Advances in Radiation Oncology最新文献

{"title":"Automatic Treatment Planning for Radiation Therapy: A Cross-Modality and Protocol Study","authors":"Gregory Szalkowski PhD ,&nbsp;Xuanang Xu PhD ,&nbsp;Shiva Das PhD ,&nbsp;Pew-Thian Yap PhD ,&nbsp;Jun Lian PhD","doi":"10.1016/j.adro.2024.101649","DOIUrl":"10.1016/j.adro.2024.101649","url":null,"abstract":"<div><h3>Purpose</h3><div>This study investigated the applicability of 3-dimensional dose predictions from a model trained on one modality to a cross-modality automated planning workflow. Additionally, we explore the impact of integrating a multicriteria optimizer (MCO) on adapting predictions to different clinical preferences.</div></div><div><h3>Methods and Materials</h3><div>Using a previously created 3-stage U-Net in-house model trained on the 2020 American Association of Physicists in Medicine OpenKBP challenge data set (340 head and neck plans, all planned using 9-field static intensity modulated radiation therapy [IMRT]), we retrospectively generated dose predictions for 20 patients. These dose predictions were, in turn, used to generate deliverable IMRT, VMAT, and tomotherapy plans using the fallback plan functionality in Raystation. The deliverable plans were evaluated against the dose predictions based on primary clinical goals. A new set of plans was also generated using MCO-based optimization with predicted dose values as constraints. Delivery QA was performed on a subset of the plans to assure clinical deliverability.</div></div><div><h3>Results</h3><div>The mimicking approach accurately replicated the predicted dose distributions across different modalities, with slight deviations in the spinal cord and external contour maximum doses. MCO optimization significantly reduced doses to organs at risk, which were prioritized by our institution while maintaining target coverage. All tested plans met clinical deliverability standards, evidenced by a gamma analysis passing rate &gt;98%.</div></div><div><h3>Conclusions</h3><div>Our findings show that a model trained only on IMRT plans can effectively contribute to planning across various modalities. Additionally, integrating predictions as constraints in an MCO-based workflow, rather than direct dose mimicking, enables a flexible, warm-start approach for treatment planning, although the benefit is reduced when the training set differs significantly from an institution's preference. Together, these approaches have the potential to significantly decrease plan turnaround time and quality variance, both at high-resource medical centers that can train in-house models and smaller centers that can adapt a model from another institution with minimal effort.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101649"},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572720","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 Artificial Intelligence-Based Autosegmentation of Organs at Risk in Low- and Middle-Income Countries","authors":"Solomon Kibudde MBChB, MMed ,&nbsp;Awusi Kavuma PhD ,&nbsp;Yao Hao PhD ,&nbsp;Tianyu Zhao PhD ,&nbsp;Hiram Gay MD ,&nbsp;Jacaranda Van Rheenen PhD ,&nbsp;Pavan Mukesh Jhaveri MD ,&nbsp;Minjmaa Minjgee MD, PhD ,&nbsp;Enkhsetseg Vanchinbazar MSc ,&nbsp;Urdenekhuu Nansalmaa MD, PhD, MPH ,&nbsp;Baozhou Sun PhD, MBA, DABR","doi":"10.1016/j.adro.2024.101638","DOIUrl":"10.1016/j.adro.2024.101638","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) processes require significant human resources and expertise, creating a barrier to rapid RT deployment in low- and middle-income countries (LMICs). Accurate segmentation of tumor targets and organs at risk (OARs) is crucial for optimal RT. This study assessed the impact of artificial intelligence (AI)-based autosegmentation of OARs in 2 LMICs.</div></div><div><h3>Methods and Materials</h3><div>Ten patients, comprising 5 head and neck (HN) cancer patients and 5 prostate cancer patients, were randomly selected. Planning computed tomography images were subjected to autosegmentation using an Food and Drug Administration-approved AI software tool and manual segmentation by experienced radiation oncologists from 2 LMIC RT clinics. The control data, obtained from a large academic institution in the United States, consisted of contours obtained by an experienced radiation oncologist. The segmentation time, DICE similarity coefficient (DSC), Hausdorff distance, and mean surface distance were evaluated.</div></div><div><h3>Results</h3><div>AI significantly reduced segmentation time, averaging 2 minutes per patient, compared with 57 to 84 minutes for manual contouring in LMICs. Compared with the control data, the AI pelvic contours provided better agreement than did the LMIC manual contours (mean DSC of 0.834 vs 0.807 in LMIC1 and 0.844 vs 0.801 in LMIC2). For HN contours, AI provided better agreement for the majority of OAR contours than manual contours in LMIC1 (mean DSC: 0.823 vs 0.821) or LMIC2 (mean DSC: 0.792 vs 0.748). Neither the AI nor LMIC manual contours had good agreement with the control data (DSC &lt; 0.600) for the optic nerves, chiasm, and cochlea.</div></div><div><h3>Conclusions</h3><div>AI-based autosegmentation generates OAR contours of comparable quality to manual segmentation for both pelvic and HN cancer patients in LMICs, with substantial time savings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101638"},"PeriodicalIF":2.2,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427441","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":"Impacts of Intrafraction Virtual Reality-Based Environment Modification on Procedural Anxiety, Heart Rate, and Overall Radiation Therapy Experience During External Beam Radiation Therapy","authors":"Conley Kriegler MD ,&nbsp;Brock Debenham MD, FRCPC ,&nbsp;Michael Piva BSc, MRT(T) ,&nbsp;Michelle Bernardo BSc, MRT(T) ,&nbsp;Amanda Bylhouwer BSc, MRT(T) ,&nbsp;Tina Karim BSc, MRT(T) ,&nbsp;Yiming Michael Zhu MD ,&nbsp;Giselle Tucker Belliveau BHS, MHS ,&nbsp;Benjamin Merrick BSc, MBDC ,&nbsp;Mustafa Al Balushi MD, FRCPC","doi":"10.1016/j.adro.2024.101640","DOIUrl":"10.1016/j.adro.2024.101640","url":null,"abstract":"<div><h3>Purpose</h3><div>Procedural anxiety of cancer treatments may negatively impact patients and treatments. Mindfulness-promoting environment modification with virtual reality (VR) is increasingly used across medicine to minimize procedural anxiety. We aimed to assess the impacts of intrafraction mindfulness-promoting VR use during external beam radiation therapy (EBRT) on radiation therapy experience and physiological measures of distress.</div></div><div><h3>Methods and Materials</h3><div>Adult patients receiving EBRT between May and October 2023 at our institution without contraindications to wearing VR were eligible. Participants had heart rates recorded before and after EBRT and completed a post-EBRT survey for 1 treatment without intervention, and 1 using VR. Participants completed the Radiotherapy Experience Questionnaire and additional questions regarding VR. Quantitative data were compared between conditions using paired samples <em>t</em> test.</div></div><div><h3>Results</h3><div>Fifty-two participants completed the project. Between pre- and post-EBRT, a significant decrease in heart rate with VR was noted (80.35 bpm vs 71.79 bpm; <em>P</em> &lt; .0001*), but not in the control condition (78.90 bpm vs 78.10 bpm; <em>P</em> = .44). Post-EBRT heart rate was significantly lower with VR than without (71.79 bpm vs 78.10 bpm; <em>P</em> &lt; .01*). Radiotherapy Experience Questionnaire responses showed participants had significantly lower situational unease (1.46 vs 2.02; <em>P</em> &lt; .001*), a more beneficial situational response (1.55 vs 2.12; <em>P</em> &lt; .01*), and improved environment acceptance (1.30 vs 1.60; <em>P</em> &lt; .01*) when using VR. Most endorsed VR as comfortable (94%), improved treatment experience (86%), and would recommend it to others (86%).</div></div><div><h3>Conclusions</h3><div>We report the first evidence of the impacts of intrafraction mindfulness-promoting VR use during EBRT. Physiological measures of distress and patient perspectives suggest that VR can minimize procedural anxiety, is well tolerated, and improves the overall treatment experience. Further research should explore modifying this tool for patients unable to wear headsets and determining where the most clinically significant benefits can be found.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101640"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427442","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":"Microboost in Localized Prostate Cancer: Analysis of a Statewide Quality Consortium","authors":"Samuel N. Regan MD ,&nbsp;Michael Dykstra MD ,&nbsp;Huiying Yin MS ,&nbsp;Margaret Grubb MS ,&nbsp;Neil Vaishampayan BS ,&nbsp;Mark Zaki MD ,&nbsp;Mazen Mislmani MD ,&nbsp;Patrick McLaughlin MD ,&nbsp;Danielle Kendrick BS ,&nbsp;Steven Miller MD ,&nbsp;Daniel Dryden MS ,&nbsp;Murshed Khadija MS ,&nbsp;Dale Litzenberg PhD ,&nbsp;Melissa Mietzel MS ,&nbsp;Vrinda Narayana PhD ,&nbsp;David Heimburger MD ,&nbsp;Matthew Schipper PhD ,&nbsp;William C. Jackson MD ,&nbsp;Robert T. Dess MD","doi":"10.1016/j.adro.2024.101629","DOIUrl":"10.1016/j.adro.2024.101629","url":null,"abstract":"<div><h3>Purpose</h3><div>Prospective trials have reported isotoxicity and improved oncologic outcomes with external beam radiation therapy (EBRT) microboost to a dominant intraprostatic lesion. There is often variability in the rate of adoption of new treatments, and current microboost practice patterns are unknown. We leveraged prospectively collected data from the multicenter Michigan Radiation Oncology Quality Consortium to understand the current state of microboost usage for localized prostate cancer.</div></div><div><h3>Materials and Methods</h3><div>Men with intermediate- and high-risk prostate adenocarcinoma treated with curative-intent radiation between October, 26, 2020, and June, 26, 2023, were included across 26 centers. Demographic-, tumor-, and treatment-related data along with DICOM files were prospectively collected. Microboost intent was prospectively documented and DICOM-confirmed. Multivariable analyses were used to evaluate associations with microboost receipt, and mixed-effects modeling evaluated facility-level variation.</div></div><div><h3>Results</h3><div>Most patients received EBRT without brachytherapy (71%, n = 524/741). Of those, a minority received an EBRT microboost (10%, n = 53/524) at a subset of sites (27%, n = 7/26), without a change in rate over the study period (<em>P</em> = .62). Grade group 4/5 (odds ration [OR] = 2.35; 95% confidence interval [CI]: 1.02-5.28), magnetic resonance imaging planning (OR = 6.34; 95%CI: 2.16-27.12), and fiducial marker/rectal spacer placement (OR = 2.59; 95% CI: 1.14-6.70) were associated with microboost use. Significant facility-level variability was present (minimum 0%; 95% CI: 0.0-10.7 to maximum 71%; 95% CI: 55.5-83.2, unadjusted, <em>P</em> &lt; .0001). Median boost volume was 20.7cc, and median boost D98% was 94.4 EQD2Gy. Compared with non-microboost cases, intermediate doses to rectum in the microboost cohort were increased (eg, V20Gy [EQD2] of 53.8% vs 36.5%, <em>P</em> = .03). However, the proportion exceeding NRG/RTOG bladder/rectal constraints was low and not significantly different between cohorts.</div></div><div><h3>Conclusions</h3><div>Despite prospective data demonstrating its benefit, EBRT microboost was used within a diverse statewide quality consortium in only 10% of cases at 27% of sites with significant facility-level heterogeneity. Concerted efforts are required to understand current barriers to microboost utilization, and results from trials such as PIVOTALboost (ISRCTN80146950) are eagerly awaited.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101629"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427445","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":"Rotationally Intensified Proton Lattice: A Novel Lattice Technique Using Spot-Scanning Proton Arc Therapy","authors":"Joseph S. Lee MD, PhD ,&nbsp;Derek A. Mumaw MD ,&nbsp;Peilin Liu MS ,&nbsp;Bailey A. Loving MD ,&nbsp;Ebin Sebastian MBBS ,&nbsp;Xiaoda Cong MS ,&nbsp;Mark S. Stefani PhD ,&nbsp;Brian F. Loughery PhD ,&nbsp;Xiaoqiang Li PhD ,&nbsp;Rohan Deraniyagala MD ,&nbsp;Muayad F. Almahariq MD, PhD ,&nbsp;Xuanfeng Ding PhD ,&nbsp;Thomas J. Quinn MD","doi":"10.1016/j.adro.2024.101632","DOIUrl":"10.1016/j.adro.2024.101632","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to explore the feasibility and dosimetric advantage of using spot-scanning proton arc (SPArc) for lattice radiation therapy in comparison with volumetric-modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) lattice techniques.</div></div><div><h3>Methods</h3><div>Lattice plans were retrospectively generated for 14 large tumors across the abdomen, pelvis, lung, and head-and-neck sites using VMAT, IMPT, and SPArc techniques. Lattice geometries comprised vertices 1.5 cm in diameter that were arrayed in a body-centered cubic lattice with a 6-cm lattice constant. The prescription dose was 20 Gy (relative biological effectiveness [RBE]) in 5 fractions to the periphery of the tumor, with a simultaneous integrated boost of 66.7 Gy (RBE) as a minimum dose to the vertices. Organ-at-risk constraints per American Association of Physicists in Medicine Task Group 101were prioritized. Dose-volume histograms were extracted and used to identify maximum, minimum, and mean doses; equivalent uniform dose; D95%, D50%, D10%, D5%; V19Gy; peak-to-valley dose ratio (PVDR); and gradient index (GI). The treatment delivery time of IMPT and SPArc were simulated based on the published proton delivery sequence model.</div></div><div><h3>Results</h3><div>Median tumor volume was 577 cc with a median of 4.5 high-dose vertices per plan. Low-dose coverage was maintained in all plans (median V19Gy: SPArc 96%, IMPT 96%, VMAT 92%). SPArc generated significantly greater dose gradients as measured by PVDR (SPArc 4.0, IMPT 3.6, VMAT 3.2; SPArc-IMPT <em>P</em> = .0001, SPArc-VMAT <em>P</em> &lt; .001) and high-dose GI (SPArc 5.9, IMPT 11.7, VMAT 17.1; SPArc-IMPT <em>P</em> = .001, SPArc-VMAT <em>P</em> &lt; .01). Organ-at-risk constraints were met in all plans. Simulated delivery time was significantly improved with SPArc compared with IMPT (510 seconds vs 637 seconds, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>SPArc therapy was able to achieve high-quality lattice plans for various sites with superior gradient metrics (PVDR and GI) when compared with VMAT and IMPT. Clinical implementation is warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101632"},"PeriodicalIF":2.2,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427409","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":"Treatment Outcomes and Prognostic Factors of Chemotherapy Combined With Radiation Therapy for Patients With Early-Stage Extranodal Natural Killer/T-Cell Lymphoma","authors":"Shu-Bei Wang MD ,&nbsp;Jia-Yi Chen MD ,&nbsp;Wei-Li Zhao MD ,&nbsp;Cheng Xu MD ,&nbsp;Wei-Guo Cao MD ,&nbsp;Yi-Min Han MD ,&nbsp;Shu Cheng MD ,&nbsp;Peng-Peng Xu MD ,&nbsp;Hui-Juan Zhong MD ,&nbsp;Gang Cai MD","doi":"10.1016/j.adro.2024.101647","DOIUrl":"10.1016/j.adro.2024.101647","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to assess the treatment outcomes, toxicity, and potential prognostic factors in patients with early-stage extranodal natural killer/T-cell lymphoma treated with radiation therapy combined with chemotherapy.</div></div><div><h3>Methods and Materials</h3><div>One hundred eighteen patients with stage I/II extranodal natural killer/T-cell lymphoma who were treated with radiation therapy combined with chemotherapy were retrospectively analyzed between July 2003 and January 2019. The median dose was 50 Gy (Range, 45-61.2 Gy). The Kaplan-Meier method was used to calculate progression-free survival and overall survival. The patients were scored according to their prognostic indices.</div></div><div><h3>Results</h3><div>The overall and complete response rates were 93.2% and 82.2%, respectively. At a median follow-up of 43 months, the 5-year overall survival and progression-free survival rates were 73.9% and 68.4%, respectively. Adverse events of grade 3 or higher were observed in 20 patients (16.9%). Patients with primary disease in the Waldeyer's ring had poorer survival (<em>P</em> = .015). Compared with anthracycline-based regimens, non–anthracycline-based regimens significantly improved the 5-year overall survival (76.6% vs 54.8%, <em>P</em> = .027) and progression-free survival (72.4% vs 53.1%, <em>P</em> = .013). After treatment, the 5-year overall survival rate was 78.6% in complete response patients versus 44.9% in noncomplete response patients (<em>P</em> = .003). For patients with low- and intermediate-low-risk according to the nomogram-revised risk index model, the complete response rate was 100%. When primary lesion data were added to the nomogram-revised risk index as the basis for another prognostic index (modified nomogram-revised risk index), the low-risk (0 to 2 risk factors) and high-risk (3 or more risk factors) categories were noted (84.2% vs 62.2%, <em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>Patients with early-stage extranodal natural killer/T-cell lymphoma had high response rates and favorable survival rates with radiation therapy and non–anthracycline-based chemotherapy regimens. Patients who achieved complete response had better survival than those who did not. The extranodal natural killer/T-cell lymphoma-specific prognostic models may require further optimization.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101647"},"PeriodicalIF":2.2,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527863","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 Evaluation of Hippocampus Sparing Intensity Modulated Radiation Therapy in Patients With Stage T1-T2 and Stage T3-T4 Nasopharyngeal Carcinoma","authors":"Xiaofeng Zhou MD ,&nbsp;Kui Wu MPhys ,&nbsp;Niharika Prasad BDS ,&nbsp;Sanjay Jaiswal PhD ,&nbsp;Biao Jiang ,&nbsp;Xia Li MPhys ,&nbsp;Wenzheng Sun PhD ,&nbsp;Lingli Mao PhD ,&nbsp;Kanghua Huang PhD ,&nbsp;Minghan Shi PhD ,&nbsp;Shen Li ,&nbsp;Qichun Wei MD, PhD","doi":"10.1016/j.adro.2024.101646","DOIUrl":"10.1016/j.adro.2024.101646","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the hippocampus (HPC) dose reduced by HPC-sparing intensity modulated radiation therapy (IMRT) plans between nasopharyngeal carcinoma (NPC) patients of stages T1-T2 and T3-T4, and to investigate the correlation between the dose of the HPC and the volume of PTV_nx70 (the planning target volume of the primary tumor in the nasopharynx that received 70 Gy).</div></div><div><h3>Methods and Materials</h3><div>Fifty-eight NPC patients were retrospectively evaluated. HPC-nonsparing IMRT or sparing IMRT for each patient was designed according to the protocol for NPC. Dose-volume histogram was used to evaluate the IMRT plans for each patient. The difference in values of HPC parameters (eg, D_min[NS] – D_min[S]) between HPC-sparing and nonsparing plans in the stage T1-T2 group and stage T3-T4 group were compared. The correlations between the dose of the HPC and the volume of PTV_nx70 were analyzed.</div></div><div><h3>Results</h3><div>There was no significance between HPC-sparing and nonsparing IMRT plans. Compared with the HPC-nonsparing plans, the HPC-sparing plans significantly decreased both dosimetric and volumetric parameters for the HPC (<em>P</em> &lt; .05), except for D_min, D_98%, and V₅. The medians of D_median[NS] – D_median[S], D_mean[NS] – D_mean[S], D_40%[NS] – D_40%[S], V₃₀[NS] – V₃₀[S], V₄₀[NS] – V₄₀[S] and V₅₀[NS] – V₅₀[S] in the T1-T2 group were significantly lower than in the T3-T4 group (<em>P</em> &lt; .05), respectively. Both dosimetric and volumetric parameters for the HPC were positively correlated with the volume of PTV_nx70 in HPC-sparing and HPC-nonsparing plans (<em>P</em> &lt; .05). The volume of PTV_nx70 was positively correlated with D_median[NS] – D_median[S], D_mean[NS] – D_mean[S], D_40%[NS] – D_40%[S], V₄₀[NS] – V₄₀[S] and V₅₀[NS] – V₅₀[S] (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>HPC-sparing IMRT plans may play a more significant role in decreasing D_median, D_mean, D_40%, and V₃₀-V₅₀ of HPC in NPC patients with stages T3-T4 than those in stages T1-T2. PTV_nx70 volume of NPC patients is positively correlated with all dosimetric and volumetric parameters of HPC and the reduction of specific dosage parameters by HPC-sparing IMRT plans.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101646"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427446","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":"Ultra–Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung","authors":"Susan Y. Wu MD ,&nbsp;Penny Q. Fang MD, MBA ,&nbsp;Ahmed Fetooh MBBS ,&nbsp;Gohar S. Manzar MD, PhD ,&nbsp;Kelsey L. Corrigan MD, MPH ,&nbsp;Benjamin R. Schrank MD, PhD ,&nbsp;Lewis Nasr MD, MS ,&nbsp;Dai Chihara MD, PhD ,&nbsp;Luis E. Malpica Castillo MD ,&nbsp;Ranjit Nair MD ,&nbsp;Raphael E. Steiner MD ,&nbsp;Preetesh Jain MBBS, MD, DM, PhD ,&nbsp;Sattva S. Neelapu MD ,&nbsp;Paolo Strati MD ,&nbsp;Loretta J. Nastoupil MD ,&nbsp;Bouthaina S. Dabaja MD ,&nbsp;Chelsea C. Pinnix MD, PhD ,&nbsp;Jillian R. Gunther MD, PhD","doi":"10.1016/j.adro.2024.101648","DOIUrl":"10.1016/j.adro.2024.101648","url":null,"abstract":"<div><h3>Purpose</h3><div>Definitive intent radiation therapy (RT) for early-stage mucosa-associated lymphoid tissue (MALT) lymphoma typically includes a dose of 24 to 30 Gy. While modest, these doses may have associated toxicity. For patients with indolent B-cell lymphoma, there is increasing support for the use of ultra–low-dose RT (ULDRT) using 4 Gy in 2 fractions as part of a response-adapted approach, as high rates of complete response have been documented. This paradigm has been prospectively evaluated in the management of orbital and gastric indolent B-cell lymphomas; however, there is limited data guiding the use of ULDRT for lung MALT.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 20 patients at our institution with lung MALT treated with ULDRT as part of a response-adapted approach. Clinical variables including prior systemic therapy and symptoms were abstracted from the electronic health record. Responses were assessed using the revised Lugano criteria.</div></div><div><h3>Results</h3><div>At a median follow up of 17 months following 4 Gy (IQR, 8-37 months), we observed 100% local control. Nineteen patients (95%) experienced a complete response. No patients with stage IE disease at RT (17/20; 85%) experienced distant progression. Nine patients (45%) were symptomatic prior to RT, with improvement or resolution of symptoms in 7 (7/9; 78%). One patient developed grade 2 pleuritic pain following RT, which resolved with a brief course of steroids. No other toxicities were noted.</div></div><div><h3>Conclusions</h3><div>ULDRT, given in a response-adapted approach, is effective and well tolerated by patients with lung MALT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101648"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527777","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":"Fifteen-Year Experience of a Single Institution: Outcomes for Early-Stage Hodgkins Lymphoma Comparing Chemotherapy Alone Versus Combined Modality Therapy","authors":"Joshua Y. Qian MD ,&nbsp;Radhesh Amin BS ,&nbsp;Humzah Ali BS ,&nbsp;Yichun Cao MPH ,&nbsp;Jeffrey M. Switchenko PhD ,&nbsp;Arif S. Rashid MD ,&nbsp;Pamela B. Allen MD ,&nbsp;Sheela Hanasoge MBBS, PhD ,&nbsp;Mohammad K. Khan MD, PhD","doi":"10.1016/j.adro.2024.101636","DOIUrl":"10.1016/j.adro.2024.101636","url":null,"abstract":"<div><h3>Purpose</h3><div>Doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy is the current standard treatment for early-stage Hodgkins lymphoma (HL). The use of consolidative radiation therapy (RT) in addition to chemotherapy may lead to better survival rates but is controversial because of concerns about long-term toxicity. The aim of this study is to compare outcomes of patients receiving ABVD chemotherapy alone (CTX alone) versus ABVD with consolidative RT (CMT).</div></div><div><h3>Methods and Materials</h3><div>A single-institution, retrospective review of patients with HL diagnosed from 2000 to 2014 was conducted. Patients were identified from the National Cancer Database. Inclusion criteria included patients aged ≥18 years, with stage I or II HL, who received ABVD with a complete response with/without CMT. Consolidative RT must have been started within 90 days of completing chemotherapy. Institutional review board approval was obtained. Follow-up details and treatment responses were collected from medical record reviews. Standard statistical analysis and Kaplan-Meier curves were used to estimate relapse-free survival (RFS).</div></div><div><h3>Results</h3><div>One hundred and 8 patients with early-stage HL were identified. The median age at diagnosis was 31 years (range, 19-72). Most patients were female (63%) and Caucasian (65%). stage II HL was present in 89%of patients, 89% had an Eastern Cooperative Oncology Group score of 0 or 1, 35% had B symptoms, and 9% had extranodal involvement. A total of 52.8% received CMT (<em>n</em> = 57) and 47.2% received CTX alone (<em>n</em> = 51). The CMT group had fewer cycles of chemotherapy compared to the CTX-alone group (mean cycles, 5.2 vs 5.7, <em>P</em> = 0.045). Twenty-four relapse events occurred in the CTX-alone group, while no relapse events occurred in the CMT group. RFS at 10 years was significantly improved in the CMT group (100%) compared to CTX alone (47.4%, <em>P</em> &lt; .0001; HR = .03, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>ABVD with consolidative RT was associated with improved RFS. Further studies of toxicity comparisons, advanced stages, and nonfavorable HL are warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101636"},"PeriodicalIF":2.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537582","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":"Use of Virtual CT and On-Treatment MRI to Reduce Radiation Dose and Anesthesia Exposure Associated With the Adaptive Workflow in Pediatric Patients Treated With Intensity Modulated Proton Therapy","authors":"Khadija Sheikh PhD ,&nbsp;Ryan Oglesby PhD ,&nbsp;William T. Hrinivich PhD ,&nbsp;Heng Li PhD ,&nbsp;Matthew M. Ladra MD ,&nbsp;Sahaja Acharya MD","doi":"10.1016/j.adro.2024.101634","DOIUrl":"10.1016/j.adro.2024.101634","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to determine whether virtual computed tomography (vCT) derived from daily cone beam computed tomography (CBCT), or on-treatment magnetic resonance imaging (MRI_tx) can replace quality assurance computed tomography (qCT) in our clinical workflow to minimize imaging dose and potentially anesthesia exposure in patients requiring plan adaptation.</div></div><div><h3>Methods and Materials</h3><div>Pediatric patients (age &lt;24 years) treated from 2020 to 2023 with intensity modulated proton therapy with at least 1 qCT during proton therapy were eligible. For cases that required plan adaptation, the dose was recalculated on vCT and compared with same-day qCT as well as the original planning computed tomography (pCT). Anatomic changes triggering plan adaptation were grouped into categories. Two pediatric radiation oncologists verified whether these changes could be detected using CBCT, qCT, and/or MRI_tx. A new adaptive imaging workflow was proposed to limit imaging dose and anesthesia exposure.</div></div><div><h3>Results</h3><div>One hundred sixty-eight pediatric patients were treated from 2020 to 2023. Across all patients, there were 517 qCT scans and 61 MRI_tx acquired. The median number of qCT scans per patient was 3 (range, 1-5). The treatment plans for 20 patients (12%) were adapted. In all patients requiring plan adaptation, there was a correlation between dose differences in target coverage and maximum body dose when comparing vCT with pCT and qCT with pCT (n = 20, r² = 0.79, <em>P</em> &lt; .01, and r² = 0.32 <em>P</em> = .01, respectively). The most common reason for adaptation was tissue change (eg, inflammation, changes in abdominal gas, or diaphragmatic variability) in the beam path (10/20) and changes in tumor volume (6/20). All cases of weight change, tissue change in beam path, and unreproducible setup could be detected on CBCT. All cases of change in tumor volume within the brain were detected on MRI_tx. Replacing the qCT with the vCT was associated with an estimated median reduction of imaging dose by 50% and anesthesia exposure by 1.5 hours.</div></div><div><h3>Conclusions</h3><div>vCT derived from daily CBCT only or MRI_tx can safely replace qCT for monitoring dosimetric changes to trigger a new pCT in our clinical workflow. This change would potentially reduce imaging dose and anesthesia exposure.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101634"},"PeriodicalIF":2.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427408","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}