Jonathan W. Lischalk MD , Vianca F. Santos MPH , Brianna Vizcaino BA , Astrid Sanchez MS , Christopher Mendez MA , Kathleen Maloney-Lutz RN , Sam Serouya MD , Seth R. Blacksburg MD, MBA , Todd Carpenter MD , Moses Tam MD , Scott Niglio MD , William Huang MD , Samir Taneja MD , Michael J. Zelefsky MD , Jonathan A. Haas MD
{"title":"Screening Colonoscopy Association With Gastrointestinal Toxicity and Quality of Life After Prostate Stereotactic Body Radiation Therapy","authors":"Jonathan W. Lischalk MD , Vianca F. Santos MPH , Brianna Vizcaino BA , Astrid Sanchez MS , Christopher Mendez MA , Kathleen Maloney-Lutz RN , Sam Serouya MD , Seth R. Blacksburg MD, MBA , Todd Carpenter MD , Moses Tam MD , Scott Niglio MD , William Huang MD , Samir Taneja MD , Michael J. Zelefsky MD , Jonathan A. Haas MD","doi":"10.1016/j.adro.2025.101747","DOIUrl":"10.1016/j.adro.2025.101747","url":null,"abstract":"<div><h3>Purpose</h3><div>Screening colonoscopies (CS) performed before prostate stereotactic body radiation therapy (SBRT) allow for identifying synchronous malignancies and comorbid gastrointestinal (GI) conditions. Performing these procedures prior to radiation precludes the necessity of post-SBRT pelvic instrumentation, which may lead to severe toxicity and fistulization. We review compliance of CSs, incidence of GI pathology, and the impact of pretreatment CS findings on subsequent physician-reported toxicity and patient-reported quality of life (QoL).</div></div><div><h3>Methods and Materials</h3><div>We reviewed an institutional database of patients treated for prostate cancer with SBRT including toxicity and QoL outcomes. A detailed review of pretreatment CS findings was reviewed including identification of diverticulosis, location of polyp resection, and presence of hemorrhoids. Pretreatment CS findings were then correlated with outcomes following SBRT.</div></div><div><h3>Results</h3><div>Identification of comorbid GI conditions was a common event, with the presence of diverticulosis in 49.5% (n = 100), hemorrhoids in 67% (n = 136), and polyps in 48% (n = 98). More than half of patients with polyps removed had at least 1 removed from the rectosigmoid. Pretreatment CS did not introduce a delay in SBRT start date. Grade 1 toxicity was significantly lower in patients who underwent CS closer to the initiation of SBRT. There was no increased risk of physician-graded toxicity in the presence of diverticulosis, hemorrhoids, or polyps. Patient-reported GI QoL pattern in our screening cohort mimicked that seen in the previously published nonscreened population. There was no overt QoL detriment observed in patients who had GI pathology identified before SBRT.</div></div><div><h3>Conclusions</h3><div>GI pathology identified in our elderly patient population was commonly identified on pretreatment CS. Screening CS may optimize bowel health for patients heading into radiation therapy. Toxicity and QoL for patients with GI pathologies identified on pretreatment CS do not preclude the delivery of prostate SBRT. We advocate for pretreatment CS in patients eligible prior to SBRT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101747"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941146","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}
Benjamin Royal-Preyra MD, FRCPC, Melanie Boucher BSc, Isabelle Marsan BSc
{"title":"Erratum to: Royal-Preyra B, Boucher M, and Marsan I. Urticaria Heralding Breast Cancer: Case Report and Literature Review. Adv Radiat Oncol. 2023;9:101433","authors":"Benjamin Royal-Preyra MD, FRCPC, Melanie Boucher BSc, Isabelle Marsan BSc","doi":"10.1016/j.adro.2025.101735","DOIUrl":"10.1016/j.adro.2025.101735","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101735"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941147","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}
Chen-Lin Kang PhD , Ya-Yu Huang MS , Jui-Chu Wang MS , Fang-Jing Li MS , Fu-Min Fang MD, PhD , Chun-Chieh Huang MD
{"title":"Evaluating the Impact of Invasive Intubation on Treatment Accuracy in Head and Neck Cancer Patients Undergoing Image-Guided Radiation Therapy","authors":"Chen-Lin Kang PhD , Ya-Yu Huang MS , Jui-Chu Wang MS , Fang-Jing Li MS , Fu-Min Fang MD, PhD , Chun-Chieh Huang MD","doi":"10.1016/j.adro.2025.101801","DOIUrl":"10.1016/j.adro.2025.101801","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess how nasogastric and tracheostomy tubes affect the precision of image-guided radiation therapy (IGRT) in head and neck cancer (HNC) patients.</div></div><div><h3>Methods and Materials</h3><div>A retrospective analysis was conducted on 79 patients treated with IGRT using the Varian EDGE linear accelerator at our institution from October 2021 to September 2023. Patients were divided into 3 groups based on the presence of invasive tubes: Group A with nasogastric tubes (n=29), Group B with tracheostomy tubes (n=20), and Group C without tubes (n=30). A total of 2580 displacement correction datasets were analyzed.</div></div><div><h3>Results</h3><div>Tracheostomy tubes significantly increased displacement errors in the X and Y-axes compared with patients without tubes (<em>P</em> =0.027 and <em>P</em> =0.028, respectively). Nasogastric tubes increased errors in the Yaw-axis compared with patients without tubes (<em>P</em> =0.034) and Pitch-axis errors compared with patients with tracheostomy tubes (<em>P</em> =0.008). The choice of immobilization mask also affected displacement accuracy; for instance, patients with tracheostomy tubes using the head and neck mask had lower X-axis displacement errors than those using the head-neck-shoulder mask (<em>P</em> <0.001).</div></div><div><h3>Conclusions</h3><div>Our findings indicate that Head and neck masks are preferable for patients with tracheostomy tubes, whereas head-neck-shoulder masks are better suited for those with nasogastric tubes. Customized asymmetric planning target volume margins for each tube–mask combination may further improve treatment accuracy and target coverage.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101801"},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147324","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}
Giuseppe Cardaci MBBS , Siddhartha Baxi MBBS , Saima Vohra PhD , Cody Allison PhD , Angela Hong MBBS , Nicola Mulholland MBBS , Mike Sathekge MBChB, PhD , Kgomotso Mokoala MBChB , Martin Heuschkel Dr. med. , Julia Tietze Dr. med. , Siroos Mirzaei FANM , Gerhard Dahlhoff Dr. med.
{"title":"Efficacy, Safety, and Patient Reported Outcomes of Rhenium-Skin Cancer Therapy for Non-Melanoma Skin Cancer: 1-Year Results from the EPIC-Skin Study","authors":"Giuseppe Cardaci MBBS , Siddhartha Baxi MBBS , Saima Vohra PhD , Cody Allison PhD , Angela Hong MBBS , Nicola Mulholland MBBS , Mike Sathekge MBChB, PhD , Kgomotso Mokoala MBChB , Martin Heuschkel Dr. med. , Julia Tietze Dr. med. , Siroos Mirzaei FANM , Gerhard Dahlhoff Dr. med.","doi":"10.1016/j.adro.2025.101802","DOIUrl":"10.1016/j.adro.2025.101802","url":null,"abstract":"<div><h3>Purpose</h3><div>Rhenium-skin cancer therapy (SCT) is an innovative, noninvasive radionuclide treatment for nonmelanoma skin cancer (NMSC), which is administered in a single outpatient treatment session. A global, multicenter, single-arm, phase 4 post-marketing clinical study was established to evaluate efficacy, safety, cosmesis, and patient-reported outcomes of OncoBeta rhenium-SCT for NMSC. This report details scheduled 12-month interim results, including toxicity, cosmesis, and patient-reported outcomes.</div></div><div><h3>Methods and Materials</h3><div>Eligible patients had biopsy-proven stage I or II basal cell carcinoma or squamous cell carcinoma (SCC) lesions ≤3 mm deep and ≤8 cm<sup>2</sup> in area. Patients were administered rhenium-SCT as a resin applied to adhesive foil affixed to the lesion/s, with a dose of 50 Gy to the deepest point. As per the treatment protocol, efficacy was assessed using modified Response Evaluation Criteria in Solid Tumors criteria after 12 months, with planned primary endpoint measuring complete response scheduled for 24 months. Secondary endpoints included patient-reported quality of life (Skin Cancer Index) treatment comfort, cosmesis (visual assessment scale; 1: poor -10: not visible), and toxicity (CTCAE v5.0).</div></div><div><h3>Results</h3><div>Response rates for 185 treated lesions from 140 patients were 94.1% (174/185) complete response, and 3.2% (6/185) partial response. The remaining lesions were classified as progressive or stable disease in 2.2% (4/185) and 0.5% (1/185), respectively. Quality of life improved by a mean 10.55 (95% CI, 3.79, 17.31) points (100-point scale) from baseline. No patients reported pain or discomfort during treatment. Most patients (88%, 129/147) developed radiation dermatitis as expected, which was predominantly grade 1 or 2 in severity and resolved rapidly. The most common 12-month toxicity in patients was grade 1 hypopigmentation (60.4%; 78/129), while there was no incidence of grade 3 or 4 toxicities at this time. Patient- and clinician-reported cosmesis visual assessment scale outcomes were broadly favorable at 8.1 and 7.7, respectively (10-point scale).</div></div><div><h3>Conclusions</h3><div>This 12-month interim analysis of EPIC-Skin indicates rhenium-SCT is an effective and well-tolerated treatment for shallow basal cell carcinoma and SCC lesions, yielding favorable safety, cosmesis, and patient-satisfaction outcomes. These outcomes underscore the utility of rhenium-SCT as a single-session, noninvasive treatment for NMSC, offering a safe, effective, and efficient alternative to surgery for patients with functional or cosmetic considerations, and/or comorbidities.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101802"},"PeriodicalIF":2.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261831","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}
Yael Berner-Wygoda MA, MD , Eitan Amir MB ChB, PhD , Philip Blumenfeld MD , Meredith Li MD , Diego Malon MBA, MD , Neha Pathak MD , Jacqueline Savil MN-RN , Yonaton Zarbiv MD , Vikaash Kumar MD
{"title":"Efficacy and Safety of Metastatic Directed Treatment of Oligometastatic Disease: Results of a Meta-analysis","authors":"Yael Berner-Wygoda MA, MD , Eitan Amir MB ChB, PhD , Philip Blumenfeld MD , Meredith Li MD , Diego Malon MBA, MD , Neha Pathak MD , Jacqueline Savil MN-RN , Yonaton Zarbiv MD , Vikaash Kumar MD","doi":"10.1016/j.adro.2025.101797","DOIUrl":"10.1016/j.adro.2025.101797","url":null,"abstract":"<div><h3>Purpose</h3><div>In patients with oligometastatic disease (OMD), local therapy to metastatic sites has gained acceptance despite uncertainty regarding its long-term benefits or whether some subgroups would benefit more than others. Here, we report a meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of adding stereotactic radiation to metastases versus the standard of care (SOC) in treating OMD.</div></div><div><h3>Methods and Materials</h3><div>A meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified from Medline and Embase databases from inception to July 16, 2024. The inclusion criteria comprised RCTs involving adults with oligometastatic solid tumors receiving metastasis-directed therapy (MDT) compared to SOC alone. OMD was divided into 4 groups according to the time of intervention: upfront therapy, consolidation therapy, unselected and oligoprogression. The primary outcomes were progression-free survival (PFS), overall survival (OS), time to new lesion (TNL), and treatment toxicity. Hazard ratios (HR) for PFS, OS, and TNL were extracted. Odd ratios (ORs) were calculated for adverse events grade 3 or higher. Data were analyzed using random effects models, with statistical significance set at <em>P</em> < .05.</div></div><div><h3>Results</h3><div>Fifteen RCTs comprising 1414 patients were included. MDT significantly improved PFS [HR: 0.48, 95% confidence interval (CI), 0.42-0.54, <em>P</em> < .01] and OS (HR, 0.60; 95% CI, 0.49-0.75; <em>P</em> < .001) compared to SOC. Subgroup analysis revealed a consistent benefit in nonmutated non small cell lung cancer (NSCLC), prostate, and epidermal growth factor receptor (EGFR)-mutated NSCLC, but not in breast cancer. The benefits of MDT were significant across all intervention points: upfront, consolidation, and unselected. No significant benefit was observed in oligoprogressive disease (HR, 0.69; <em>P</em> = .11). MDT did not prolong the TNL compared to SOC (HR, 0.81; 95% CI, 0.62-1.08; <em>P</em> = .15). MDT was associated with a higher odds of adverse events (odd ratio: 1.46, <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>MDT provides significant improvement in PFS and OS, though these effects were not observed in breast cancer or in oligoprogressive disease.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101797"},"PeriodicalIF":2.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124168","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":"Phase 2 Trial of Stereotactic Body Radiation Therapy with Dose Escalation Using Simultaneous Integrated Boost for Spinal Metastases","authors":"Takamasa Mitsuyoshi MD, PhD , Peter J. K. Tokuda MD , Yumi Kokubo MD , Takahiro Iwai MD , Hiroyuki Inoo MD , Ryo Ashida MD, PhD , Ryosuke Nasada MS , Mikiko Yamashita PhD , Hiroaki Tanabe MS , Shigeki Arizono MD, PhD , Toshiyuki Imagumbai MD , Masaki Kokubo MD, PhD","doi":"10.1016/j.adro.2025.101760","DOIUrl":"10.1016/j.adro.2025.101760","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic body radiation therapy (SBRT) is an effective treatment approach for spinal metastases. However, local recurrence may occur. This prospective phase 2 trial evaluated whether SBRT with dose escalation in the gross tumor volume through simultaneous integrated boost (SIB–SBRT) can improve local control (LC) without increasing adverse events (AEs).</div></div><div><h3>Methods and Materials</h3><div>Eligible patients aged ≥ 20 years with spinal metastases and a life expectancy of > 1 year received SIB–SBRT in 5 fractions over 1 week. The prescribed dose was 30 Gy to the planning target volume for evaluation and an escalated dose of 40 to 45 Gy to the gross tumor volume through SIB. Neurologic examinations and magnetic resonance imaging were performed at 3-, 6-, and 12-month follow-up and every 6 months thereafter. The primary endpoint was the 1-year LC rate. The secondary endpoints included overall survival and AEs, such as vertebral compression fractures (VCFs).</div></div><div><h3>Results</h3><div>A total of 25 patients with 28 vertebral segments from September 2020 to March 2023 were enrolled in this study. The median follow-up was 26.2 months, and 24 segments in 21 patients were followed up for >1 year. The 1- and 2-year LC rates were 100.0% and 95.0%, respectively. Local recurrence developed in only 1 patient at 18 months. The 1- and 2-year overall survival rates were 92.0% and 72.8%, respectively. Six patients developed VCFs (3 cases each of grades 1 and 2), with 1- and 2-year cumulative incidence rates of 3.6% and 15.6%, respectively. No radiation myelopathy or other grade ≥ 2 AEs occurred, except for 1 case of grade 2 pain.</div></div><div><h3>Conclusions</h3><div>Dose-escalated SIB–SBRT for spinal metastases demonstrates excellent LC with acceptable toxicity, supporting the need for a larger comparative trial.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101760"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868486","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}
Amir Razavi BSA , Michael K. Rooney MD, PhD , Clifton D. Fuller MD, PhD , James B. Yu MD, MHS , Neil T. Pfister MD, PhD , Charles R. Thomas Jr MD , John M. Buatti MD , Sophia C. Kamran MD , Heather M. McGee MD, PhD , Debra Nana Yeboa MD , Ana P. Kiess MD, PhD , Andrew M. Baschnagel MD , Randall J. Kimple MD, PhD, MBA, FASTRO
{"title":"National Institutes of Health Funding to Support Radiation Oncology Research: A Comparative Trend Analysis Over a Decade, 2011-2021","authors":"Amir Razavi BSA , Michael K. Rooney MD, PhD , Clifton D. Fuller MD, PhD , James B. Yu MD, MHS , Neil T. Pfister MD, PhD , Charles R. Thomas Jr MD , John M. Buatti MD , Sophia C. Kamran MD , Heather M. McGee MD, PhD , Debra Nana Yeboa MD , Ana P. Kiess MD, PhD , Andrew M. Baschnagel MD , Randall J. Kimple MD, PhD, MBA, FASTRO","doi":"10.1016/j.adro.2025.101767","DOIUrl":"10.1016/j.adro.2025.101767","url":null,"abstract":"<div><h3>Purpose</h3><div>Funding to support radiation oncology discovery and research is essential for advancement in therapeutic strategies to improve outcomes for patients with cancer. We aimed to comprehensively characterize trends in National Institutes of Health (NIH) funding that supports radiation oncology research over time to identify trends, successes, and areas for improvement.</div></div><div><h3>Methods and Materials</h3><div>We queried the NIH Research Portfolio Online Reporting Tools Expenditures and Results database to identify all awarded grants to support radiation oncology research conducted by principal investigators at academic centers, using 3 individual years as representative samples (2011, 2016, and 2021). Abstracts and keywords for resulting grants were manually searched to identify resulting awards topically related to the field of radiation oncology; principal investigators departmental affiliation was also used as a supplemental method serving as a sensitivity analysis to define radiation oncology-related research. Descriptive statistics were used to describe patterns in funding. χ<sup>2</sup> testing was used to assess differences in proportions of categorical variables.</div></div><div><h3>Results</h3><div>Less than 0.5% of the total NIH budget and < 2% of the total National Cancer Institute budget supported radiation oncology research during the representative study years. There were no significant changes in this allocation pattern over time. A small cohort of institutions held a relatively large proportion of NIH-supported radiation oncology grant funding. Individuals holding PhDs alone received the majority of funding (62%), whereas those with dual-degrees (MD/PhD) held 21% of funding, and those with MD alone were awarded 17% of funding. There was a trend toward an increased proportion of grants awarded to MD/PhDs over time (24% vs 15% in 2021 and 2011, respectively, <em>P</em> = .075).</div></div><div><h3>Conclusions</h3><div>Despite radiation therapy's essential role in multidisciplinary cancer care, NIH, and National Cancer Institute funding to support radiation oncology research has remained disproportionally low over the last decade. These data may be useful to inform future policy aimed at promoting research advancement in radiation oncology both at the micro (individual) as well as macro (institutional and national) level.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101767"},"PeriodicalIF":2.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859121","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}
Roshan S. Prabhu MD, MS , Rachel Russek MPH , Zachary K. Vaslow MD , Jennifer K. Matsui PhD , Neda Haghighi MD , Tu Dan MD , Mark V. Mishra MD , Erin S. Murphy MD , Susan Boyles RTT , Haley K. Perlow MD , Joshua D. Palmer MD , Cristian Udovicich MD , Toral R. Patel MD , Zabi Wardak MD , Graeme F. Woodworth MD , Alexander Ksendzovsky MD, PhD , Kailin Yang MD, PhD , Samuel T. Chao MD , Anthony L. Asher MD , Stuart H. Burri MD
{"title":"Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study","authors":"Roshan S. Prabhu MD, MS , Rachel Russek MPH , Zachary K. Vaslow MD , Jennifer K. Matsui PhD , Neda Haghighi MD , Tu Dan MD , Mark V. Mishra MD , Erin S. Murphy MD , Susan Boyles RTT , Haley K. Perlow MD , Joshua D. Palmer MD , Cristian Udovicich MD , Toral R. Patel MD , Zabi Wardak MD , Graeme F. Woodworth MD , Alexander Ksendzovsky MD, PhD , Kailin Yang MD, PhD , Samuel T. Chao MD , Anthony L. Asher MD , Stuart H. Burri MD","doi":"10.1016/j.adro.2025.101794","DOIUrl":"10.1016/j.adro.2025.101794","url":null,"abstract":"<div><h3>Purpose</h3><div>Single fraction preoperative stereotactic radiosurgery (SRS) has historically used a 10% to 20% dose reduction standard dosing. However, the effects of this dose reduction are not well characterized. The goal of this study was to compare outcomes and toxicity of standard dose (SD) with reduced dose (RD) single fraction preoperative SRS.</div></div><div><h3>Methods and Materials</h3><div>Patients with brain metastases from solid cancers, of which at least 1 lesion measuring ≤ 4 cm was treated with single fraction preoperative SRS and underwent planned resection were included from the Preoperative Radiosurgery for Brain Metastases (PROPS-BM international multicenter combined prospective and retrospective registries from 8 institutions. SD was a priori defined as ≥20 Gy for lesions ≤2 cm, ≥17 Gy for >2 to 3 cm, and ≥14 Gy for >3 to 4 cm based on institutional dosing practices. Multivariable and propensity score matched analyses were performed.</div></div><div><h3>Results</h3><div>The cohort consisted of 307 patients with 307 preoperative SRS treated index lesions. SD was used in 124 patients (40%) and RD was used in 183 patients (60%). Median dose for lesions 0 to 2 cm (n = 73), >2 to 3 cm (n = 152), and >3 to 4 cm (n = 82) was 20, 18, and 15 Gy in the SD cohort and 16, 15, and 13 Gy in the RD cohort, respectively. There was no difference in 2-year cavity local recurrence (LR, 16% vs 15%, <em>P</em> = .69), adverse radiation effect (ARE, 8% vs 6%, <em>P</em> = .77), meningeal disease (2% vs 8%, <em>P</em> = .07), composite endpoint of cavity LR, ARE, or nodular meningeal disease (23% vs 22%, <em>P</em> = .86), or overall survival (49% vs 36%, <em>P</em> = .15). Results were similar within each specific lesion diameter subgroup and within the propensity score matched cohorts (n = 168).</div></div><div><h3>Conclusions</h3><div>Both SD and RD single fraction preoperative SRS demonstrate excellent rates of cavity LR and ARE. Cavity LR risk increased with larger lesion size, regardless of SRS dose category. There does not seem to be an advantage in efficacy or toxicity for RD over SD single fraction preoperative SRS. Additional studies are warranted to optimize preoperative SRS dose and fractionation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101794"},"PeriodicalIF":2.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115530","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}
Maryam Ebadi MD , Hakan Gem PhD, DDS , Gale Sebastian DDS , Rania Abasaeed DDS , Michele Lloid RDH , Yolanda D. Tseng MD , Omar Y. Mian MD, PhD , Samuel Minot PhD , David R. Dean DDS , Armin Rashidi MD, PhD
{"title":"Different Patterns of Oral Mucositis and Microbiota Injury After Total Body Irradiation- Versus Chemotherapy-Based Myeloablative Allogeneic Hematopoietic Cell Transplantation","authors":"Maryam Ebadi MD , Hakan Gem PhD, DDS , Gale Sebastian DDS , Rania Abasaeed DDS , Michele Lloid RDH , Yolanda D. Tseng MD , Omar Y. Mian MD, PhD , Samuel Minot PhD , David R. Dean DDS , Armin Rashidi MD, PhD","doi":"10.1016/j.adro.2025.101787","DOIUrl":"10.1016/j.adro.2025.101787","url":null,"abstract":"<div><h3>Purpose</h3><div>Oral mucositis (OM) is a common complication of allogeneic hematopoietic cell transplantation, causing pain, infections, swallowing/speech impairment, and poor quality of life. We hypothesized that patterns (severity and dynamics) of OM and oral microbiota disruptions may be different after high-dose total body irradiation (TBI)- versus chemotherapy-based myeloablative conditioning.</div></div><div><h3>Methods and Materials</h3><div>We conducted an exploratory study including comprehensive, longitudinal mucositis assessment, paired with supragingival plaque and saliva collection. OM was assessed at baseline and days +7, +14, +21, +28, and +84. Total mucositis score at each timepoint was calculated from objective findings in 2 domains and 9 oral sites using a validated scoring system. Plaque and saliva samples (baseline and days +14, +28, and +84) were profiled using shotgun metagenomic sequencing.</div></div><div><h3>Results</h3><div>A total of 249 OM assessments were performed and 342 samples were collected from 47 patients (27 chemotherapy-based, 20 TBI-based). Salivary flow rate remained stable in the chemotherapy-based cohort, but steadily declined in the TBI-based cohort, reaching a significantly lower level in the TBI-based cohort at day +84 both compared to baseline and the chemotherapy-based cohort. OM severity peaked at day +7 in the TBI-based cohort versus day +14 in the chemotherapy-based cohort. Day +14 OM was significantly more severe in the chemotherapy-based cohort; other timepoints were not different. Although the cohorts were similar in plaque microbiota composition at baseline, they became significantly different at all post- hematopoietic cell transplantation timepoints. Salivary microbiota composition was not significantly different between the 2 cohorts. Day +84 plaque microbiota diversity was significantly higher in the TBI-based cohort.</div></div><div><h3>Conclusions</h3><div>We demonstrated different patterns of OM, microbiota injury, and salivary flow rate after TBI- versus chemotherapy-based conditioning. If validated in future studies, our findings could enhance evidence-based pretransplant counseling on oral toxicity and have implications for short- and long-term oral health in transplant survivors.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101787"},"PeriodicalIF":2.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931706","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}
Matthew A. Barrett MD , Biniyam G. Demissei MD, MSC, PhD , Ray Hu MD , Amanda M. Smith MA , Gary Freedman MD , John Plastaras MD , Steven Feigenberg MD , Eva Berlin MD , Hari K. Narayan MD, MSCE , Benedicte Lefebvre MD , Marielle Scherrer Crosbie MD, PhD , Michael Fradley MD , Joseph Carver MD , Jinbo Chen PhD , Bonnie Ky MD, MSCE
{"title":"3D Echocardiographic Phenotyping of Left Ventricular Mechanics and Function With Contemporary Radiation Therapy","authors":"Matthew A. Barrett MD , Biniyam G. Demissei MD, MSC, PhD , Ray Hu MD , Amanda M. Smith MA , Gary Freedman MD , John Plastaras MD , Steven Feigenberg MD , Eva Berlin MD , Hari K. Narayan MD, MSCE , Benedicte Lefebvre MD , Marielle Scherrer Crosbie MD, PhD , Michael Fradley MD , Joseph Carver MD , Jinbo Chen PhD , Bonnie Ky MD, MSCE","doi":"10.1016/j.adro.2025.101786","DOIUrl":"10.1016/j.adro.2025.101786","url":null,"abstract":"<div><h3>Purpose</h3><div>Our objective was to characterize the early changes in cardiac function after thoracic radiation therapy (RT) using 3D echocardiography.</div></div><div><h3>Methods and Materials</h3><div>In a prospective longitudinal cohort study of 69 patients with breast cancer, lung cancer, or mediastinal lymphoma treated with chemotherapy and RT, clinical and 3D echocardiographic data were assessed before, immediately after, and 5 to 9 months after RT completion. 3D left ventricular ejection fraction, global circumferential strain, global longitudinal strain (GLS), average 3D strain, twist, and torsion were quantified. Associations among mean heart dose (MHD), V5, and V30 and early changes in echocardiography-derived measures of cardiac function were assessed with generalized estimating equations.</div></div><div><h3>Results</h3><div>The median (quartile 1, quartile 3) estimates of MHD ranged from 1.2 Gy (1.0-1.9) in patients with breast cancer (<em>n</em> = 39), to 6.8 Gy (4.0-12.5) in patients with mediastinal lymphoma (<em>n</em> = 17), and 19.4 Gy (11.3-21.7) in patients with lung cancer (<em>n</em> = 13). There were no significant changes in 3D echocardiography measures in patients with breast cancer over time. However, in patients with lung cancer/lymphoma, there was a worsening in 3D left ventricular ejection fraction, GLS, and average 3D strain from pre-RT to RT completion (<em>P</em> < .05). This worsening in 3D GLS persisted at 5 to 9 months (<em>P</em> < .05). Across the entire cohort, MHD, V5, and V30 were not associated with changes in global 3D echocardiography-derived measures (<em>P</em> > .05).</div></div><div><h3>Conclusions</h3><div>Early abnormalities in cardiac function as measured by 3D echocardiography can be detected following RT. Additional work is needed to define the determinants of changes in cardiac function with RT and long-term impact of early changes on clinical outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101786"},"PeriodicalIF":2.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147323","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}