Advances in Radiation Oncology最新文献

{"title":"Investigating the Uptake of Hypofractionation for Breast and Prostate Cancer in Sub-Saharan Africa: A Qualitative Study of Physician and Medical Physicist Perspectives","authors":"Rohini K. Bhatia MD ,&nbsp;Suzanne M. Grieb PhD ,&nbsp;Katharine A. Rendle PhD, MPH ,&nbsp;Wilfred Ngwa PhD, MSc ,&nbsp;Surbhi Grover MD, MPH","doi":"10.1016/j.adro.2024.101683","DOIUrl":"10.1016/j.adro.2024.101683","url":null,"abstract":"<div><h3>Purpose</h3><div>In prostate and breast cancer, moderate hypofractionation (HF) has demonstrated comparable, if not greater, efficacy than conventional fractionation. There is a stark disparity in the uptake of HF between North America and Africa. Using the Consolidative Framework for Implementation Research, we evaluated barriers and facilitators for implementing HF in Sub-Saharan Africa (SSA).</div></div><div><h3>Methods and Materials</h3><div>Radiation oncologists and medical physicists working in SSA were recruited via the AORTIC Radiation Oncology Special Interest Group and subsequent snowball sampling. Interviews were conducted virtually between November 2022 and January 2023. Transcripts were analyzed using directed content analysis guided by a Consolidative Framework for Implementation of research interview domains and constructs.</div></div><div><h3>Results</h3><div>In total, 19 interviewees (17 radiation oncologists and 2 medical physicists) from 11 SSA countries participated, of which 94% noted the use of HF (40.05 Gy/15fx or 42.67 Gy/16fx) in breast cancer clinics and 38% in prostate cancer clinics (60-66 Gy/20fx). While nearly all participants identified the benefits of HF for both clinics and patients, many also noted that the lack of long-term data within an African population created discomfort in using HF. Many participants believed in the utility of HF but expressed a lack of confidence in its use caused by uncertainty about the safety of the technique, especially in centers with cobalt or 3-dimensional conformal radiation therapy-only capabilities. In breast HF, participants expressed concern regarding breast size and ideal eligibility criteria for patients. In prostate HF, on-treatment imaging and lack of fiducials were identified as barriers. Key facilitators in adopting HF included hands-on training, partnerships with disease-site-specific individuals with HF experience, and consensus on patient eligibility and technique requirements.</div></div><div><h3>Conclusions</h3><div>HF is regarded as a valuable tool for breast and prostate cancer in SSA, and breast HF is widely used. Attention to the use of 3-dimensional conformal radiation therapy with HF, long-term toxicity data in African populations, and training sessions may facilitate further use of HF for prostate cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101683"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942549","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":"Patterns of Care in Adjuvant Radiation Therapy for Stage II Endometrioid Endometrial Adenocarcinoma: A National Cancer Database Analysis","authors":"Jessica Cruttenden MD ,&nbsp;Christopher Weil MD ,&nbsp;Danae Byer BS ,&nbsp;Lindsay Burt MD ,&nbsp;Gita Suneja MD ,&nbsp;David Gaffney MD, PhD ,&nbsp;Cristina DeCesaris MD","doi":"10.1016/j.adro.2024.101698","DOIUrl":"10.1016/j.adro.2024.101698","url":null,"abstract":"<div><h3>Purpose</h3><div>Treating stage II endometrial cancer involves total hysterectomy, bilateral salpingo-oophorectomy, and risk-adapted adjuvant therapy. Professional guidelines support various adjuvant treatments, but high-level data supporting specific options are conflicting. We sought to evaluate adjuvant radiation therapy (RT) trends for these patients, hypothesizing increased utilization of pelvic external beam RT (EBRT) over time.</div></div><div><h3>Methods and Materials</h3><div>Patients diagnosed in 2004-2019 with stage II endometrioid endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and surgical staging were identified in the National Cancer Database. Patient characteristics per adjuvant RT received were compared using Wilcoxon rank sum and analysis of variance testing. Multivariable regression analysis (MVA) identified variables associated with EBRT, vaginal brachytherapy (VBT), or RT omission. A <em>P</em> value &lt; .05 was significant, except in MVA, where Bonferroni correction was employed (<em>p</em> value &lt; .017).</div></div><div><h3>Results</h3><div>Patients meeting criteria totaled 18,798; 19% received adjuvant EBRT alone, 25% VBT alone, 24% EBRT + VBT, and 32% no RT. Adjuvant RT use increased from 2004 to 2019, particularly EBRT + VBT (<em>p</em> &lt; .05). In MVA, community hospital treatment (odds ratio [OR], 1.8; <em>p</em> &lt; .001), Midwest location (OR, 1.2; <em>p</em> = .02), single-agent chemotherapy receipt (OR, 6.9; <em>p</em> &lt; .001), lymphovascular space invasion (OR, 1.4; <em>p</em> &lt; .001), and positive surgical margins (OR, 1.8; <em>p</em> &lt; .001) were positively associated with EBRT. No variables were positively associated with VBT. Black race (OR, 1.2; <em>p</em> = .03), community hospital treatment (OR, 1.4; <em>p</em> = .04), South (OR, 2.2; <em>p</em> &lt; .001) or West (OR, 2.1; <em>p</em> &lt; .001) location, distance &gt;50 miles from the treatment center (OR, 1.5; <em>p</em> &lt; .001), and grade 2 (OR, 1.2; <em>p</em> &lt; .001) or 3 (OR, 1.3; <em>p</em> = .01) disease were associated with RT omission.</div></div><div><h3>Conclusions</h3><div>Adjuvant RT for stage II endometrial cancer increased over time, particularly EBRT + VBT. Patient-related factors such as race, region, and distance from the treatment center were associated with RT omission, suggesting sociodemographic barriers to care. Tumor-related factors such as positive surgical margins and lymphovascular space invasion were associated with EBRT receipt, suggesting consideration of high-risk factors for locoregional recurrence in adjuvant RT approaches.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101698"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982436","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":"Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series","authors":"Danielle N. Burner BS ,&nbsp;Peter G. Hendrickson MD, PhD ,&nbsp;Diana M. Cardona MD ,&nbsp;Dan G. Blazer III MD ,&nbsp;James B. Mullins CMD ,&nbsp;David G. Kirsch MD, PhD","doi":"10.1016/j.adro.2024.101689","DOIUrl":"10.1016/j.adro.2024.101689","url":null,"abstract":"<div><h3>Purpose</h3><div>Optimal treatment of retroperitoneal sarcoma (RPS) remains undefined. Here, we report the feasibility of using high-dose boost radiation (3-4 Gy) to the central part of the tumor in patients with unresectable RPS.</div></div><div><h3>Methods and Materials</h3><div>Five patients with unresectable RPS were treated with radiation therapy using a central boost technique with intensity modulated radiation therapy. On average, doses of 25 Gy to 45 Gy were delivered to the outer part of the tumor (planning target volume 1), while the central part of the tumor (planning target volume 2) received a 56 Gy to 75 Gy physical dose, which translates to a 62.67 Gy to 87.5 Gy equivalent dose in 2 Gy fractions (EQD2). To minimize radiation toxicity to the adjacent bowel and other organs, we used sequential, interdigitated, or simultaneous integrated boost (SIB) techniques.</div></div><div><h3>Results</h3><div>In this case series of variable RPS histology, the median survival postradiation therapy was 30 months. Three of the 5 patients had clinically stable local disease on follow-up scans, and none of the patients experienced clinically significant toxicity.</div></div><div><h3>Conclusions</h3><div>In summary, in this small case series of 5 patients, treatment was tolerated well, and excellent local responses were observed regardless of the timing of the central boost. Given the high rates of metastatic disease that developed in responding patients, effective systemic therapy will likely be needed for unresectable RPS treated with aggressive radiation therapy to the central part of the tumor.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101689"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982444","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":"Dosimetric Predictors of Acute Radiation Pneumonitis and Esophagitis in Hypofractionated Thoracic Irradiation of Non-Small Cell Lung Cancer Patients With Poor Prognostic Factors","authors":"Saskia Kenndoff BSc, MD ,&nbsp;Alexander Nieto MD ,&nbsp;Julian Elias Guggenberger MD ,&nbsp;Julian Taugner MD ,&nbsp;Sina Mansoorian MD ,&nbsp;Lukas Käsmann MD, MHBA ,&nbsp;Nina-Sophie Schmidt-Hegemann MD ,&nbsp;Farkhad Manapov MD ,&nbsp;Claus Belka MD ,&nbsp;Chukwuka Eze MD","doi":"10.1016/j.adro.2024.101682","DOIUrl":"10.1016/j.adro.2024.101682","url":null,"abstract":"<div><h3>Purpose</h3><div>The proliferation rates of non-small cell lung cancer (NSCLC) and associated radiation resistance highlight the potential of hypofractionated radiation therapy (hypoRT). However, radiation pneumonitis and esophagitis remain dose-limiting adverse events. This study investigates dosimetric factors influencing the risk of pneumonitis and esophagitis in highly multimorbid patients undergoing moderately hypoRT.</div></div><div><h3>Methods and Materials</h3><div>Forty-seven NSCLC patients with poor performance status treated between January 2014 and July 2021 were included. Dosimetric parameters including mean lung dose (MLD), percentage of normal (ipsi-/contralateral) lung volume (Vx) receiving ≥x Gy (x = 20, 18, 10, and 5 Gy); mean heart dose (MHD), percentage of the heart volume (HVx) receiving ≥x Gy (x = 20, 10, and 5 Gy); and mean esophageal dose (MED), percentage of esophagus volume (EVx) receiving ≥x Gy (x = 40, 30, 20, 18, 10, and 5 Gy) were analyzed retrospectively. Acute radiation pneumonitis/esophagitis events were assessed within 6/3 months posttreatment. Statistical analyses included random forests, binary logistic regression, and linear regression.</div></div><div><h3>Results</h3><div>Among the 47 patients with compromised lung function and poor prognostic factors, 8 (17%) and 26 (55%) patients developed all-grade pneumonitis or esophagitis, while 4 (9%) and 10 (21%) patients developed CTCAE grade ≥2 pneumonitis and esophagitis, respectively. Exploratory analyses suggest that V10, V18, and MLD values are associated with an increased risk of pneumonitis. Linear regressions confirmed this for MLD values greater than 9.2 Gy (<em>P</em> = .050). Additionally, higher V5 and V10 values in the contralateral lung were associated with a greater risk of pneumonitis (<em>P</em> = .013/<em>P</em> = .032). Dmax proved to be a significant predictor of esophagitis (<em>P</em> = .020). Moreover, evidence suggests that EV5 and EV40 may portend esophagitis onset.</div></div><div><h3>Conclusions</h3><div>This study provides insights into dosimetric factors influencing pneumonitis/esophagitis development in NSCLC patients undergoing hypoRT. While MLD and Dmax emerged as significant predictors of pneumonitis and esophagitis, the small sample size limited the depth of conclusions. Further research with larger cohorts is warranted to validate these observations, potentially optimizing treatment planning and outcomes in this challenging patient population.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101682"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078319","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":"Early Outcomes from Proton Craniospinal Irradiation for Leptomeningeal Metastasis From Solid Tumors","authors":"Keng Lam MD ,&nbsp;Lewis F. Nasr MD ,&nbsp;Clark R. Andersen MS ,&nbsp;Kathryn E. Marqueen MD ,&nbsp;Jing Li MD, PhD ,&nbsp;Chenyang Wang MD ,&nbsp;Thomas H. Beckham MD, PhD ,&nbsp;Nazanin K. Majd MD, PhD ,&nbsp;Ashley E. Aaroe MD ,&nbsp;Monica Loghin MD ,&nbsp;Barbara J. O'Brien MD ,&nbsp;Susan L. McGovern MD, PhD","doi":"10.1016/j.adro.2024.101697","DOIUrl":"10.1016/j.adro.2024.101697","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment options for leptomeningeal metastasis (LM) are limited. A recent phase 2 study found that proton craniospinal irradiation (pCSI) was well-tolerated and improved survival. We report our experience with pCSI for solid-tumor LM.</div></div><div><h3>Methods and Materials</h3><div>This is a retrospective review of patients treated with pCSI for solid-tumor LM from December 2020 to January 2024 at our center. Patient characteristics were summarized using descriptive statistics. Median overall survival and median central nervous system progression-free survival from the first day of pCSI were estimated using Kaplan-Meier survival curves.</div></div><div><h3>Results</h3><div>We identified 45 patients who completed pCSI. The median age was 54 years (range, 23-79); 73% were female, and 53% lived more than 100 miles from our center. Breast cancer (53%), lung cancer (20%), and melanoma (9%) were the most common primary cancers; 51% of patients had stable systemic disease at LM diagnosis. All had imaging evidence of LM, and 64% of cases were confirmed using cytologic examination of the cerebrospinal fluid. Eighty percent had symptomatic LM, and the median Karnofsky performance scale at LM diagnosis was 80. The median time from primary cancer diagnosis to LM detection was 23.1 months (range, 0-221.3). Fifty-three percent of patients had active brain metastasis at LM diagnosis; 33% of all patients had received prior intracranial radiation. The median time from simulation to pCSI start was 12 days. At the first visit following pCSI, the median Karnofsky performance scale score was 70. During or right after radiation, 76% of patients reported nausea, 51% headache, and 31% fatigue. Following pCSI, 4% received intrathecal chemotherapy, 67% systemic therapy, and 9% hospice care; 18% were observed and 2% lost to follow-up. Median overall survival was 13.7 months (95% confidence interval [CI], 11.2 to not reached), and median progression-free survival was 6.5 months (95% CI, 4.9-12.8).</div></div><div><h3>Conclusions</h3><div>The outcomes in our cohort are comparable to those recently reported in a phase 2 trial. Further study is indicated to determine the optimal candidates for pCSI and sequential therapies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101697"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Image Quality Evaluation and Motion Phantom Studies of an Ultra-Fast (6-Second) Cone-Beam Computed Tomography Imaging System on a Ring Gantry Linear Accelerator","authors":"Hui Zhao PhD ,&nbsp;Geoff Nelson PhD ,&nbsp;Vikren Sarkar PhD ,&nbsp;Courtney Oare PhD ,&nbsp;Martin Szegedi ,&nbsp;Sara St. James PhD ,&nbsp;Jeremy Kunz PhD ,&nbsp;Ryan Price PhD ,&nbsp;Y. Jessica Huang PhD","doi":"10.1016/j.adro.2024.101681","DOIUrl":"10.1016/j.adro.2024.101681","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the image quality of an ultrafast cone-beam computed tomography (CBCT) system—Varian HyperSight.</div></div><div><h3>Methods and Materials</h3><div>In this evaluation, 5 studies were performed to assess the image quality of HyperSight CBCT. First, a HyperSight CBCT image quality evaluation was performed and compared with Siemens simulation-CT and Varian TrueBeam CBCT. Second, a visual comparison of image quality among simulation-CTs, HyperSight CBCT, and TrueBeam CBCT was performed for a patient with head and neck cancer and patients with metal dental fillings and prostheses. Third, the Hounsfield unit (HU) versus electron density curve of HyperSight CBCT was compared with GE and Siemens simulation CTs. Fourth, Siemens simulation-CT and HyperSight CBCT scans were acquired on the Catphan set-up at different locations inside the bore (±10 cm in all 3 principal directions from the center), and the HU variations for different materials were evaluated. Fifth, a 4-dimensional lung tumor phantom study was performed to assess moving tumor alignment during image registration.</div></div><div><h3>Results</h3><div>Significant improvement of image contrast, HU constancy, and noise level on HyperSight CBCT was observed compared with TrueBeam CBCT. Significant image quality improvement was observed on HyperSight CBCT for patients with dental fillings and prostheses compared with simulation-CT without metal artifact reduction. The linear fit trendline of HU versus electron density curves for GE simulation-CT, Siemens simulation-CT, and HyperSight CBCT showed a 0.6% difference for HU values below 2000. The maximum HU difference for HyperSight CBCT when Catphan was positioned within ±10 cm in all 3 principal directions was ≤ 98 on bone 50%, ≤ 29 other than bone, and was ≤ 31 on bone 50%, and ≤ 17 other than bone for Siemens simulation-CT. Both tumor shape and tumor alignment discrepancies on CBCT scans were observed in a 4-dimensional phantom study.</div></div><div><h3>Conclusions</h3><div>This evaluation shows significant image improvement of HyperSight CBCT over conventional CBCT on image contrast, HU constancy, and noise level with scatter correction and metal artifact reduction reconstruction methods. HyperSight CBCT has similar image quality to simulation-CTs and shows the potential application for treatment planning. The rapid acquisition of HyperSight CBCT showed both tumor shape and tumor alignment discrepancies of moving targets. Careful considerations of patient respiratory motion monitoring and target matching are highly recommended.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101681"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881104","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":"Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy","authors":"Avani D. Rao MD ,&nbsp;Alexander Goughenour CS, CMD ,&nbsp;Betelehem Kebede BS ,&nbsp;Caroline Bamberger BS ,&nbsp;Grayden MacLennan MS, CMD ,&nbsp;Jackeline Castro BS, CMD ,&nbsp;Lisa Stephenson MS, CMD ,&nbsp;Amanuel Negussie MS, CMD ,&nbsp;Sydney Seracino CMD ,&nbsp;Hongkun Wang PhD ,&nbsp;Stella Hetelekidis MD ,&nbsp;Sarah J. Gao MD ,&nbsp;Lonika Majithia MS, MD ,&nbsp;Ashish Chawla MD ,&nbsp;Ashkan Parniani MBA, CMD ,&nbsp;Peng Wang PhD, DABR ,&nbsp;Jiajin Fan PhD, DABR","doi":"10.1016/j.adro.2024.101653","DOIUrl":"10.1016/j.adro.2024.101653","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).</div></div><div><h3>Methods and Materials</h3><div>In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally &lt; 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.</div></div><div><h3>Results</h3><div>A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, <em>P</em> &lt; .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all <em>P</em> ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, <em>P</em> = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, <em>P</em> = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, <em>P</em> = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, <em>P</em> = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.</div></div><div><h3>Conclusions</h3><div>The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101653"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969302","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":"First-in-Men Online Adaptive Robotic Stereotactic Body Radiation Therapy: Toward Ultrahypofractionation for High-Risk Prostate Cancer Patients","authors":"Victor J. Brand MD,&nbsp;Maaike T.W. Milder PhD,&nbsp;Miranda E.M.C. Christianen MD, PhD,&nbsp;Kim C. de Vries MD,&nbsp;Mischa S. Hoogeman PhD,&nbsp;Luca Incrocci MD, PhD,&nbsp;Femke E. Froklage MD, PhD","doi":"10.1016/j.adro.2024.101701","DOIUrl":"10.1016/j.adro.2024.101701","url":null,"abstract":"<div><h3>Purpose</h3><div>Ultrahypofractionation presents challenges for a subset of high-risk prostate cancer patients due to the large planning target volume (PTV) margin required for the seminal vesicles. Online adaptive radiation therapy could potentially reduce this margin. This paper focuses on the development, preclinical validation, and clinical testing of online adaptive robotic stereotactic body radiation therapy for this patient group.</div></div><div><h3>Methods and Materials</h3><div>An online adaptive workflow was developed for the CyberKnife with integrated in-room CT-on-rails. Preclinical validation involved comparing deep learning–based auto-contouring with deformable or rigid contour propagation in terms of subsequent editing time. A fast treatment planning method was implemented and compared with the conventional method in terms of optimization time and adherence to planning constraints. Clinical testing was conducted in the first study patients of the UPRATE trial, which investigates the feasibility of seminal vesicle PTV margin reduction in low-volume metastasized prostate cancer patients. Treatment time and patient experience were recorded.</div></div><div><h3>Results</h3><div>Rigid registration for prostate and deep-learning auto-contouring for seminal vesicles and organs at risk were selected based on editing time and robustness for anatomic changes. The fast treatment planning method reduced the optimization time from 10 to 3.5 minutes (<em>P</em> = .005). No significant differences in dose parameters were observed compared with the conventional plans. During clinical testing, 53 of 60 fast treatment plans adhered to the planning constraints, and all 60 were clinically accepted and delivered. The average total treatment time was 67.7 minutes, showing a downward trend. The treatment was well-experienced overall.</div></div><div><h3>Conclusions</h3><div>Online adaptive stereotactic body radiation therapy using CyberKnife with integrated CT-on-rails is clinically feasible for prostate cancer patients with seminal vesicles included in the target volume. The UPRATE trial outcome will reveal the extent to which online adaptation can reduce the PTV margin of the seminal vesicles.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101701"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045460","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":"Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients","authors":"Sanjeev Sreenivasan MD, MCh ,&nbsp;Salem Najjar BA ,&nbsp;Daniel Ma MD ,&nbsp;Sabrina L. Begley BS ,&nbsp;Yen-Ruh Wuu MD ,&nbsp;Zaker Rana MD ,&nbsp;Emile Gogineni DO ,&nbsp;Michael Schulder MD ,&nbsp;Anuj Goenka MD","doi":"10.1016/j.adro.2024.101709","DOIUrl":"10.1016/j.adro.2024.101709","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We aimed to conduct a comprehensive review of a consecutive cohort of patients diagnosed with high-risk atypical meningioma who underwent SRS, either as a single-fraction SRS or in the hypofractionated SRS (hf-SRS), and evaluate the LC rates (LCR) with a specific emphasis on patterns of treatment failure.</div></div><div><h3>Methods and Materials</h3><div>We identified consecutive patients diagnosed with high-risk World Health Organization grade 2 meningioma treated with SRS at a single institution between 2014 and 2021. High-risk meningioma was defined as a residual disease or recurrence after initial gross total resection. Follow-up data were analyzed to evaluate LCRs and patterns of treatment failure. We defined local failure as tumor recurrence wthin the prescription isodose line, marginal failure as recurrence within 5 mm but outside the prescription isodose line, and distant/regional failure as recurrence beyond 5 mm of the prescription isodose line but within 2 cm of the surgical cavity.</div></div><div><h3>Results</h3><div>We identified 45 pathologically confirmed atypical meningiomas in 25 patients. Thirty-three tumors underwent single-fraction SRS, and 12 tumors received hf-SRS. The median follow-up was 36 months (range, 2-86 months). The 3-year LCR was 84.6%, and overall survival was 96.0%. Four patients with a total of 7 tumors experienced treatment failure. Failures were either local (3 patients and 3 lesions) or marginal (3 patients and 4 lesions). Patients treated with hf-SRS did not exhibit local, marginal, or distant failures.</div></div><div><h3>Conclusions</h3><div>Our institutional data on atypical patients with meningioma treated with radiosurgery compare favorably to existing literature using fractionated radiation therapy. SRS offers a promising strategy to improve LC in this patient population, and the occurrence of marginal failure plays a role in creating clinical target volume margins.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101709"},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093657","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 Phase I/II Study of Ultra-Hypofractionated Carbon-ion Radiation therapy for Low- and Intermediate-Risk Localized Prostate Cancer","authors":"Noriyuki Okonogi MD, PhD ,&nbsp;Hiroshi Tsuji MD, PhD ,&nbsp;Kana Kobayashi MD, PhD ,&nbsp;Mio Nakajima MD, PhD ,&nbsp;Shuri Aoki MD, PhD ,&nbsp;Takanobu Utsumi MD, PhD ,&nbsp;Hiroyoshi Suzuki MD, PhD ,&nbsp;Koichiro Akakura MD, PhD ,&nbsp;Tomohiko Ichikawa MD, PhD ,&nbsp;Hitoshi Ishikawa MD, PhD","doi":"10.1016/j.adro.2024.101705","DOIUrl":"10.1016/j.adro.2024.101705","url":null,"abstract":"<div><h3>Purpose</h3><div>We report herein the 3-year results of a phase I/II prospective study of 4-fraction course of carbon-ion radiation therapy (CIRT) in patients with localized prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>The present was a single-institution, phase I/II prospective study including patients with low- or intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network criteria. Eligible patients were randomly assigned (1:1) to a 1- or 2-week schedule. Dose-limiting toxicities (DLTs) were defined as any genitourinary (GU) or gastrointestinal (GI) toxicity grade 3 or higher within 90 days of beginning CIRT. Ten patients were enrolled in each group, and the CIRT dose was increased in a stepwise manner if there were fewer than 4 cases of DLT. The initial CIRT dose was 36 Gy, followed by 40 Gy or 44 Gy. Low-risk patients did not receive androgen deprivation therapy (ADT), whereas intermediate-risk patients received 4 to 8 months of neoadjuvant ADT.</div></div><div><h3>Results</h3><div>Between October 2018 and October 2020, 60 patients were enrolled in the present study and completed the treatment regimen. The median post-CIRT follow-up period was 42 months (range, 27-59 months). Of the 60 patients enrolled, 10 were in the low-risk group, and 50 were in the intermediate-risk group. Neither group experienced grade 3 or higher GI or GU adverse events; therefore, no dose-limiting toxicities were observed. The incidence of grade 2 GU toxicity within 90 days post CIRT was significantly higher in the 44 Gy group than in the 36 to 40 Gy group (<em>P</em> &lt; .01, chi-square test with Yates correction). Biochemical failure was observed in 3 cases by 3 years post CIRT. No clinical recurrence or death because of prostate cancer occurred.</div></div><div><h3>Conclusions</h3><div>Forty Gy in 4 fractions of CIRT may be appropriate for balancing the therapeutic effects and toxicity. Our findings support further investigations into the efficacy of this strategy.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101705"},"PeriodicalIF":2.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094116","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}