Advances in Radiation Oncology最新文献

{"title":"Severe Treatment-Related Toxicity in Oral Cavity Squamous Cell Carcinoma with Dyskeratosis Congenita: A Case Report and Critical Review of Radiation-Induced Complications","authors":"Rufus Banks BS, Akul Munjal MD, Erin Healy MD, Jeremy P. Harris MD, MPhil","doi":"10.1016/j.adro.2025.101828","DOIUrl":"10.1016/j.adro.2025.101828","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101828"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634358","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":"Interstitial High-Dose-Rate Brachytherapy for Radiorecurrent Atypical Meningioma: A Brief Report.","authors":"William Delery, Michael Kim, Regan Laird, Erika Jank, Eulanca Liu, Kayla Kafka, Sang-June Park, Tania Kaprealian, Katelyn Chang, Richard Everson, Won Kim, Ricky Savjani","doi":"10.1016/j.adro.2025.101858","DOIUrl":"10.1016/j.adro.2025.101858","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"101858"},"PeriodicalIF":2.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12351179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870848","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":"Proton Therapy for Uveal Melanoma on a Pencil Beam Scanning Gantry","authors":"Hang Qi PhD ,&nbsp;Lei Hu PhD ,&nbsp;Sheng Huang PhD ,&nbsp;Yen-Po Lee MS ,&nbsp;Qing Chen MS ,&nbsp;Francis Yu MS ,&nbsp;Huifang Zhai MS ,&nbsp;Yunjie Yang PhD ,&nbsp;Minglei Kang PhD ,&nbsp;Peter Park CMD ,&nbsp;Andy Shim CMD ,&nbsp;Xiaoxuan Xu PhD ,&nbsp;David H. Abramson MD ,&nbsp;Jasmine H. Francis MD ,&nbsp;Arpit Chhabra MD ,&nbsp;Charles B. Simone II, MD ,&nbsp;Christopher A. Barker MD ,&nbsp;Haibo Lin PhD","doi":"10.1016/j.adro.2025.101782","DOIUrl":"10.1016/j.adro.2025.101782","url":null,"abstract":"<div><h3>Purpose</h3><div>We present our experience treating ocular tumors in a standard pencil beam scanning (PBS) gantry room without apertures, which could broaden access to proton therapy for patients with ocular cancer globally. Besides, this study explores the dosimetric benefits of beam-specific apertures.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively evaluated 11 consecutive patients with uveal melanoma treated in a clinic gantry room. The dose deviations between the planned and received by the patient were investigated by assessing the forward calculation of the treatment plan on the synthetic computed tomography of cone beam computed tomography. Each plan was forward calculated with a beam-specific brass aperture (BSA) using a Monte Carlo algorithm to explore dosimetric improvements. We compared the plan quality to the delivered plan (DP) using target coverage (D95%) and mean/maximum doses to the adjacent organs.</div></div><div><h3>Results</h3><div>A close agreement between the planned and delivered dose was achieved, with D95% deviations within 3.6% for all treatments, maintaining dose constraints for critical organs. Similar target coverage was reached, with D95% at 101% ± 1.0% (DP) and 101% ± 3.2% (BSA). BSA was effective (<em>P</em> &lt; .05) in reducing the mean [<em>D</em>_Mean (DP, BSA)Gy] and maximum [<em>D</em>_Max (DP, BSA)Gy] dose to organs: retina <em>D</em>_Mean (37.7, 29.5), cornea <em>D</em>_Mean (10.7, 2.4), conjunctiva <em>D</em>_Mean (13.6, 4.1), lacrimal gland <em>D</em>_Mean (25.5, 14.1), optic nerve <em>D</em>_Mean (19.6, 13.1), lens <em>D</em>_Max (22.4, 8.5), cornea <em>D</em>_Max (24.4, 10.2), eyebrow <em>D</em>_Max (15.3, 6.8). BSA lowered the mean dose to surrounding organs and significantly decreased the maximum dose to nonabutting organs (lens, cornea, eyebrow), but had little impact on the maximum dose to the abutting organs (retina, optic nerve).</div></div><div><h3>Conclusions</h3><div>We demonstrate the successful implementation of ocular proton treatment with a standard PBS gantry beamline without apertures. The beam-specific apertures effectively reduced doses to the organs adjacent to the target in the PBS proton treatment while maintaining similar target coverage. This approach offers an opportunity to expand access to ocular proton therapy widely.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101782"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614596","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":"Concurrent Radiation and Immunotherapy for Unresectable Hepatocellular Carcinoma With Extensive Portal Vein Tumor Thrombus","authors":"Nithya Krishnamurthy BA ,&nbsp;Daniel Cherry MD ,&nbsp;Carlos Rodriguez-Russo MD ,&nbsp;Michael Buckstein MD","doi":"10.1016/j.adro.2025.101856","DOIUrl":"10.1016/j.adro.2025.101856","url":null,"abstract":"<div><h3>Purpose</h3><div>While immunotherapy has been established as the standard of care for patients with Barcelona Clinic for Liver Cancer class C hepatocellular carcinoma (HCC), outcomes for patients with portal vein thrombus (PVT) remain poor. This study evaluates the benefit of radiation therapy (RT) in addition to immunotherapy for patients with advanced PVT.</div></div><div><h3>Methods and Materials</h3><div>A retrospective chart screen was performed to identify patients with HCC with PVT treated with definitive RT with concurrent (defined as within 6 weeks) immunotherapy. Kaplan-Meier survival analysis was performed to assess progression-free survival (PFS) and overall survival (OS). Cox proportional hazard modeling was employed for each covariate using R software version 4.3.3.</div></div><div><h3>Results</h3><div>Sixty-two patients met the inclusion criteria from 2016 to 2023. The median follow-up was 18.9 months. Most patients were male (85.8%), with a median age of 64, and 61% had Child-Turcotte-Pugh (CTP) A liver function. Treatments included stereotactic body RT (61%) or fractionated RT (39%) with immunotherapy (74% single-agent). Portal vein tumor thrombosis classifications were Vp3 (47%) and Vp4 (45%). Median overall PFS was 3.70 months, and OS was 7.7 months. Patients with CTP A had better outcomes (PFS 5.3 months, OS 10.2 months; PFS hazard ratio 2.13, OS hazard ratio 3.08, <em>P</em> &lt; .05). There was no significant difference in PFS or OS for patients who received single-agent immunotherapy with radiation versus multiagent immunotherapy (atezolizumab-bevacizumab) with radiation. Multivariate analysis identified no other significant predictors.</div></div><div><h3>Conclusions</h3><div>The addition of radiation to immunotherapy may improve outcomes for patients with advanced PVT with HCC who have inferior outcomes with immunotherapy alone. Particularly for patients with CTP A liver function who would be eligible for clinical trials, the addition of radiation may improve OS beyond reported outcomes. Prospective studies are needed to verify these results.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101856"},"PeriodicalIF":2.7,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827704","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":"Remarkable Resolution of Radiation Necrosis Post-Obsessive-Compulsive Disorder Radiosurgery With Boswellia Serrata: Case Report","authors":"Rituraj Upadhyay MD ,&nbsp;Pavnesh Kumar MD ,&nbsp;Raj Singh MD,&nbsp;Raju R. Raval MD,&nbsp;Joshua D. Palmer MD,&nbsp;Evan M. Thomas MD, PhD","doi":"10.1016/j.adro.2025.101860","DOIUrl":"10.1016/j.adro.2025.101860","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101860"},"PeriodicalIF":2.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010366","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 Parameters Associated With Intracranial Progression Burden Following an Initial Stereotactic Radiosurgery Course in a Multi-institutional Brain Metastases Cohort","authors":"Christina C. Huang MD, MS ,&nbsp;David J. Carpenter MD, MS ,&nbsp;Jim Leng MD ,&nbsp;Jamiluddin Qazi MD ,&nbsp;Brahma Natarajan MD ,&nbsp;Muzamil Arshad MD, PhD ,&nbsp;Michael J. Moravan MD, PhD ,&nbsp;Eugene J. Vaios MD ,&nbsp;Zachary J. Reitman MD, PhD ,&nbsp;John P. Kirkpatrick MD, PhD ,&nbsp;Scott R. Floyd MD, PhD ,&nbsp;Steven J. Chmura MD, PhD ,&nbsp;Julian C. Hong MD, MS ,&nbsp;Joseph K. Salama MD ,&nbsp;Trey C. Mullikin MD","doi":"10.1016/j.adro.2025.101859","DOIUrl":"10.1016/j.adro.2025.101859","url":null,"abstract":"<div><h3>Purpose</h3><div>Following initial stereotactic radiosurgery (SRS), risk factors for high-burden intracranial progression (ICP) necessitating whole brain radiation remain poorly characterized. We hypothesize that specific clinical parameters at initial SRS are associated with high-burden ICP—defined as either ≥5 brain metastases (BMs) (ICP5) or ≥11 BMs (ICP11).</div></div><div><h3>Materials and Methods</h3><div>Across 2 institutions, we retrospectively identified all patients completing an initial SRS course from January 2015 to December 2020. ICP was defined as any radiographic concern for distant and/or in-field progression. Overall survival (OS) and freedom from ICP were estimated via the Kaplan-Meier method. Cox models assessed the association between clinical parameters and freedom from ICP5 and ICP11.</div></div><div><h3>Results</h3><div>We identified 1383 patients completing SRS. Post-SRS ICP was identified for 555 (40.1%) patients: 72.6% had 1 to 4 progressive BMs, 11.5% had 5 to 10 BMs, and 15.9% had ≥11 new BMs. Among these groups, 12-month OS was 56.8% (95% CI: 52.1%-61.9%), 46.0% (95% CI: 35.1%-60.1%), and 38.7% (95% CI: 29.4%-50.9%), respectively (<em>P</em> &lt; .001). Neurologic symptoms at ICP were observed in 21.1%, 28.1%, and 50.0% of cases, respectively (<em>P &lt;</em> .001). Oligometastatic disease at the time of SRS [ICP5: hazard ratio (HR) 0.68, 95% CI: 0.47-0.99; ICP11: 0.59; 95% CI: 0.36-0.97], no pre-SRS immunotherapy (ICP11: HR 1.74, 95% CI: 1.03-2.97), receipt of post-SRS immunotherapy (ICP5: HR 0.60, 95% CI: 0.402-0.906; ICP11: HR 0.57, 95% CI: 0.332-0.988), and a single BM at initial SRS (1 vs 2 BM, ICP 5: HR 0.51, 95% CI: 0.31-0.82; ICP11: HR 0.45, 95% CI: 0.24-0.84) were negative predictive factors of high-burden ICP.</div></div><div><h3>Conclusions</h3><div>High-burden ICP was associated with decreased OS and neurologic decline. Patients who had oligometastatic disease, who received post-SRS immunotherapy, who did not receive pre-SRS immunotherapy, and who had a single BM had improved freedom from high-burden ICP. These findings may justify consideration of upfront whole brain radiation for those at risk for high-burden ICP and prospective analysis of short-interval post-SRS surveillance in this population.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101859"},"PeriodicalIF":2.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763860","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":"Prospective Phase II Trial of Definitive Chemoradiation and Concurrent Nivolumab in Locally Advanced p16+ Oropharynx Cancer","authors":"Samuel Nicholas Regan MD ,&nbsp;Jennifer Shah MD ,&nbsp;Krithika Suresh PhD ,&nbsp;Krystal A. Morales MD, PhD ,&nbsp;Yue Cao PhD ,&nbsp;Madhava Aryal PhD ,&nbsp;Benjamin S. Rosen PhD ,&nbsp;Heather Walline PhD ,&nbsp;Choonik Lee PhD ,&nbsp;Jessica Aldous BS ,&nbsp;Paul L. Swiecicki MD ,&nbsp;Keith A. Casper MD ,&nbsp;Steven B. Chinn MD ,&nbsp;Kelly M. Malloy MD ,&nbsp;Mark E.P. Prince MD ,&nbsp;Chaz L. Stucken MD ,&nbsp;Andrew G. Shuman MD ,&nbsp;Molly Heft-Neal MD ,&nbsp;Teresa H. Lyden MA, CCC-SLP ,&nbsp;Anna Blakely MA, CCC-SLP ,&nbsp;Michelle L. Mierzwa MD","doi":"10.1016/j.adro.2025.101832","DOIUrl":"10.1016/j.adro.2025.101832","url":null,"abstract":"<div><h3>Purpose</h3><div>We conducted a prospective, single-institution phase II trial to test the hypothesis that the addition of nivolumab to definitive chemoradiation would improve the progression-free survival (PFS) among patients with high-risk p16+ oropharyngeal squamous cell carcinoma (OPSCC).</div></div><div><h3>Methods and Materials</h3><div>Patients with previously-untreated locoregionally advanced, p16+ OPSCC (clinical T4/N3, matted lymph nodes, and/or retropharyngeal lymphadenopathy) were enrolled. Patients received a priming dose of nivolumab, concurrent nivolumab and chemoradiation (70 Gy to PTVhigh, 56 Gy to PTVlow, weekly carboplatin/paclitaxel), and 4 cycles of adjuvant nivolumab over 12 weeks. The primary endpoint was 2-year PFS compared to an institutional historic control of 68%. Exploratory endpoints included associations between survival and circulating tumor DNA kinetics during treatment and pretreatment/midtreatment ¹⁸F-fluorodeoxyglucose positron-emission tomography with computed tomography and magnetic resonance imaging metrics (gross tumor volume, low blood volume tumor subvolume, low apparent diffusion coefficient tumor subvolume, and metabolic tumor volume ≥50% of maximum standardized uptake value).</div></div><div><h3>Results</h3><div>Twenty-six patients were enrolled prior to an interim analysis; 65% cT4, 46% with matted nodes, with a median total gross tumor volume of 60 cc (range, 36-165). Estimated 2-year PFS was 65% (2-sided 90% CI, 46%-79%) and 2-year distant metastasis-free survival was 84% (66%-93%). The majority (69%) did not complete the full course of nivolumab because of toxicity, and 54% experienced grade ≥3 acute dysphagia. Statistical analyses showed that increasing values of imaging-defined primary tumor subvolumes were significant associated with inferior PFS (eg, midtreatment low apparent diffusion coefficient: HR, 5.61; <em>P</em> = .05) and distant metastasis-free survival (eg, pretreatment metabolic tumor volume ≥50% of maximum standardized uptake value: HR, 2.97; <em>P</em> = .05). Midtreatment circulating tumor DNA kinetics were not associated with survival endpoints.</div></div><div><h3>Conclusions</h3><div>Concurrent and adjuvant nivolumab did not improve PFS in locoregionally advanced Human papillomavirus+ OPSCC and was associated with significant toxicity. Physiological magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron-emission tomography with computed tomography imaging markers are potential biomarkers to guide future therapy escalation strategies in high-risk oropharynx cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101832"},"PeriodicalIF":2.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827705","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":"Deep Learning-Based Cardiac Chamber Segmentation in Magnetic Resonance-Guided Adaptive Radiation Therapy","authors":"Xinru Chen PhD ,&nbsp;Yao Ding PhD ,&nbsp;Julius Weng MD ,&nbsp;Carol C. Wu MD ,&nbsp;Yao Zhao PhD ,&nbsp;Angela Sobremonte BS ,&nbsp;Mustefa Mohammedsaid MS ,&nbsp;Zhan Xu PhD ,&nbsp;Xiaodong Zhang PhD ,&nbsp;Joshua S. Niedzielski PhD ,&nbsp;Sanjay S. Shete PhD ,&nbsp;Laurence E. Court PhD ,&nbsp;Zhongxing Liao MD ,&nbsp;Jihong Wang PhD ,&nbsp;Ergys Subashi PhD ,&nbsp;Percy P. Lee MD ,&nbsp;Jinzhong Yang PhD","doi":"10.1016/j.adro.2025.101845","DOIUrl":"10.1016/j.adro.2025.101845","url":null,"abstract":"<div><h3>Purpose</h3><div>Accurate cardiac chamber segmentation is crucial for improving cardiac sparing in magnetic resonance (MR)-guided adaptive radiation therapy, especially in patients at risk for radiation-induced cardiotoxicity. Here, we developed and evaluated automatic segmentation models for cardiac chambers that use daily MR images acquired on a 1.5-T MR-Linac system.</div></div><div><h3>Methods and Materials</h3><div>Twenty healthy volunteers underwent daily MR scanning on a 1.5-T MR-Linac, with 2 radial sequences: T2/T1 3DVaneXD balanced fast field echo with spectral attenuated inversion recovery (bFFE-SPAIR) and T1 3DVaneXD mDixon. Three flip angles were tested for each sequence to determine optimal image quality for chamber segmentation. Full-resolution 3D nnU-Net models were trained for the following: (1) bFFE-SPAIR (bFFE model); (2) T1 mDixon (mDixon model); and (3) both sequences (hybrid model). Models were evaluated based on Dice similarity coefficient (DSC) and mean surface distance against manual contours. Clinical acceptance of the automatic segmentation was assessed with a 5-point Likert scale. An in-silico planning study was performed to assess cardiac chamber sparing during plan adaptation.</div></div><div><h3>Results</h3><div>The average contrast-to-noise ratios in bFFE-SPAIR were 8.7 (20°), 34.2 (50°), and 37.3 (80°); for T1 mDixon, these values were 3.6 (5°), 5.9 (10°), and 4.9 (20°). The bFFE model achieved the highest segmentation performance (average DSC 0.85 ± 0.05 and mean surface distance 2.2 ± 0.6 mm). The T1 mDixon sequence, despite lower contrast-to-noise ratios, provided similar segmentation accuracy (DSC 0.83 ± 0.06). A hybrid model combining both sequences showed no significant improvement over the bFFE model. Clinical evaluation indicated that 95% of the autosegmented contours from the bFFE model were acceptable for clinical use (score ≥4). Adaptive plan greatly reduced individual cardiac chamber dose while maintaining similar target coverage.</div></div><div><h3>Conclusions</h3><div>This study demonstrated the feasibility of using bFFE-SPAIR and T1 mDixon sequences to accurately segment cardiac chambers on a 1.5-T MR-Linac. These models offer potential for improved cardiac sparing in MR-guided adaptive radiation therapy.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101845"},"PeriodicalIF":2.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770559","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":"Impact of Normal Lung Volume Choices on Radiation Pneumonitis Risk Prediction in Locally Non-small Cell Lung Cancer Radiation Therapy","authors":"Alyssa Gadsby MS,&nbsp;Tian Liu PhD,&nbsp;Robert Samstein MD,&nbsp;Jiahan Zhang PhD,&nbsp;Yang Lei PhD,&nbsp;Kenneth E. Rosenzweig MD,&nbsp;Ming Chao PhD","doi":"10.1016/j.adro.2025.101825","DOIUrl":"10.1016/j.adro.2025.101825","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the impact of varying definitions of normal lung volume on the prediction of radiation pneumonitis (RP) risk in patients with locally advanced non-small cell lung cancer undergoing radiation therapy.</div></div><div><h3>Methods and Materials</h3><div>Dosimetric variables V20, V5, and mean lung dose (MLD) were extracted from the treatment plans of 442 patients enrolled in the NRG Oncology Radiation Therapy Oncology Group 0617 trial. Three different definitions of lung volume were evaluated: total lung excluding gross tumor target, total lung excluding clinical target volume, and total lung excluding planning target volume (TL-PTV). Patients were grouped as “no-RP2” (<em>N</em> = 377, grade ≤1 RP) and “RP2” (<em>N</em> = 65, grade ≥2 RP). Statistical analyses were performed to assess the effect of lung volume definition on RP2 prediction. Three supervised machine learning models—logistic regression, k-nearest neighbor (kNN), and eXtreme Gradient Boosting—were used to evaluate predictive performance. Model performance was quantified using the area under the receiver operating characteristic curve, and statistical significance was tested via a bootstrap analysis. Shapley Additive Explanations (SHAP) were applied to interpret feature contributions to model predictions.</div></div><div><h3>Results</h3><div>Statistical analyses showed that V20 and MLD were significantly associated with RP2, while differences among the lung volume definitions were not statistically significant. Both k-nearest neighbor and eXtreme Gradient Boosting classifiers consistently yielded higher area under the receiver operating characteristic curve values for the TL-PTV definition compared to the other definitions, a finding supported by bootstrap analysis. SHAP analysis further indicated that V20 and MLD were the most influential predictors of RP2.</div></div><div><h3>Conclusions</h3><div>In line with previous studies, both statistical analysis and SHAP interpretation confirmed that V20 and MLD were associated with RP2. The machine learning models indicated that defining normal lung volume as TL-PTV yielded the highest predictive performance for RP2 risk. Further validation using external data sets are warranted to confirm these findings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101825"},"PeriodicalIF":2.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144536247","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":"Dosimetric Clues to Addressing Urinary Toxicity Following Stereotactic Prostate Radiation Therapy","authors":"Michael Cardoso MBBS ,&nbsp;Matthew Richardson BMedRadSc ,&nbsp;Phillip Chlap MSc ,&nbsp;Sarah Keats BSc ,&nbsp;Alan Glyde BSc ,&nbsp;Sankar Arumugam PhD ,&nbsp;David Pryor MBBS ,&nbsp;Joseph Bucci MBBS ,&nbsp;Jarad Martin PhD ,&nbsp;Mark Sidhom MBBS","doi":"10.1016/j.adro.2025.101850","DOIUrl":"10.1016/j.adro.2025.101850","url":null,"abstract":"<div><h3>Purpose</h3><div>Delayed genitourinary (GU) toxicity is reported following definitive stereotactic body radiation therapy (SBRT) for prostate cancer in 15% to 30% of patients. The purpose of this study is to investigate whether there is a relationship between radiation dose to the bladder and urethra and GU toxicity grade ≥ 2 (National Cancer Institute Common Terminology Criteria for Adverse Events 4.0) in patients treated with SBRT.</div></div><div><h3>Methods and Materials</h3><div>PROstate Multicenter External beam radioTHErapy Using Stereotactic boost was a phase 2 multicenter trial exploring an SBRT boost of 19 to 20 Gy in 2 fractions to the prostate combined with fractionated external beam radiation therapy as a virtual high-dose-rate brachytherapy boost for patients with prostate cancer. Several bladder and urethral constraints were mandated prospectively. Bladder and the urethral planning organ at risk volume (PRV) dosimetry was correlated with physician-reported GU toxicity for patients ≥ 6 months following SBRT. An association between prior transurethral resection of the prostate (TURP) and urinary toxicity was also examined. Univariant and multivariate analyses were performed.</div></div><div><h3>Results</h3><div>Of the 151 patients, 87 had complete dosimetric data, and these patients were included in this analysis. In this cohort, 19.5% experienced grade ≥ 2 GU toxicity more than 6 months after stereotactic radiation therapy. On univariate analysis, prostatic urethral length, urethral PRV volume, bladder D2 cc, D5 cc, D10 cc, D15 cc, and bladder V8 were predictive of GU toxicity (all <em>P</em> &lt; .05). In the 14 patients who had prior TURP, 6 (43%) experienced GU toxicity compared with 15% for those without prior TURP (<em>P</em> = .015). Multivariate analysis showed that prostatic urethral length, urethral PRV volume, bladder 10 cc, and bladder 15 cc remained statistically significant factors predicting GU toxicity.</div></div><div><h3>Conclusions</h3><div>Prostate SBRT delivered as a virtual high-dose-rate boost is well tolerated overall. However, delayed GU toxicity is experienced by a significant minority of patients. Additional bladder constraints including D10 cc &lt; 17 Gy and D15 cc &lt; 15 Gy may further reduce the risk of delayed GU toxicity. Prior TURP may be a plausible additional risk factor.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101850"},"PeriodicalIF":2.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144696977","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}