Advances in Radiation Oncology最新文献

{"title":"Esophageal Cancer Cells Exhibit Heterogeneity in DNA Double-Strand Break Repair and G2/M Checkpoint Arrest Associated With Cell Viability After Ionizing Radiation","authors":"Kohei Tateno ,&nbsp;Ken Okuda ,&nbsp;Shunji Haruna ,&nbsp;Mayu Isono ,&nbsp;Takaaki Ishikawa ,&nbsp;Hikaru Okumura ,&nbsp;Ryota Hayashi ,&nbsp;Ryuta Suzuki ,&nbsp;Takumi Takahashi ,&nbsp;Tamaki Saito ,&nbsp;Takehiko Yokobori ,&nbsp;Yuki Uchihara ,&nbsp;Keiji Suzuki ,&nbsp;Motohiro Yamauchi ,&nbsp;Ken Shirabe ,&nbsp;Hiroshi Saeki ,&nbsp;Atsushi Shibata","doi":"10.1016/j.adro.2025.101987","DOIUrl":"10.1016/j.adro.2025.101987","url":null,"abstract":"<div><h3>Purpose</h3><div>Esophageal cancer lacks characteristic mutations in DNA repair genes; therefore, DNA damage response (DDR) factors have not been widely explored as predictive biomarkers in esophageal cancer. In this study, we explored the potential heterogeneity of DDR capabilities following exposure to ionizing radiation (IR).</div></div><div><h3>Methods and Materials</h3><div>DNA repair protein RAD51 homolog 1/Rad51 recombinase (RAD51), breast cancer susceptibility gene 1, and replication protein A foci formation were analyzed in 15 esophageal cancer cell lines after IR. DNA damage signaling, including phosphorylation of ataxia telangiectasia mutation, Chk2, and Chk1, was examined by immunoblotting. G2/M checkpoint arrest after IR was assessed by scoring mitotic cells. The mode of cell death and cell viability after IR were evaluated using immunofluorescence staining and colony formation assay.</div></div><div><h3>Results</h3><div>Notably, we found significant variations in RAD51 foci formation among 15 esophageal cancer cell lines. Analyzing 2 cell lines, with the highest and lowest RAD51 foci formation each, revealed that cells with low RAD51 foci formation (DDR-defective cell lines) exhibited impaired double-strand break (DSB) end resection, and reduced ataxia telangiectasia mutation-Chk2 and ATR-Chk1 signaling. The DDR-defective cell lines showed increased mitosis with DSBs and enhanced radiosensitivity. Conversely, DDR-proficient cell lines that exhibited intact G2/M checkpoint arrest become significantly more radiosensitive when treated with ATR or WEE1 inhibitors, which abrogate G2/M checkpoint arrest and increase mitosis with DSBs.</div></div><div><h3>Conclusions</h3><div>Esophageal cancer cell lines with lower capability of RAD51 foci formation exhibited defective DDR and G2/M checkpoint arrest associated with higher radiosensitivity. These findings suggest novel possibilities for predicting the efficacy of DNA damage-inducing cancer therapies, such as chemoradiotherapy, based on DDR proficiency, potentially guiding personalized treatment strategies for esophageal cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101987"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185102","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":"Real-World Data on Barrigel and SpaceOAR Rectal Spacers in Prostate Cancer Radiation Therapy: A Comparative Analysis","authors":"Shruti Prusty MD ,&nbsp;Deborah Cho MD ,&nbsp;Ken Thong MBBS, FRANZCR ,&nbsp;Albert Tiu MBBS, MMED, FRACS ,&nbsp;Nicholas McLeod BSc, BMed, FRACS ,&nbsp;Lucy Leigh PhD, BMath, BMRS ,&nbsp;Jarad Martin MBChB, PhD, DMed, BSc ,&nbsp;Michael Chao MBBS, DMedSc, FRANZCR ,&nbsp;Eric Wegener MBBS, BMedSci, FRANZCR","doi":"10.1016/j.adro.2025.101989","DOIUrl":"10.1016/j.adro.2025.101989","url":null,"abstract":"<div><h3>Purpose</h3><div><strong>:</strong> Hydrogel rectal spacers are in widespread and routine clinical use for prostate cancer radiation therapy. Theses spacers separate the prostate from the rectum, thereby reducing the radiation dose to the rectum. Two major hydrogels are in use, SpaceOAR and Barrigel, yet there are no real-world data comparing these two. This study aims to compare these gels with respect to quality of insertion and dosimetric outcomes.</div></div><div><h3>Methods and Materials</h3><div>A multicenter retrospective analysis was performed on all men with prostate cancer undergoing radiation therapy from 2017 to 2023. Demographic, radiation therapy, and magnetic resonance imaging details were imported for analysis. Each multiparametric magnetic resonance imaging was scored on rectal spacing placement by 2 independent observers.</div></div><div><h3>Results</h3><div>Eight hundred twenty-two patients were included for dosimetric and 605 for quality of insertion analysis. The median SpaceOAR volume (13.80 cc) was larger than the median Barrigel volume (5.10 cc) (<em>P</em> &lt; .01). SpaceOAR was more likely to achieve a higher Spacer Quality Score (SQS) compared to Barrigel (5-fraction odds ratio [OR], 6.25; &gt;5 fractions OR, 2.16; <em>P</em> &lt; .01 for both respectively). SpaceOAR achieved lower irradiated rectal volumes for 20 fractions, at v60, v46, v38, and v30 (<em>P</em> &lt; .01 for all) and 5 fractions, v30 (<em>P</em> = .04), v20 (<em>P</em> = .01). After accounting for spacer volume, Barrigel achieved better rectal dosimetric outcomes for 20 fraction patients compared to SpaceOAR for volumes between 6 and 13 cc, v57 (<em>P</em> = .01), v54 (<em>P</em> = .01). Higher SQS correlated with improved dosimetric outcomes (<em>P</em> &lt; .05), whereas no similar monotonic trend was observed with the Fischer-Valuck (FV) score across evaluated dose levels, including v36 (<em>P</em> = .10), v32 (<em>P</em> = .26), and v30 (<em>P</em> = .45). Incidence of rectal wall infiltration among SpaceOAR patients was 7/287 (2.44%) compared to none for Barrigel.</div></div><div><h3>Conclusions</h3><div>Real-world data show that SpaceOAR achieves better dosimetry than Barrigel likely due to larger insertion volumes. At similar insertion volumes, Barrigel achieves lower irradiated rectal volumes compared to SpaceOAR. Dosimetric outcomes are more likely impacted by volume rather than symmetry of insertion. The SQS scoring method may have better utility than the FV scoring method for assessing dosimetric outcomes. Our data also indicate that Barrigel has a lower incidence of rectal wall infiltration compared with SpaceOAR.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101989"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185101","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":"In Reply to Marwaha, Shepard, and Wegner","authors":"Roshan S. Prabhu MD, MS ,&nbsp;Stuart H. Burri MD","doi":"10.1016/j.adro.2025.101943","DOIUrl":"10.1016/j.adro.2025.101943","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101943"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448888","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":"Innovative and Customized 3-Dimensional-Printed Mold Brachytherapy Treatment of Genital Extramammary Paget’s Disease","authors":"Ruben Del Castillo Pacora MD ,&nbsp;Moti R. Paudel PhD ,&nbsp;Mackenzie Smith MSC ,&nbsp;Gerard Morton MD ,&nbsp;Elizabeth Barnes MD ,&nbsp;Mohammad Kazem ,&nbsp;Michael Sidiropoulos MD ,&nbsp;Amandeep S. Taggar MD","doi":"10.1016/j.adro.2025.101969","DOIUrl":"10.1016/j.adro.2025.101969","url":null,"abstract":"<div><h3>Purpose</h3><div>Extramammary Paget’s disease (EMPD) is a rare intraepithelial neoplasm that affects apocrine gland-rich areas of the perineal region. Surgical treatment is the standard of care but is associated with significant morbidity. Nonsurgical options, such as surface mold brachytherapy (SMBT) with custom 3-dimensional (3D)-printed applicators, offer an innovative, organ-preserving alternative. Our aim was to evaluate the efficacy, safety, and cosmetic outcomes of custom 3D-printed SMBT in patients diagnosed with EMPD.</div></div><div><h3>Methods and Materials</h3><div>A retrospective case series involving 9 patients treated for EMPD between November 2019 and April 2023 was included. Patient demographics, clinical characteristics, treatment parameters, and outcomes were analyzed. Primary outcomes included clinical response rates, acute and late toxicities (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5), and patient-reported cosmetic outcomes.</div></div><div><h3>Results</h3><div>All 9 patients (6 men and 3 women) achieved a complete clinical response, with 1 patient experiencing marginal recurrence at 13.6 months posttreatment. Acute grade 3 dermatitis occurred in all patients and resolved, on average, within 54 days (range, 35-72). Late toxicities included hypopigmentation (4 patients) and telangiectasia (3 patients). Cosmetic outcomes were rated as excellent or very good by 89% of patients.</div></div><div><h3>Conclusions</h3><div>This study represents the first report on the use of custom 3D-printed SMBT for EMPD. This technique demonstrates excellent local control, manageable toxicity, and favorable cosmetic outcomes, offering a promising alternative to surgery in this anatomically complex area.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101969"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881695","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":"Overall Survival in Men 80 and Older With Intermediate-Risk Prostate Cancer Who are Treated With Dose-Escalated Radiation and Androgen Deprivation Therapy Versus Dose-Escalated Radiation Alone: A National Cancer Database Analysis","authors":"Timothy P. Dougherty MD ,&nbsp;Mengying Deng MMATH ,&nbsp;Shelly Hayes MD","doi":"10.1016/j.adro.2025.101977","DOIUrl":"10.1016/j.adro.2025.101977","url":null,"abstract":"<div><h3>Purpose</h3><div>Men 80 and over are not well represented on randomized clinical trials, including the studies that examined the addition of androgen deprivation (ADT) to radiation therapy (RT). However, octogenarians may be a group particularly susceptible to the side effects of ADT due to the rapid increase in age-related changes as one enters their 9th decade. We hypothesized that ADT, when added to RT in octogenarians with intermediate-risk prostate cancer, might be associated with worse overall survival, and that this effect would not hold for their younger counterparts.</div></div><div><h3>Methods and Materials</h3><div>The National Cancer Database (NCDB) was queried for men ≥60 years old who received dose-escalated RT (EQD2_α/β=2 ≥ 74 Gy) for intermediate-risk prostate cancer. Intermediate risk was defined as prostate specific antigen (PSA) &gt; 10 and ≤ 20, Gleason score 7 (either 3+4 or 4+3), or T2 disease. Men were separated by age (60-69, 70-79, ≥80) and receipt of ADT. Overall survival was evaluated using Kaplan-Meier analysis. Cox proportional hazards were used to determine the relationship between ADT usage on survival in different age cohorts.</div></div><div><h3>Results</h3><div>There were 10,168 men who received RT + ADT versus 12,396 who received RT alone. In the RT + ADT group, a larger percentage of men had Gleason 4+3 disease (43% vs 26%, <em>P</em> = .004), T2 stage (35% vs 25%, <em>P</em> = .019), and a higher PSA (median 7.6 vs 6.8, <em>P</em> &lt; .0001). There were 672 (6.6%) octogenarians who received ADT versus 772 (6.2%) who did not. Hazard ratios (HRs) for overall survival, accounting for Gleason score, T stage, PSA, and comorbid conditions, showed improved survival in those 60 to 69 with the addition of ADT to dose-escalated RT (HR = 0.90 [95% CI, 0.81-0.99], <em>P</em> = .039), while no difference in those 70-79 (HR = 0.98 [0.90-1.06], <em>P</em> = .541) or 80 and older (HR = 1.13 [0.97-1.32], <em>P</em> = .124).</div></div><div><h3>Conclusions</h3><div>In this NCDB analysis, the addition of ADT to dose-escalated radiation in men between the ages of 60 and 70 with intermediate-risk prostate cancer showed improved overall survival. However, adding ADT to dose escalation in those 80 and older did not demonstrate an overall survival benefit.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101977"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939762","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":"Outcomes of Adjuvant Radiation Therapy in Penile Cancer","authors":"Gerim Prasai MD ,&nbsp;David K. Simson DNB ,&nbsp;Sauharda Lohani MD ,&nbsp;Sarthak Tandon DNB ,&nbsp;Varghese Antony DNB ,&nbsp;Parveen Ahlawat DNB ,&nbsp;Shaifali Mahajan DNB ,&nbsp;Anurag Mehta MD ,&nbsp;Vineet Talwar DM ,&nbsp;Ashish Khanna MCH ,&nbsp;Amitabh Singh MCH ,&nbsp;Munish Gairola MD ,&nbsp;Sudhir Rawal MCH ,&nbsp;Jaskaran Singh Sethi DNB","doi":"10.1016/j.adro.2025.101986","DOIUrl":"10.1016/j.adro.2025.101986","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the long-term outcomes of adjuvant radiation therapy (RT) in patients with penile cancer treated over 14 years.</div></div><div><h3>Methods and Materials</h3><div>In this retrospective cohort study, patients with squamous cell carcinoma of the penis who underwent surgery followed by adjuvant RT with or without concurrent chemotherapy from January 2010 to December 2022 were included, with follow-up continuing until December 2023. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS), with additional analyses of toxicity and recurrence patterns. Survival rates were estimated using the Kaplan-Meier method, and univariate analysis was performed using Cox proportional hazards regression to assess the associations between clinical variables and outcomes (OS and RFS). Hazard ratios with 95% CIs were calculated, and a <em>P</em> value of &lt;.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>A total of 30 patients met the selection criteria. The median age was 57 years (IQR, 52-63), with a median follow-up of 84 months (95% CI, 74.02-92.81 months). The median OS was 77.2 months, while the median RFS was not reached. Five-year and 7-year survival rates were 52% and 46%, respectively. The 5-year RFS was 66%. Among 8 patients with recurrence, 6 had locoregional and 2 had distant metastasis. RT was generally well tolerated, with lymphedema as the most common side effect.</div></div><div><h3>Conclusions</h3><div>Despite adjuvant RT, survival outcomes remain suboptimal, with high rates of locoregional relapse. These findings underscore the need for improved treatment strategies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101986"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185100","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":"New Findings in the Visualization of Subepithelial Melanoma or Pseudoprogression-Like Phenomena in Oral Mucosal Melanoma During Carbon-Ion Radiation Therapy","authors":"Hiroaki Ikawa DDS, PhD ,&nbsp;Masashi Koto MD, PhD ,&nbsp;Makoto Shinoto MD, PhD ,&nbsp;Hitoshi Ishikawa MD, PhD","doi":"10.1016/j.adro.2025.101976","DOIUrl":"10.1016/j.adro.2025.101976","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101976"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973958","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":"Successful Stereotactic Body Radiation Therapy for Prostate Cancer in a Patient With Prior Total Colectomy and Ileal Pouch-Anal Anastomosis: A Case Report and Technical Considerations","authors":"Takero Hirata MD, PhD ,&nbsp;Shinichiro Fukuhara MD, PhD ,&nbsp;Kentaro Takezawa MD, PhD ,&nbsp;Naoki Kai MS ,&nbsp;Masataka Nakai MD ,&nbsp;Yasutoshi Fumimoto MD ,&nbsp;Nobuyuki Tamaki MD ,&nbsp;Shotaro Tatekawa MD, PhD ,&nbsp;Kazuhiko Hayashi MD, PhD ,&nbsp;Keisuke Tamari MD, PhD ,&nbsp;Taigo Kato MD, PhD ,&nbsp;Koji Hatano MD, PhD ,&nbsp;Atsunari Kawashima MD, PhD ,&nbsp;Shinichi Shimizu MD, PhD ,&nbsp;Norio Nonomura MD, PhD ,&nbsp;Kazuhiko Ogawa MD, PhD","doi":"10.1016/j.adro.2025.101965","DOIUrl":"10.1016/j.adro.2025.101965","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101965"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802197","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":"Feasibility and Outcomes of Perirectal Spacer Implantation in Previously Treated Prostate Cancer Patients Undergoing Salvage Proton Therapy Radiation","authors":"Irini Yacoub MD ,&nbsp;Keyur Mehta MD ,&nbsp;Daniel Gorovets MD ,&nbsp;Shaakir Hasan DO ,&nbsp;J. Isabelle Choi MD ,&nbsp;Arpit M. Chhabra MD ,&nbsp;Stanislav Lazarev MD ,&nbsp;Madhur Garg MD, MBA ,&nbsp;Charles B. Simone II MD","doi":"10.1016/j.adro.2025.101985","DOIUrl":"10.1016/j.adro.2025.101985","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment of recurrent prostate cancer following prior therapy is challenging due to the risk of toxicities to previously irradiated normal tissues, particularly the rectum. Proton therapy offers a conformal approach that may reduce this risk. Perirectal spacers have been shown to further minimize rectal dose in primary treatment, but the ability to be placed and their value in the retreatment setting have not been thoroughly evaluated to date. The purpose of this study was to evaluate feasibility of rectal spacer placement after prior pelvic radiation or other local treatments for prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>We conducted a retrospective review of 30 consecutive patients with biopsy-confirmed, locally recurrent prostate adenocarcinoma treated with salvage proton therapy at the New York Proton Center (2020-2024). All patients had prior local therapies including high intensity focused ultrasound (HIFU), brachytherapy (BT), external beam radiation therapy (EBRT) or combination BT and EBRT, and underwent perirectal spacer placement (SpaceOAR or Barrigel). Spacer feasibility, maximum and minimum separation distances, rectal symmetry, rectal Dmax (% of prescription dose), and gastrointestinal toxicities were assessed. Toxicity was graded using Common Terminology Criteria for Adverse Events, version 5.0.</div></div><div><h3>Results</h3><div>Median patient age was 74 years, and the median time from prior therapy was 102 months. Spacer placement was successfully completed in 28 of 30 (93%) patients. Two placements were aborted due to excessive fibrosis. The median maximum and minimum midaxial anterior-posterior separations were 10.8 mm and 3.5 mm, respectively. Median rectal Dmax was 91.55% (range, 44%-102.4%). Seven patients had Dmax &gt;100%, including 3 with prior HIFU. At a median follow-up of 12.5 months, gastrointestinal toxicities were limited to grade 1 diarrhea (n=3) No grade ≥ 2 toxicities or procedural complications were reported.</div></div><div><h3>Conclusions</h3><div>This is the first reported study evaluating the feasibility of perirectal spacer implantation in men with prior treatment to the pelvis, undergoing salvage radiation with protons. Our report shows perirectal spacer implantation is feasible and safe in patients undergoing salvage proton therapy, including those with prior EBRT or BT. Although technically more challenging in HIFU-treated patients, successful placement was achieved in the majority, with minimal toxicity and favorable dosimetric outcomes, although longer follow-up is needed.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101985"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146185099","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":"Safety and Efficacy of External Beam Radiation Therapy in Hepatocellular Carcinoma Patients Previously Treated With Yttrium 90 Transarterial Radioembolization","authors":"Kanokphorn Thonglert MD ,&nbsp;Joseph Tsai MD, PhD ,&nbsp;Wayne L. Monsky MD ,&nbsp;August C. Anderson MD ,&nbsp;Clemens Grassberger PhD ,&nbsp;Stephen R. Bowen PhD ,&nbsp;Matthew J. Nyflot PhD ,&nbsp;Yulun He PhD ,&nbsp;Peter Zaki MD ,&nbsp;Guy E. Johnson MD ,&nbsp;Smith Apisarnthanarax MD","doi":"10.1016/j.adro.2025.101984","DOIUrl":"10.1016/j.adro.2025.101984","url":null,"abstract":"<div><h3>Purpose</h3><div>Data on the safety and efficacy of external beam radiation therapy (EBRT) after yttrium 90 transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) are limited. We report our experience using EBRT to treat HCC patients previously treated with TARE.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively analyzed 31 HCC patients who received EBRT following TARE. Eighteen (58%) were treated with photon therapy, and 13 (42%) with proton therapy. Eighteen patients (58%) had been previously treated with TARE within the EBRT-treated lesion, with a median total dose of 72 mCi (range, 49-272). Twenty-one patients (68%) had prior TARE outside the EBRT zone, with a median total dose of 84 mCi (range, 21-330). Toxicities and survival outcomes were analyzed.</div></div><div><h3>Results</h3><div>The number of prior TARE treatments ranged from 1 to 5: 14 patients (45%) received 1, and 17 (55%) received 2 or more. Indications for EBRT included incomplete TARE response (n = 2), technical TARE limitations (n = 25), and other reasons (n = 4). The median tumor size was 3.8 cm (range, 1.6-19.4). Most patients (87%) had a Child-Pugh (CP)-A score. With a median follow-up of 30 months, the 2-year progression-free survival and overall survival rates were 18% and 43%, respectively. The 2-year cumulative incidence of local failure was 7%. CP+2 progression was observed in 4 patients (13%). There was no significant difference in local failure or CP+2 rates based on the EBRT target location relative to prior TARE. Grade 3+ biliary complications occurred in 3 patients (10%): 2 biloma and 1 biliary stricture. All 3 patients had received at least 2 prior TARE treatments that overlapped with the area treated with EBRT and had tumors located near the central bile duct.</div></div><div><h3>Conclusions</h3><div>EBRT for HCC patients previously treated with yttrium 90 is feasible and offers excellent local control. Liver dysfunction and biliary toxicities are potential complications and should be weighed against the clinical benefits.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101984"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177131","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}