Advances in Radiation Oncology最新文献

{"title":"Provider Practices and Perceived Barriers and Facilitators in Improving Quality Practices in Radiation Oncology Peer Review","authors":"Leslie Chang MD ,&nbsp;Sara Alcorn MD, PhD ,&nbsp;Khinh Ranh Voong MD, MPH ,&nbsp;Todd R. McNutt PhD ,&nbsp;Ori Shokek MD ,&nbsp;Suzanne Evans MD, MPH ,&nbsp;Jean L. Wright MD","doi":"10.1016/j.adro.2024.101708","DOIUrl":"10.1016/j.adro.2024.101708","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation oncology peer review evaluates case-specific qualitative treatment planning decisions. We sought to understand interdisciplinary perspectives on peer review to identify factors affecting stakeholder engagement and implementation of recommendations.</div></div><div><h3>Materials and Methods</h3><div>Semistructured interviews and Likert surveys (scaled, 0-10) with radiation oncology peer review participants were audio-recorded and transcribed. Two independent coders utilized a grounded theory approach to extract dominant themes.</div></div><div><h3>Results</h3><div>Participants included 6 academic and 3 community radiation oncologists, 2 residents, 2 medical physicists, 2 radiation therapists, 4 dosimetrists, and 1 industry representative. Thematic priorities of peer review included adherence to institutional guidelines, clinical background to inform decision-making, detection of rare errors, and education. Key facilitators included pretreatment peer review, clear planning guidelines, and feedback on peer recommendations. Barriers to recommendation adoption included resource limitations and a lack of prospective data guiding qualitative recommendations. Participants perceived benefits of peer review were assessed with Likert surveys with higher values placed on reducing practice variation (8.0) and education (7.6) and a lower value placed on the detection of medical errors (7.4) and reduction of treatment delivery incidents (6.9). When comparing Likert scores by participant role, nonphysicians rated the overall importance of peer review (mean, 9.8 vs 6.5, <em>P</em> = .03) and education (mean, 9.0 vs 6.7, <em>P</em> = .02) significantly higher than physicians.</div></div><div><h3>Conclusion</h3><div>Participants in radiation oncology acknowledged the importance of peer review, but there was significant variation in the perceived benefits. A higher value was placed on the alignment of clinical practice and nonphysician participant education. Future processes to improve communication and prospective plan review were identified as beneficial to peer review-mediated plan changes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101708"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093658","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":"Raising the Bar for Assessing Nutritional Risk Among Patients with Cancer","authors":"Miriam A. Knoll MD ,&nbsp;Julie Wilcox MS","doi":"10.1016/j.adro.2024.101645","DOIUrl":"10.1016/j.adro.2024.101645","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101645"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174833","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":"Outcomes and Toxicities After Treatment for Men Diagnosed With Localized Prostate Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis","authors":"Doris Kitson-Mills MPH, MPhil ,&nbsp;Andrew Donkor PhD ,&nbsp;Yaw Ampem Amoako MBChB, FWACS ,&nbsp;Kofi Adesi Kyei PhD ,&nbsp;Ernest Barwuah Osei Bonsu MBChB, FWACS ,&nbsp;Verna Vanderpuye MBChB, FWACS ,&nbsp;Yaw Amo Wiafe PhD","doi":"10.1016/j.adro.2024.101670","DOIUrl":"10.1016/j.adro.2024.101670","url":null,"abstract":"<div><h3>Purpose</h3><div>Current management for clinically localized prostate cancer in low- and middle-income countries (LMICs) includes surgery, external beam radiation therapy (EBRT), and brachytherapy either alone or in combination, with plus or minus hormone therapy. The toxicity profiles and oncological outcomes of these treatment modalities vary. This systematic review and meta-analysis aimed to determine the prevalence of treatment-related outcomes and toxicities for men diagnosed with localized prostate cancer in LMICs.</div></div><div><h3>Methods and Materials</h3><div>The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane Library, Embase, and Medline were searched for eligible articles. Meta-analysis was performed with Review Manager version 5.4.1 using a random effects model at a 95% confidence interval.</div></div><div><h3>Results</h3><div>A total of 2,820 patients were analyzed from 24 articles that met the inclusion criteria. Following 3-dimensional conformal radiation therapy (3D-CRT), the most common clinician-reported toxicities were acute skin grade 1, acute genitourinary grade 1, acute gastrointestinal grade 1, and late gastrointestinal grade 1, with 46%, 29%, 24%, and 18%, respectively. Acute and late genitourinary grade 3 and gastrointestinal grade 3 toxicities were below 3% with no grade 4 toxicities reported after 3D-CRT. In the brachytherapy group, the prevalence of acute genitourinary grade 1 toxicity was 19%. Perioperative rectal injury was the least prevalent (2%) after retropubic radical prostatectomy. Following 3D-CRT, the 5-year overall survival rate was 87%, and for the combined brachytherapy and EBRT group, it increased to 96%. The prevalence of 5-year biochemical failure following EBRT and brachytherapy was 18% and 30%, respectively. The 4- and 3-year biochemical failure after radical prostatectomy and combined EBRT with brachytherapy were 22% and 2%, respectively.</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis indicate that in LMICs, EBRT, brachytherapy, and radical prostatectomy, either alone or in combination has an excellent potential for localized prostate cancer control with low toxicities and good oncological outcomes. Results of treatment-related toxicities and outcomes can support policymakers, patients, and clinicians on informed decision-making to strengthen prostate cancer care in the region. However, efforts are required to improve early detection, treatment accessibility, regular post-treatment follow-up care, consistent quality assurance practices, and staff continues development to help minimize treatment toxicities and improve outcomes of localized prostate cancer in LMICs.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101670"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930389","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":"Optimal Setup and Parameters of Diffusion-Weighted Magnetic Resonance Imaging for Translational Evaluation of a Tumor Progression Model for Soft Tissue Sarcomas","authors":"Nadya Shusharina PhD ,&nbsp;Stephan E. Maier MD, PhD ,&nbsp;Miranda B. Lam MD, MBA ,&nbsp;Evangelia Kaza PhD","doi":"10.1016/j.adro.2024.101661","DOIUrl":"10.1016/j.adro.2024.101661","url":null,"abstract":"<div><h3>Purpose</h3><div>Defining a microscopic tumor infiltration boundary is critical to the success of radiation therapy. Currently, radiation oncologists use margins to geometrically expand the visible tumor for radiation treatment planning in soft tissue sarcomas (STS). Image-based models of tumor progression would be critical to personalize the treatment radiation field to the pattern of sarcoma spread. Evaluation of these models is necessary to demonstrate feasibility in the clinical setting. This study presents an imaging protocol for the preclinical evaluation of a tumor progression model in extremity STS.</div></div><div><h3>Methods and Materials</h3><div>We recruited 7 healthy volunteers and acquired diffusion-weighted magnetic resonance imaging (DW-MRI) images of the thigh on a magnetic resonance imaging scanner used for imaging cancer patients in a radiation oncology department. We developed a protocol that includes positioning the patient, configuring the radiofrequency coils, and setting the DW-MRI sequence parameters. To find the optimal parameter configuration, the image signal-to-noise ratio (SNR) and the directional variability (DV) of the principal eigenvector of the diffusion tensor were calculated.</div></div><div><h3>Results</h3><div>The mean SNR across all trials and 12 thigh muscles was 41, with a range of 12 to 72. The mean DV was 13° and ranged from 11° to 23°. The longest scan time was 22 minutes and 58 seconds, and the shortest was 11 minutes and 46 seconds. For the high-resolution image with a voxel volume of 1.3 × 1.3 × 6 mm³ and 38 slices, the optimal parameters were found to be a repetition time of 8000 ms, 12 signal averages, and 6 gradient directions. This configuration resulted in a scan time of 11 minutes and 46 seconds, an SNR of 34, and a DV of 13°.</div></div><div><h3>Conclusions</h3><div>A DW-MRI scan duration acceptable for imaging cancer patients was achieved with an image quality suitable for reproducible modeling of tumor infiltration. The developed protocol can be used for preclinical evaluation in STS patients.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101661"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930385","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":"The Burden of Insurance Prior Authorization on Cancer Care: A Review of Evidence From Radiation Oncology","authors":"Jayden Gracie MD ,&nbsp;Rachel Jimenez MD ,&nbsp;Karen M. Winkfield MD, PhD","doi":"10.1016/j.adro.2024.101654","DOIUrl":"10.1016/j.adro.2024.101654","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite its high cost-effectiveness, radiation oncology faces the greatest prior authorization (PA) burden of any medical specialty. Insurance denials and resulting treatment delays have been documented across several treatment modalities, including stereotactic body radiation, intensity modulated radiation, and proton therapy. Although insurance companies suggest that PA is intended to control health care spending and ensure the implementation of evidence-based practice, the number of radiation treatment plans reviewed by the PA process that result in changes is quite low. Yet, the cost to patients, providers, and the health care system is rising.</div><div>The increased administrative work required to address the appeal process, including the development of radiation plan comparisons, results in lost productivity of radiation staff and increased clinic costs that are not currently reimbursed. Treatment delays from PA may elevate patient anxiety and affect their ability to enroll in clinical trials, resulting in decreased quality of care. As a result of possible harm to patients, the Centers for Medicare and Medicaid Services developed a ruling that mandates increased transparency of insurers’ requirements, decreased allowable time for arriving at PA decisions, and a more efficient electronic communication system to address the time and resource burden of PA.</div></div><div><h3>Methods and Materials</h3><div>This article summarizes key discussions from the literature and provides recommendations to help mitigate insurance PA strain.</div></div><div><h3>Results</h3><div>These recommendations broadly address the following key areas: (1) omission of PA for routine care and clinical trials, (2) implementation of efficient, streamlined electronic peer-to-peer communication, (3) increased transparency of insurance requirements and rationale for denials, and (4) decreased time allowances for PA decisions.</div></div><div><h3>Conclusions</h3><div>Policy reform focused on evidence-driven treatment coverage, reduction of the proportion of cases requiring PA, and a simplified, timely insurance appeal process is necessary to ensure optimal cancer care for patients requiring radiation therapy as part of their cancer journey.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101654"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930399","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":"FCB-CHOPS: An Evolution of a Commonly Used Acronym for Evaluating Radiation Treatment Plans","authors":"Michael Weisman MD ,&nbsp;Shearwood McClelland III MD ,&nbsp;Namita Agrawal MD ,&nbsp;Rachel B. Jimenez MD ,&nbsp;Raphael Yechieli MD ,&nbsp;Emma Fields MD ,&nbsp;Omar Ishaq MD ,&nbsp;Jordan A. Holmes MD, MPH ,&nbsp;Daniel W. Golden MD, MHPE ,&nbsp;Raymond Mak MD ,&nbsp;Kevin Shiue MD","doi":"10.1016/j.adro.2024.101627","DOIUrl":"10.1016/j.adro.2024.101627","url":null,"abstract":"<div><div>Checklists have been used across many fields as a systematic framework to reduce human error and improve safety. In radiation oncology, the CB-CHOP acronym was previously developed as a tool to aid physicians in assessing the quality of radiation treatment plans for approval. This manuscript updates the acronym for the modern era with the addition of F and S to create FCB-CHOPS: fusion, contours, beams, coverage, heterogeneity, organs at risk, prescription, and dose summation. These 2 additions reflect the evolution and importance of image fusion to aid in the delineation of targets and organs at risk and dose summation to reflect the increased incidence of reirradiation and the need to consider prior treatment courses in the final plan evaluation. Utilization of this and similar checklists is critical in maintaining high-quality and safe radiation oncology treatments.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101627"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175449","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":"Identifying Nutritional Inequities of Patients with Cancer Residing in Food Deserts","authors":"Lara LePore BS ,&nbsp;Dahlia Kronfli MD ,&nbsp;Kaysee Baker MS ,&nbsp;Caitlin Eggleston BS ,&nbsp;Kaitlin Schotz RD, LDN, CSO ,&nbsp;Amber S. Kleckner PhD ,&nbsp;Søren M. Bentzen PhD, DMSc, FASTRO ,&nbsp;Pranshu Mohindra MD, MBBS ,&nbsp;Melissa A.L. Vyfhuis MD, PhD","doi":"10.1016/j.adro.2024.101641","DOIUrl":"10.1016/j.adro.2024.101641","url":null,"abstract":"<div><h3>Purpose</h3><div>Nutrition is essential for cancer care, and patients who reside in food priority areas (FPAs) may experience limited access to healthy meals. There are few data evaluating the consequence of residing in FPAs because it relates to perceived food insecurity, psychosocial needs, or nutritional status of patients with cancer. This study aimed to determine the nutritional and psychosocial needs of patients with cancer who do and do not reside in FPAs.</div></div><div><h3>Methods and Materials</h3><div>From May 2019 to December 2022, a cross-sectional analysis was conducted using a validated questionnaire, offered at various time points before and after therapy, evaluating the psychosocial needs of patients with curable cancers. Groups were compared using X² and Mann-Whitney <em>U</em> tests as appropriate. Binary logistic regression was used to identify predictors of food insecurity.</div></div><div><h3>Results</h3><div>Survey compliance was 74% (n = 320 of 434 patients). Patients who resided in FPAs (26%; n = 114) were more likely to self-identify as Black (60.5% vs 39.5%; <em>P</em> &lt; .001), single (70% vs 37%; <em>P</em> &lt; .001), and have a lower median income ($47,225 vs $91,305; <em>P</em> &lt; .001) when compared with non-FPA residents. Residents of FPAs had a higher unmet nutritional needs index (median nutritional unmet needs score: 2.42 vs 2.00; <em>P</em> = .003), which included higher demands for healthier food choices (67.6% vs 54.4; <em>P</em> = .047) and greater food insecurity (44.4% vs 19.9%; <em>P</em> = .002). FPA residence was associated with a 3-fold increased risk of food insecurity (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.59-6.57; <em>P</em> &lt; .001). On multivariate analysis, predictors for food insecurity included Black race (OR, 9.46; 95% CI, 3.93-22.76; <em>P</em> &lt; .001), stage (stage IV vs l OR, 4.27; 95% CI, 1.12-16.34; <em>P</em> = .034), and recurrent disease (OR, 10.26; 95% CI, 2.29-46.09; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>Inequities were identified in patients residing in FPAs, where race and higher stage were important predictors of food insecurity. Demographics can be readily used by clinicians to identify high-risk patients early in their cancer care in order to provide continuous nutritional resources to improve food insecurity perceptions. Future prospective studies are needed to confirm if such interventions improve cancer outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101641"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174835","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":"Hypofractionated Radiation Therapy for Subcutaneous Rosai-Dorfman Disease: A Case Report","authors":"Rachael M. Guenzel DNP ,&nbsp;William G. Breen MD ,&nbsp;Ronald S. Go MD ,&nbsp;Andrew L. Feldman MD ,&nbsp;Scott C. Lester MD","doi":"10.1016/j.adro.2024.101710","DOIUrl":"10.1016/j.adro.2024.101710","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101710"},"PeriodicalIF":2.2,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078256","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 Comparison of Noncoplanar VMAT Without Rotating the Patient Couch Versus Conventional Coplanar/Noncoplanar VMAT for Head and Neck Cancer: First Report of Dynamic Swing Arc","authors":"Kouta Hirotaki MS ,&nbsp;Kento Tomizawa MD, PhD ,&nbsp;Satoe Kitou BS ,&nbsp;Shunta Jinno MS ,&nbsp;Shunsuke Moriya PhD ,&nbsp;Takeshi Fujisawa MD ,&nbsp;Sadamoto Zenda MD, PhD ,&nbsp;Takeji Sakae PhD ,&nbsp;Masashi Ito BS","doi":"10.1016/j.adro.2024.101706","DOIUrl":"10.1016/j.adro.2024.101706","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective planning study aimed to verify the usefulness of a clinically available method, dynamic swing arc (DSA), a noncoplanar volumetric modulated arc therapy (VMAT) technique, of the new accelerator OXRAY for head and neck squamous cell carcinoma (HNSCC). We performed dosimetric comparisons between DSA and conventional coplanar/noncoplanar VMAT (C-VMAT/NC-VMAT) plans for HNSCC.</div></div><div><h3>Methods and Materials</h3><div>We selected 32 patients with oropharyngeal and hypopharyngeal cancer treated with C-VMAT at National Cancer Center Hospital East between September 2018 and July 2023. DSA and C/NC-VMAT plans were generated using OXRAY and TrueBeam, respectively. DSA employed noncoplanar 2-arc beams with an O-ring gantry swing, whereas C-VMAT and NC-VMAT used coplanar and noncoplanar 2-arc beams, respectively. Dosimetric parameters, normal tissue complication probability, and delivery times were compared pairwise using the Wilcoxon signed-rank test with Bonferroni correction.</div></div><div><h3>Results</h3><div>For high-risk planning target volume (PTV), D98 values in NC-VMAT plans were closest to the prescribed dose, significantly differing from C-VMAT and DSA plans. DSA plans showed significantly better median conformity and homogeneity indices (0.97 and 7.33, respectively) compared to C-VMAT (0.95 and 8.36) and NC-VMAT (0.96 and 7.96) plans. DSA plans significantly reduced the mean ipsilateral/contralateral parotid gland dose by 5.78/6.93 and 2.88/1.56 Gy (median) compared to C-VMAT and NC-VMAT. NC-VMAT and DSA plans significantly decreased the mean oral cavity dose by 2.16 and 3.22 Gy (median) compared to C-VMAT. DSA plans had the lowest median normal tissue complication for xerostomia with significant differences, followed by NC-VMAT and C-VMAT. The delivery time for DSA plans was longer than VMAT (151 seconds vs 124 seconds), but shorter than NC-VMAT.</div></div><div><h3>Conclusions</h3><div>DSA plans using OXRAY for HNSCC maintained PTV coverage while reducing parotid gland and oral cavity mean doses compared to coplanar VMAT plans, although delivery times increased. DSA plans reduced parotid gland doses and delivery times compared to noncoplanar VMAT plans.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101706"},"PeriodicalIF":2.2,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094115","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 the Number of Administered Systemic Treatment Lines on Local Response to Radiation Therapy for Multiple Myeloma","authors":"Andrea Emanuele Guerini MD ,&nbsp;Eneida Mataj MD ,&nbsp;Paolo Borghetti MD ,&nbsp;Luca Triggiani ,&nbsp;Ludovica Pegurri MD ,&nbsp;Stefania Nici ,&nbsp;Stefano Riga ,&nbsp;Alessandra Tucci MD ,&nbsp;Angelo Belotti MD ,&nbsp;Marco Lorenzo Bonù MD ,&nbsp;Giorgio Facheris MD ,&nbsp;Stefano Maria Magrini ,&nbsp;Luigi Spiazzi ,&nbsp;Michela Buglione","doi":"10.1016/j.adro.2024.101696","DOIUrl":"10.1016/j.adro.2024.101696","url":null,"abstract":"<div><h3>Purpose</h3><div>Multiple myeloma (MM) tends to develop resistance to systemic therapy through multiple mechanisms that might as well induce radioresistance, as suggested by preclinical studies. The aim of the present analysis was to elucidate whether the number of systemic treatment lines received prior to radiation therapy (RT) might confer radioresistance and influence local response.</div></div><div><h3>Methods and Materials</h3><div>This single-center retrospective study enrolled patients who received RT for MM at our institution between January 1, 2005, and January 31, 2023. Information regarding RT, systemic therapy, and characteristics of the patients and disease were retrieved from medical records. The primary outcome for this analysis was radiologic local response at 6 months after RT, according to RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) or PERCIST 1.0 (Positron Emission Tomography Response Criteria in Solid Tumors) criteria. The secondary outcome was toxicity reported during the RT course.</div></div><div><h3>Results</h3><div>Data from 665 MM lesions from 366 patients were analyzed. Data regarding local response at 6 months were available for 217 lesions, reporting 29 complete responses (13.4%), 141 partial responses (65%), 42 stable diseases (19.4%), and only 5 disease progressions (2.3%). The number of previous systemic treatment lines had no impact on radiologic response at 6 months (<em>p</em> = .721). RT BED₁₀ (Biologically Effective Dose) had a significant impact on response at 6 months (<em>p</em> = .007). The toxicity profile was optimal, as grade &gt; 2 events during RT were reported only in 0.9% of cases.</div></div><div><h3>Conclusions</h3><div>In this large retrospective cohort of MM patients, the number of systemic treatment lines administered before RT had no impact on the local response, confuting concerns of cross-resistance raised by multiple preclinical studies. Disease control after RT was optimal, and instances of severe toxicities during treatment were rare.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101696"},"PeriodicalIF":2.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094117","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}