Advances in Radiation Oncology最新文献

{"title":"Preservation of Graft Kidney with De Novo Pelvic Urothelial Carcinoma Via Stereotactic Body Radiation Therapy: A Case Report","authors":"Koyo Kikuchi MD, PhD , Yoshiro Ieko PhD , Ei Shiomi MD, PhD , Ayato Ito MD, PhD , Ryuji Nakamura MD, PhD , Hisanori Ariga MD, PhD","doi":"10.1016/j.adro.2025.101846","DOIUrl":"10.1016/j.adro.2025.101846","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101846"},"PeriodicalIF":2.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702694","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 , Marrissa J. McIntosh PhD , Eric Wallat PhD , Keegan R. Staab MSc , Andrew D. Hahn PhD , Katherine J. Carey PhD , Gregory P. Barton PhD , Andrew M. Baschnagel MD , John E. Bayouth MD , Rodrigo M. Bello MD , Scott B. Perlman MD , 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":"Adaptive Repeat Quad Shot Radiation Therapy for Uncontrolled Symptomatic Fungating or Skin-Infiltrating Primary and Regional Nodes in Patients with Metastatic Breast Cancer: Durable In-Field Tumor Control Without Interrupting Systemic Therapy","authors":"Whoon Jong Kil MD , Wyatt Smith CMD , Eugene Muchnik MD , Ryan Collins MD , David Cousins MD","doi":"10.1016/j.adro.2025.101842","DOIUrl":"10.1016/j.adro.2025.101842","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101842"},"PeriodicalIF":2.2,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes After Proton Therapy Reirradiation for Recurrent Malignant Glioma: Analysis From the Prospective Proton Collaborative Group Registry","authors":"Omer Gal MD ,&nbsp;Stephen Mihalcik MD ,&nbsp;Lia M. Halasz MD ,&nbsp;John H. Chang MD ,&nbsp;C. Jake Wang MD ,&nbsp;J. Isabelle Choi MD ,&nbsp;Charles B. Simone II MD ,&nbsp;Carlos E. Vargas MD ,&nbsp;Henry K. Tsai MD ,&nbsp;Rupesh Kotecha MD ,&nbsp;Robert H. Press MD","doi":"10.1016/j.adro.2025.101834","DOIUrl":"10.1016/j.adro.2025.101834","url":null,"abstract":"<div><h3>Purpose</h3><div>Optimal treatment for recurrent glioma after prior radiation therapy (RT) is not well established. Proton therapy (PT) is increasingly used for reirradiation (ReRT); however, treatment outcomes, toxicities, and prognostic factors for PT-ReRT remain poorly defined.</div></div><div><h3>Methods and Materials</h3><div>The prospective, multi-institutional Proton Collaborative Group registry was queried for patients with malignant glioma who underwent PT-ReRT between July 2011 and December 2023; only patients with at least one follow-up encounter were included. Overall survival (OS) and progression-free survival were assessed using the Kaplan-Meier method, and Cox proportional hazards regression was used for uni- and multivariable analyses (univariable analysis and multivariable analysis).</div></div><div><h3>Results</h3><div>The study cohort included 143 patients, the median follow-up was 11.2 months, and the median time interval (TI) from prior RT (median 58.5 Gy, IQR, 54-60 Gy) to PT-ReRT (median 44.6 Gy, IQR, 39.4-55.9 Gy) was 42.4 months. Median progression-free survival and OS were 8.1 and 11.2 months, respectively. On univariable analysis, improved OS was associated with oligodendroglioma and astrocytoma histology compared to glioblastoma, TI &gt;60 months, Eastern Cooperative Oncology Group performance status 0, and ReRT dose ≥50 Gy. On multivariable analysis, improved OS remained associated only with oligodendroglioma and TI &gt;60 months. Acute and late grade 3 toxicity occurred in 7% and 4%, respectively. Acute grade 3 toxicity was associated with poor performance status. Incidence of radiographic radiation necrosis was 19%.</div></div><div><h3>Conclusions</h3><div>In the largest series of glioma PT-ReRT reported to date, retreatment was well tolerated with variable outcomes based on clinical prognostic factors. Toxicity rates were similar compared to photon-based literature despite a high median ReRT prescription dose.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101834"},"PeriodicalIF":2.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564112","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":"Stereotactic Radiation Therapy for the Treatment of Glandular Metastases From Renal Cell Carcinoma","authors":"Mihailo Miljanic MD ,&nbsp;Tidie Song BS ,&nbsp;Alana Christie MS ,&nbsp;Allen Yen MD ,&nbsp;Young Suk Kwon MD, MPH ,&nbsp;Aurelie Garant MD ,&nbsp;Todd A. Aguilera MD, PhD ,&nbsp;Zabihullah Wardak MD ,&nbsp;Hans Hammers MD ,&nbsp;Kevin Courtney MD, PhD ,&nbsp;Suzanne Cole MD ,&nbsp;James Brugarolas MD, PhD ,&nbsp;Robert Timmerman MD ,&nbsp;Raquibul Hannan MD, PhD","doi":"10.1016/j.adro.2025.101835","DOIUrl":"10.1016/j.adro.2025.101835","url":null,"abstract":"<div><h3>Purpose</h3><div>The optimal management strategies for glandular metastases in patients with metastatic renal cell carcinoma (mRCC) are currently unknown. While local therapy may be effective, there is a paucity of data on Stereotactic Ablative Body Radiation (SABR) particularly considering the risks of duodenal injury and adrenal insufficiency with high-dose radiation in these locations.</div></div><div><h3>Methods and Materials</h3><div>We conducted an institutional review board-approved, single-institution, retrospective study of patients with RCC metastases to the adrenal and pancreas treated with SABR. Data on patient characteristics, therapies, toxicities, and outcomes were collected and analyzed. Outcome of patient with SABR-treated mRCC was compared between those with and without glandular metastasis.</div></div><div><h3>Results</h3><div>A total of 46 patients with a median follow-up of 20 months with mRCC were included with 36 adrenal and 19 pancreatic metastases treated with SABR with a median dose of 40 Gray (Gy) delivered in 5 treatments. One-year overall survival was 82.2%, progression-free survival was 48.2%, and local control was 95.9%. Acute grade 2 and 3 toxicity related to SABR was 7.4%. One patient experienced a grade 3 duodenal bleed as a result of pancreatic SABR, whereas 6.1% of patients experienced adrenal insufficiency with a median time to onset of 4 months following adrenal SABR.</div></div><div><h3>Conclusions</h3><div>SABR for RCC metastases to the pancreas and adrenal gland is feasible, safe, and effective at achieving high rates of local control with a small risk of duodenal injury and adrenal insufficiency, respectively. Oncological outcomes of patients with SABR-treated mRCC with glandular metastasis were comparable to those without glandular metastasis.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101835"},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749478","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":"Asymptomatic Bladder Stones Exacerbate Acute Genitourinary Adverse Events During Radiation Therapy for Prostate Cancer: Insights From Two Case Reports","authors":"Uchina Hiya MD ,&nbsp;Masashi Endo MD ,&nbsp;Kohei Okada MD, PhD ,&nbsp;Satoru Takahashi MD ,&nbsp;Kazunari Ogawa MD ,&nbsp;Machi Nakagawa MD ,&nbsp;Michiko Nakamura MD ,&nbsp;Chiaki Shibayama MD, PhD ,&nbsp;Yukiko Fukuda MD ,&nbsp;Keiko Akahane MD, PhD ,&nbsp;Masahiro Kawahara MD, PhD ,&nbsp;Harushi Mori MD, PhD ,&nbsp;Katsuyuki Shirai MD, PhD","doi":"10.1016/j.adro.2025.101833","DOIUrl":"10.1016/j.adro.2025.101833","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101833"},"PeriodicalIF":2.2,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589164","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":"Comparative Analysis of 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging for Gross Tumor Volume Delineation in Radiation Therapy Planning of Prostate Cancer","authors":"Hamed Bagheri PhD ,&nbsp;Seied Rabi Mahdavi PhD ,&nbsp;Parham Geramifar PhD ,&nbsp;Ali Neshasteh-Riz PhD ,&nbsp;Masoumeh Sajadi-Rad MD ,&nbsp;Habibollah Dadgar PhD ,&nbsp;Hossein Arabi PhD ,&nbsp;Habib Zaidi PhD","doi":"10.1016/j.adro.2025.101821","DOIUrl":"10.1016/j.adro.2025.101821","url":null,"abstract":"<div><h3>Purpose</h3><div>Magnetic resonance imaging (MRI) with multiparametric assessment is a cornerstone in radiation therapy planning for primary prostate cancer (PCa), offering the potential for focal dose escalation to dominant intraprostatic lesions to enhance PCa management. The prostate-specific membrane antigen (PSMA), which is frequently overexpressed in PCa, has led to the development of ⁶⁸Ga-labeled PSMA inhibitors for positron emission tomography (PET)/computed tomography (CT), showing promising results in PCa detection. This study aimed to conduct a comparative analysis of ⁶⁸Ga-PSMA PET/CT and multiparametric MRI (mpMRI) in delineating the gross tumor volume (GTV) in PCa.</div></div><div><h3>Methods and Materials</h3><div>A retrospective analysis was performed on 25 PCa patients who underwent ⁶⁸Ga-PSMA PET/CT and mpMRI at 2 distinct centers. The GTVs were delineated on MRI (GTV-MRI) by 2 nuclear medicine physicians and 1 radiation oncologist independently, while the GTVs based on PET/CT (GTV-PET) were outlined by 2 nuclear medicine physicians. The laterality (left, right, and bilateral) prostate lobes on mpMRI and PET/CT was assessed. To account for registration uncertainties, both GTV-PET and GTV-MRI were expanded isotropically by 5 mm to form the planning target volume (PTV), and the overlap between specific PTVs and their corresponding GTVs was quantified.</div></div><div><h3>Results</h3><div>The average ± SD GTV-MRI and GTV-PET were 5.468 ± 11.6 cm³ and 11.136 ± 14.3 cm³, respectively, with the GTV-PET being significantly larger than the GTV-MRI (<em>P</em> = .003). GTV-MRI exhibited an intersection with GTV-PET of 3.5 ± 6.0 cm³. The PTV derived from PSMA PET/CT encompassed 62% ± 27% of the GTV-MRI, with 44.4% of patients having the PTV covering 100% of the GTV-MRI. Conversely, the PTV based on GTV-MRI covered 50% ± 31% (mean ± SD) of the GTV-PET.</div></div><div><h3>Conclusions</h3><div>⁶⁸Ga-PSMA PET/CT and mpMRI demonstrated consistent outcomes in 47% of patients (40%-54% of lesions). Notably, the GTV-PET was larger than the GTV-MRI, indicating a potential role for ⁶⁸Ga-PSMA PET/CT in radiation therapy planning for targeted radiation delivery to PCa.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101821"},"PeriodicalIF":2.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634359","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}