation Therapy Immobilization Devices Using Computer Numerical Control (CNC) -Milled Polystyrene Molds","authors":"Samuel Hellman PhD ,&nbsp;Laszlo Voros MS ,&nbsp;Victoria Y. Yu PhD ,&nbsp;Dale M. Lovelock PhD ,&nbsp;Sean Berry PhD ,&nbsp;Lei Zhang PhD ,&nbsp;Margie Hunt MS ,&nbsp;Joseph O. Deasy PhD ,&nbsp;Laura Cervino PhD","doi":"10.1016/j.adro.2024.101544","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101544","url":null,"abstract":"<div><h3>Purpose</h3><p>In radiation therapy (RT), if an immobilization device is lost or damaged, the patient may need to be brought back for resimulation, device fabrication, and treatment planning, causing additional imaging radiation exposure, inconvenience, cost, and delay. We describe a simulation-free method for replacing lost or damaged RT immobilization devices.</p></div><div><h3>Methods and Materials</h3><p>Replacement immobilization devices were fabricated using existing simulation scans as design templates by computer numerical control (CNC) milling of molds made from extruded polystyrene (XPS). XPS material attenuation and bolusing properties were evaluated, a standard workflow was established, and 12 patients were treated. Setup reproducibility was analyzed postfacto using Dice similarity coefficient (DSC) and mean distance to agreement (MDA) calculations comparing onboard treatment imaging with computed tomography (CT) simulations.</p></div><div><h3>Results</h3><p>Results showed that XPS foam material had less dosimetric impact (attenuation and bolusing) than materials used for our standard immobilization devices. The average direct cost to produce each replacement mold was $242.17, compared with over $2000 for standard resimulation. Hands-on time to manufacture was 86.3 minutes, whereas molds were delivered in as little as 4 hours and mostly within 24 hours, compared with a week or more required for standard resimulation. Each mold was optically scanned after production and was measured to be within 2-mm tolerance (pointwise displacement) of design input. All patients were successfully treated using the CNC-milled foam mold replacements, and pretreatment imaging verified satisfactory clinical setup reproduction for each case. The external body contours from the setup cone beam CT and the original CT simulation with matching superior-inferior extent were compared by calculating the DSC and MDA. DSC average was 0.966 (SD, 0.011), and MDA average was 2.694 mm (SD, 0.986).</p></div><div><h3>Conclusions</h3><p>CNC milling of XPS foam is a quicker and more convenient solution than traditional resimulation for replacing lost or damaged RT immobilization devices. Satisfactory patient immobilization, low dosimetric impact compared with standard immobilization devices, and strong correlation of onboard contours with CT simulations are shown. We share our clinical experience, workflow, and manufacturing guide to help other clinicians who may want to adopt this solution.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101544"},"PeriodicalIF":2.2,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001076/pdfft?md5=65a237c1b6cd6e04708b4dc805634c32&pid=1-s2.0-S2452109424001076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484496","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":"Improving the Efficiency of Single-Isocenter Multiple Metastases Stereotactic Radiosurgery Treatment","authors":"","doi":"10.1016/j.adro.2024.101538","DOIUrl":"10.1016/j.adro.2024.101538","url":null,"abstract":"<div><h3>Purpose</h3><p>Multiple brain metastases can be treated efficiently with stereotactic radiosurgery (SRS) using a single-isocenter dynamic conformal arc (SIDCA) technique. Currently, plans are manually optimized, which may lead to unnecessary table angles and arcs being used. This study aimed to evaluate an automatic 4π optimization SIDCA algorithm for treatment efficiency and plan quality.</p></div><div><h3>Methods and Materials</h3><p>Automatic 4π-optimized SIDCA plans were created and compared with the manually optimized clinical plans for 54 patients who underwent single-fraction SRS for 2 to 10 metastases. The number of table angles and number of arcs were compared with a paired <em>t</em> test using a Bonferroni-corrected significance level of <em>P</em> &lt; .05/4 = .0125. The reduction in treatment time was estimated from the difference in the number of table angles and arcs. Plan quality was assessed through the volume-averaged inverse Paddick Conformity Index (CI) and Gradient Index (GI) and the volume of normal brain surrounding each metastasis receiving 12 Gy (local V12 Gy). For a 5-patient subset, the automatic plans were manually adjusted further. CI and GI were assessed for noninferiority using a 1-sided <em>t</em> test with the noninferiority limit equal to the 95% interobserver reproducibility limit from a separate planning study (corrected significance level <em>P</em> &lt; .05/[4 − 1] = .017).</p></div><div><h3>Results</h3><p>The automatic plans significantly improved treatment efficiency with a mean reduction in the number of table angles and arcs of −0.5 ± 0.1 and −1.3 ± 0.2, respectively (±SE; both <em>P</em> &lt; .001). Estimated treatment time saving was −2.7 ± 0.5 minutes, 14% of the total treatment time. The volume-averaged CI and GI were noninferior to the clinical plans (both <em>P</em> &lt; .001), although there was a small systematic shift in CI of 0.07 ± 0.01. The resulting difference in local V12 Gy, 0.25 ± 0.04 cm³, was not clinically significant. Minor manual adjustment of the automatic plans removed these slight differences while preserving the improved treatment efficiency.</p></div><div><h3>Conclusions</h3><p>Automatic 4π optimization can generate SIDCA SRS plans with improved treatment efficiency and noninferior plan quality.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101538"},"PeriodicalIF":2.2,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001015/pdfft?md5=c449d0955a3ad9aec0796c1335bb36f4&pid=1-s2.0-S2452109424001015-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027708","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":"Intensity Modulated Therapy for Patients With Breast Cancer. Practical Guidelines and Tips for an Effective Treatment Planning Strategy","authors":"Antonella Fogliata MSc ,&nbsp;Hester Burger MSc ,&nbsp;Annemari Groenewald PhD ,&nbsp;Lydia Punt MD ,&nbsp;Jeannette Parkes MD ,&nbsp;Luca Cozzi PhD","doi":"10.1016/j.adro.2024.101535","DOIUrl":"10.1016/j.adro.2024.101535","url":null,"abstract":"<div><h3>Purpose</h3><p>Practical guidelines and tips for effective and robust radiation therapy treatment planning for patients with breast cancer are addressed for fixed-field intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) techniques. The concepts described here are general and valid on all treatment planning systems. However, some details shown here have been applied to the Varian platforms used at the authors’ institutions.</p></div><div><h3>Methods and Materials</h3><p>The specific aspects of using C-arm– or O-ring–mounted linear accelerators are covered in the document, as well as tips for dealing with certain resource constraints, target cropping, and skin flash aiming to reduce risks of skin toxicity and to manage (residual after breath control) respiration motion or edema.</p></div><div><h3>Results</h3><p>A decision tree is presented, and practical solutions for cases where a target volume is contoured or not and where volumetric modulated arc therapy or fixed-beam intensity modulation should be applied and details about the technical implementation (tangential IMRT, butterfly IMRT or VMAT, and large partial VMAT arcs) are discussed. Target cropping and skin flash implications are discussed in detail, and links to plan robustness are outlined.</p></div><div><h3>Conclusions</h3><p>Practical guidelines for breast planning are presented and summarized with a decision tree and technical summaries.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101535"},"PeriodicalIF":2.3,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000988/pdfft?md5=48a61e92eaea3b397b1f1e3a22f705a3&pid=1-s2.0-S2452109424000988-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047558","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":"On Patient Experience and Anxiety During Treatment With Magnetic Resonance–Guided Radiation Therapy","authors":"Jasmijn M. Westerhoff MD ,&nbsp;Pim T.S. Borman PhD ,&nbsp;Reijer H.A. Rutgers BSc ,&nbsp;Bas W. Raaymakers PhD ,&nbsp;Neil Winchester MSc ,&nbsp;Helena M. Verkooijen PhD ,&nbsp;Martin F. Fast PhD","doi":"10.1016/j.adro.2024.101537","DOIUrl":"10.1016/j.adro.2024.101537","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess patient experience and anxiety during magnetic resonance (MR)–guided radiation therapy (MRgRT) using a hybrid 1.5Tesla (T) MR-guided linear accelerator (MR-Linac) when offered calming video content.</p></div><div><h3>Methods and Materials</h3><p>A single-center study was conducted within the Multi-Outcome Evaluation of Radiation Therapy Using the MR-Linac (MOMENTUM) cohort. Patients were offered to watch calming video content on a video monitor during treatment. Questionnaires were used to assess patient experience (MR-Linac patient-reported experience) and anxiety (State-Trait Anxiety Inventory, STAI) at first treatment fraction (M1) and at third, fourth, or fifth treatment fraction (M2). Paired <em>t</em> tests were used to test for significant differences, and effect sizes (ESs) were used to estimate the magnitude of the difference.</p></div><div><h3>Results</h3><p>Between November 2021 and November 2022, 66 patients were included. The majority were men (n = 59, 89%). MRgRT was most frequently delivered to prostate cancer (n = 45, 68%) followed by a lesion in the pancreas (n = 8, 12%). At M1 and M2, 24 of 59 patients (41%) preferred to watch calming video content. One patient was not able to look at the video monitor comfortably at M1. Patient experience was generally favorable or neutral; tingling sensations were reported by 17% of patients. Anxiety levels were high (16%), moderate (18%), or low to none (67%) prior to M1. STAI scores were 33 (SD, 9) prior to M1 and 29 (SD, 7) after M1 (ES, 0.7; <em>P</em> &lt; .001). STAI scores were 32 (SD, 9) prior to M2 and 31 (SD, 8) after M2 (ES, 0.4; <em>P</em> = .009).</p></div><div><h3>Conclusions</h3><p>Patients were able to comfortably view the video monitor during MRgRT. Consequently, this setup could be used for future applications, such as biofeedback. A sizable minority of patients preferred to watch calming videos that distracted them during treatment. Although the patients’ experience was overall excellent, anxiety was reported. Anxiety levels were highest prior to treatment and decreased after treatment.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101537"},"PeriodicalIF":2.2,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001003/pdfft?md5=607d9c8c23bc2ef27ab2d5ee8d674bb2&pid=1-s2.0-S2452109424001003-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038269","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":"Impact of Clinical Factors on 18F-Flotufolastat Detection Rates in Men With Recurrent Prostate Cancer: Exploratory Analysis of the Phase 3 SPOTLIGHT Study","authors":"","doi":"10.1016/j.adro.2024.101532","DOIUrl":"10.1016/j.adro.2024.101532","url":null,"abstract":"<div><h3>Purpose</h3><p>¹⁸F-Flotufolastat (¹⁸F-rhPSMA-7.3) is a newly approved prostate-specific membrane antigen targeting radiopharmaceutical for diagnostic imaging of prostate cancer (PCa). SPOTLIGHT (National Clinical Trials 04186845) evaluated ¹⁸F-flotufolastat in men with suspected PCa recurrence. Here, we present results of predefined exploratory endpoints from SPOTLIGHT to evaluate the impact of clinical factors on ¹⁸F-flotufolastat detection rates (DR).</p></div><div><h3>Methods and Materials</h3><p>The impact of baseline prostate-specific antigen (PSA), PSA doubling time (PSAdt), and International Society of Urologic Pathology Grade Group (GG) on ¹⁸F-flotufolastat DR was evaluated among all SPOTLIGHT patients with an evaluable scan, with DR stratified according to the patients’ prior treatment (radical prostatectomy ± radiation therapy [RP] or radiation therapy only [RT]). The patients underwent positron emission tomography 50 to 70 minutes after receiving ¹⁸F-flotufolastat (296 MBq IV), and scans were read by 3 blinded central readers, with the majority read representing agreement between ≥2 readers.</p></div><div><h3>Results</h3><p>In total, 389 men (median PSA: 1.10 ng/mL) were evaluable. By majority read, ¹⁸F-flotufolastat identified distant lesions in 39% and 43% of patients treated with prior RP or RT, respectively. The overall DR broadly increased with increasing PSA (&lt;0.2 ng/mL: 33%; ≥10 ng/mL: 100%). Among patients with PSA &lt;1 ng/mL, 68% had positive scans, and 27% had extrapelvic findings. PSAdt was available for 145/389 (37%) patients. PSAdt did not appear to influence ¹⁸F-flotufolastat DR (77%-90% across all PSAdt categories). Among patients with prior RP, DR ranged from 70% to 83% across PSAdt categories, and 100% DR was reported for all post-RT patients. In total, 362/389 (93%) patients had baseline GG data. Overall DRs were uniformly high (75%‒95%) across all GG. When stratified by prior treatment, DRs across all GG were 69% to 89% in patients with prior RP and ≥96% in patients with prior RT.</p></div><div><h3>Conclusions</h3><p>¹⁸F-Flotufolastat-positron emission tomography enabled the accurate detection of recurrent PCa lesions across a wide range of PSA, PSAdt, and International Society of Urologic Pathology GG, thus supporting its clinical utility for a broad range of patients with recurrent PCa.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101532"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000952/pdfft?md5=52d6d6627ce3ef308d040e3c629b718c&pid=1-s2.0-S2452109424000952-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029097","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":"Treatment Planning Methods for Dose Painting by Numbers Treatment in Gamma Knife Radiosurgery","authors":"","doi":"10.1016/j.adro.2024.101534","DOIUrl":"10.1016/j.adro.2024.101534","url":null,"abstract":"<div><h3>Purpose</h3><p>Dose painting radiation therapy delivers a nonuniform dose to tumors to account for heterogeneous radiosensitivity. With recent and ongoing development of Gamma Knife machines making large-volume brain tumor treatments more practical, it is increasingly feasible to deliver dose painting treatments. The increased prescription complexity means automated treatment planning is greatly beneficial, and the impact of dose painting on stereotactic radiosurgery (SRS) plan quality has not yet been studied. This research investigates the plan quality achievable for Gamma Knife SRS dose painting treatments when using optimization techniques and automated isocenter placement in treatment planning.</p></div><div><h3>Methods and Materials</h3><p>Dose painting prescription functions with varying parameters were applied to convert voxel image intensities to prescriptions for 10 sample cases. To study achievable plan quality and optimization, clinically placed isocenters were used with each dose painting prescription and optimized using a semi-infinite linear programming formulation. To study automated isocenter placement, a grassfire sphere-packing algorithm and a clinically available Leksell gamma plan isocenter fill algorithm were used. Plan quality for each optimized treatment plan was measured with dose painting SRS metrics.</p></div><div><h3>Results</h3><p>Optimization can be used to find high quality dose painting plans, and plan quality is affected by the dose painting prescription method. Polynomial function prescriptions show more achievable plan quality than sigmoid function prescriptions even with high mean dose boost. Automated isocenter placement is shown as a feasible method for dose painting SRS treatment, and increasing the number of isocenters improves plan quality. The computational solve time for optimization is within 5 minutes in most cases, which is suitable for clinical planning.</p></div><div><h3>Conclusions</h3><p>The impact of dose painting prescription method on achievable plan quality is quantified in this study. Optimization and automated isocenter placement are shown as possible treatment planning methods to obtain high quality plans.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101534"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000976/pdfft?md5=608466e3ee613eecd6026e214a108272&pid=1-s2.0-S2452109424000976-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141024365","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":"A Visualization and Radiation Treatment Plan Quality Scoring Method for Triage in a Population-Based Context","authors":"Alexandra O. Leone MBS ,&nbsp;Abdallah S.R. Mohamed MD, PhD ,&nbsp;Clifton D. Fuller MD, PhD ,&nbsp;Christine B. Peterson PhD ,&nbsp;Adam S. Garden MD ,&nbsp;Anna Lee MD, MPH ,&nbsp;Lauren L. Mayo MD ,&nbsp;Amy C. Moreno MD ,&nbsp;Jay P. Reddy MD, PhD ,&nbsp;Karen Hoffman MD ,&nbsp;Joshua S. Niedzielski PhD ,&nbsp;Laurence E. Court PhD ,&nbsp;Thomas J. Whitaker PhD","doi":"10.1016/j.adro.2024.101533","DOIUrl":"10.1016/j.adro.2024.101533","url":null,"abstract":"<div><h3>Purpose</h3><p>Our purpose was to develop a clinically intuitive and easily understandable scoring method using statistical metrics to visually determine the quality of a radiation treatment plan.</p></div><div><h3>Methods and Materials</h3><p>Data from 111 patients with head and neck cancer were used to establish a percentile-based scoring system for treatment plan quality evaluation on both a plan-by-plan and objective-by-objective basis. The percentile scores for each clinical objective and the overall treatment plan score were then visualized using a daisy plot. To validate our scoring method, 6 physicians were recruited to assess 60 plans, each using a scoring table consisting of a 5-point Likert scale (with scores ≥3 considered passing). Spearman correlation analysis was conducted to assess the association between increasing treatment plan percentile rank and physician rating, with Likert scores of 1 and 2 representing clinically unacceptable plans, scores of 3 and 4 representing plans needing minor edits, and a score of 5 representing clinically acceptable plans. Receiver operating characteristic curve analysis was used to assess the scoring system's ability to quantify plan quality.</p></div><div><h3>Results</h3><p>Of the 60 plans scored by the physicians, 8 were deemed as clinically acceptable; these plans had an 89.0th ± 14.5 percentile value using our scoring system. The plans needing minor edits or deemed unacceptable had more variation, with scores falling in the 62.6nd ± 25.1 percentile and 35.6th ± 25.7 percentile, respectively. The estimated Spearman correlation coefficient between the physician score and treatment plan percentile was 0.53 (<em>P</em> &lt; .001), indicating a moderate but statistically significant correlation. Receiver operating characteristic curve analysis demonstrated discernment between acceptable and unacceptable plan quality, with an area under the curve of 0.76.</p></div><div><h3>Conclusions</h3><p>Our scoring system correlates with physician ratings while providing intuitive visual feedback for identifying good treatment plan quality, thereby indicating its utility in the quality assurance process.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101533"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000964/pdfft?md5=1ec273f3ec0b3ebf2b0a60ff2373317f&pid=1-s2.0-S2452109424000964-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056759","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":"Optical Surface-guided Radiation Therapy for Upper and Lower Limb Sarcomas: An Analysis of Setup Errors and Clinical Target Volume-To-Planning Target Volume Margins","authors":"Yan-Xin Zhang MS ,&nbsp;Fu-Kui Huan MB ,&nbsp;Bao Wan MB,&nbsp;Zhao-Hui Li BS,&nbsp;Wei Li BS,&nbsp;Geng-Qiang Zhu BS,&nbsp;Zhi-Wei Wang BS,&nbsp;Huan Chen BS,&nbsp;Lu Hou MB,&nbsp;Hao Jing MD,&nbsp;Shu-Lian Wang MD,&nbsp;Ning-Ning Lu MD","doi":"10.1016/j.adro.2024.101526","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101526","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the clinical benefits of surface-guided radiation therapy (SGRT) in terms of setup error, positioning time, and clinical target volume-to-planning target volume (CTV-PTV) margin in extremity soft tissue sarcoma (STS).</p></div><div><h3>Methods and Materials</h3><p>Fifty consecutive patients treated with radiation therapy were selected retrospectively. Treatment setup was performed with either laser-based imaging only (control group), or with laser-based and daily optical surface-based imaging (SGRT group). Pretreatment cone beam computed tomography images were acquired daily for the first 3 to 5 fractions and weekly thereafter, with the frequency adjusted as necessary. Translational and rotational errors were collected. CTV-PTV margin was calculated using the formula, 2.5Σ + 0.7σ.</p></div><div><h3>Results</h3><p>Each group consisted of 10 and 15 upper and lower limb STSs, respectively. For patients with upper limb sarcomas, the translation errors were 1.64 ± 1.34 mm, 1.10 ± 1.50 mm, and 1.24 ± 1.45 mm in the SGRT group, and 1.48 ± 3.16 mm, 2.84 ± 2.85 mm, and 3.14 ± 3.29 mm in control group in the left-right, supero-inferior, and antero-posterior directions, respectively. Correspondingly, for patients with lower limb sarcomas, the translation errors were 1.21 ± 1.65 mm, 1.39 ± 1.71 mm, and 1.48 ± 2.10 mm in the SGRT group, and 1.81 ± 2.60 mm, 2.93 ± 3.28 mm, and 3.53 ± 3.75 mm in control group, respectively. The calculated CTV-PTV margins of the SGRT group and control group were 5.0, 3.8, 4.1 versus 5.9, 9.1, 10.1 mm for upper limb sarcomas; and 4.2, 4.7, 5.2 mm versus 6.3, 9.6, and 11.4 mm for lower limb sarcomas in the left-right, supero-inferior, and antero-posterior directions, respectively.</p></div><div><h3>Conclusions</h3><p>Daily optical surface guidance can effectively improve the setup accuracy of extremity STS patients, and safely reduce the required CTV-PTV margins.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101526"},"PeriodicalIF":2.2,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000897/pdfft?md5=107e7ba8a24a5700b72242013256c9c7&pid=1-s2.0-S2452109424000897-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484495","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":"Ultrahypofractionated Radiation Therapy for Prostate Cancer Including Seminal Vesicles in the Target Volume: A Treatment-planning Study Based on the HYPO-RT-PC Fractionation Schedule","authors":"Elinore Wieslander PhD ,&nbsp;Vilberg Jóhannesson PhD ,&nbsp;Per Nilsson PhD ,&nbsp;Elisabeth Kjellén MD, PhD ,&nbsp;Adalsteinn Gunnlaugsson MD, PhD","doi":"10.1016/j.adro.2024.101531","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101531","url":null,"abstract":"<div><h3>Purpose</h3><p>Ultrahypofractionated (UHF) radiation therapy (RT) has become a treatment alternative for patients with localized prostate cancer. In more advanced cases, seminal vesicles (SVs) are routinely included in the target volume. The Scandinavian HYPO-RT-PC trial, which compared 42.7 Gy in 7 fractions (fr) to conventional fractionation (CF), did not include SVs in the clinical target volume. The primary objective of the present work was to implement a ultrahypofractionated-simultaneous integrated boost (UHF-SIB) for prostate cancer RT, incorporating SVs into the target volume based on this fractionation schedule. A secondary objective was to analyze the unintentional dose coverage of SVs from state-of-the-art volumetric modulated arc therapy treatments to the prostate gland only.</p></div><div><h3>Methods and Materials</h3><p>Two different equieffective UHF-SIB treatment schedules to SVs were derived based on the CF clinical schedule (50.0 Gy/25 fr to elective SVs and 70.0 Gy/35 fr to verified SV-invasion (SVI)) using the linear quadric model with α/β = 2 Gy and 3 Gy. The dose to the prostate was 42.7 Gy/7 fr in both schedules, with 31.2 Gy/37.8 Gy (α/β = 2 Gy) and 32.7 Gy/40.1 Gy (α/β = 3 Gy) to elective SV/verified SVI. Volumetric modulated arc therapy plans to the proximal 10 mm and 20 mm were optimized, and dose-volume metrics for target volumes and organs at risk were evaluated.</p></div><div><h3>Results</h3><p>Dose metrics were overall lower for UHF-SIB compared with CF. QUANTEC-based volume criteria were 2% to 7% lower for the rectum and 2% to 4% lower for the bladder in the UHF-SIB. The D_98% to elective SV was 7 to 12 Gy₃ lower with UHF-SIB, and the corresponding data for verified SVI were approximately 2 to 3 Gy₃. The SV(10 mm) V_{90%/(29.5 Gy)} for prostate-only treatments (42.7 Gy) were as follows: median (IQR), 99% (87-100) and 78% (58-99) for the clinical target volume and planning target volume, respectively.</p></div><div><h3>Conclusions</h3><p>UHF RT based on the HYPO-RT-PC fractionation schedule, with a SIB technique, to the prostate and the base of the SV can be planned with lower doses (EQD2) to organs at risk, compared with CF. The unintentional dose to the proximal parts of SVs in prostate-only treatment can be substantial.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 7","pages":"Article 101531"},"PeriodicalIF":2.3,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000940/pdfft?md5=9a1c0706c9ed6d6e8792a782f49ca6b0&pid=1-s2.0-S2452109424000940-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141241390","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":"Exacerbated Inflammatory Gene Expression After Impaired G2/M-Checkpoint Arrest in Fibroblasts Derived From a Patient Exhibiting Severe Adverse Effects","authors":"Takahiro Oike ,&nbsp;Ken Okuda ,&nbsp;Shunji Haruna ,&nbsp;Akiko Shibata ,&nbsp;Ryota Hayashi ,&nbsp;Mayu Isono ,&nbsp;Kohei Tateno ,&nbsp;Nobuteru Kubo ,&nbsp;Akihiko Uchiyama ,&nbsp;Sei-Ichiro Motegi ,&nbsp;Tatsuya Ohno ,&nbsp;Yuki Uchihara ,&nbsp;Yu Kato ,&nbsp;Atsushi Shibata","doi":"10.1016/j.adro.2024.101530","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101530","url":null,"abstract":"<div><h3>Purpose</h3><p>Recent radiation therapy (RT), such as intensity modulated radiation therapy and particle RT, has improved the concentration of the radiation field targeting tumors. However, severe adverse effects still occur, possibly due to genetic factors in patients. We aimed to investigate the mechanism of exacerbated inflammation during RT.</p></div><div><h3>Methods and Materials</h3><p>Dermal fibroblasts derived from a patient with severe inflammatory adverse effects during RT were compared with 2 normal human dermal fibroblasts. Micronuclei formation, G2/M-checkpoint arrest, DNA damage signaling and repair, and inflammatory gene expression were comprehensively examined.</p></div><div><h3>Results</h3><p>We found greater micronuclei formation in radiation-sensitive fibroblasts (RS-Fs) after ionizing radiation (IR). RS-Fs exhibited premature G2/M-checkpoint release after IR, which triggers micronuclei formation because RS-Fs undergo mitosis with unrepaired DNA double-strand breaks (DSBs). Additionally, we found that DSB end-resection and activation of the ATR-Chk1 pathway were impaired in RS-Fs after IR. Consistent with the increase in the formation of micronuclei, which can deliver cytosolic nucleic acids resulting in an innate immune response, the expression of genes associated with inflammatory responses was highly upregulated in RS-Fs after IR.</p></div><div><h3>Conclusions</h3><p>Although this is a single case of RT-dependent adverse effect, our findings suggest that impaired G2/M-checkpoint arrest due to the lack of DSB end-resection and activation of the ATR-Chk1 pathway causes exacerbated inflammation during RT; therefore, genes involved in G2/M-checkpoint arrest may be a predictive marker for unexpected inflammatory responses in RT.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101530"},"PeriodicalIF":2.3,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000939/pdfft?md5=81ab3126a13885d4171e487f32898eaa&pid=1-s2.0-S2452109424000939-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423925","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}