Advances in Radiation Oncology最新文献

{"title":"The Use of Breast Cup Immobilization in Radiation Therapy and Patient-Reported Outcomes on Cosmesis and Pain","authors":"Daniel Chapman M.D., M.P.H , Andrea Matsumoto D.N.P. , Kate Aldridge , Maggie Yin M.S. , Kent Griffith M.S. , Melissa Mietzel M.S. , Eleanor M. Walker M.D.","doi":"10.1016/j.adro.2025.101759","DOIUrl":"10.1016/j.adro.2025.101759","url":null,"abstract":"<div><h3>Purpose</h3><div>Breast cosmesis and breast pain are among the most reported outcomes in patients undergoing adjuvant breast irradiation. The degree to which such adverse reactions occur can be variable based on different patient-specific characteristics. It has been found that women with a larger body habitus, and larger breasts, tend to have an increased chance of experiencing worse toxicity from treatment. As such, attempts to improve cosmetic and pain outcomes have been a highly explored topic. One such technique, that is studied here, is to explore whether the use of a breast cup during treatment leads to worse breast pain and cosmetic outcomes when compared with those treated without a breast cup. This proves to be an important topic because it is believed that the use of a breast cup would provide a significant dosimetric advantage (ie, breast coverage and organ at risk dosing) during treatment. We now explore this treatment option through the scope of a retrospective analysis of patient-reported outcomes experienced during and after completing postoperative radiation therapy to the breast.</div></div><div><h3>Methods and Materials</h3><div>A total of 645 patients undergoing adjuvant breast irradiation were evaluated from 2011 to 2019. Of the 645 patients, 79 were treated using a breast cup. The mean heart dose was analyzed and compared between the 2 treatment groups. Additionally, patient-reported outcomes among the entire cohort were collected via survey documentation forms during treatment, at 1 month after the completion of treatment, and at 1 year after the completion of treatment. These results were collected using the Michigan Radiation Oncology Quality Consortium database because each patient was consented to enroll in the Michigan Radiation Oncology Quality Consortium prior to starting treatment. The outcomes of skin changes, lymphedema, and breast pain among the 2 treatment groups were then compared for statistically significant differences via a logistic regression analysis.</div></div><div><h3>Results</h3><div>Of the 79 patients treated with a breast cup, grade 2 pruritus of the treated breast along with grade 1 alteration in skin texture was reported in 49.4%, 35.4%, and 22.8% while on treatment, at 1 month after the completion of treatment, and at 1 year after treatment, respectively; <em>P</em>-values were nonsignificant at all timepoints when data compared with non-cup-treated patients. With regard to lymphedema, 59.5%, 40.5%, and 10.1% of breast cup patients at the prespecified timepoints reported this sequela; all <em>P</em>-values were nonsignificant except for the 1-month mark (<em>P</em>-value .03). Lastly, breast pain was noted in 36.7%, 15.2%, and 11.4% of breast cup-treated patients while on treatment, at 1 month after the completion of treatment, and at 1 year after treatment, respectively; again, <em>P</em>-values for data analysis at each timepoint were nonsignificant. Other than the patient-reported out","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101759"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143825706","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":"Target Contour Consistency During Magnetic Resonance-Guided Online Adaptive Stereotactic Body Radiation Therapy","authors":"Suzanne Kirby BS ,&nbsp;Kiana Rahimi BS ,&nbsp;William Song PhD,&nbsp;Elisabeth Weiss MD","doi":"10.1016/j.adro.2025.101765","DOIUrl":"10.1016/j.adro.2025.101765","url":null,"abstract":"<div><h3>Purpose</h3><div>Adaptive magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) requires expeditious recontouring of target volumes based on daily anatomy. Contouring of the gross tumor volume (GTV) is frequently performed by covering radiation oncologists who may be less familiar with the case than the primary physician (PP). The objective of this study is to determine consistency in GTV contouring between PP and covering physician (CP) and to analyze the effect of resources to support accurate GTV delineation.</div></div><div><h3>Methods and Materials</h3><div>Between 2021 and 2023, 59 patients underwent 302 fractions of MRgSBRT at our institution. GTVs were analyzed for the effect of 3 different types of contouring support resources: (a) number of slices of the original GTV, (b) external software displaying original GTV contours, and (c) alerting if GTVs differed &gt; 10% from the original. Differences between physicians and contouring support resources were analyzed for different tumor sites and fractions using 2-tailed <em>t</em> test and analysis of variance.</div></div><div><h3>Results</h3><div>One hundred nineteen out of 302 (39.4%) MRgSBRT treatments were supervised by a CP. The difference in the mean absolute percent volume change of GTV compared with original GTV for PPs (11.1%) versus CPs (4.6%) across all treatment fractions was statistically significant (<em>P</em> = .00006). Significant differences were observed for pancreas (12.8% vs 5.0%, <em>P</em> = .03), liver (13.0% vs 4.0%, <em>P</em> = .007), and lymph nodes (12.4% vs 2.1%, <em>P</em> = .004) with larger volume differences for PPs. No significant differences were observed for tumors of the prostate (3.7% vs 3.6%) and adrenal glands (9.7% vs 12.2%). No significant GTV differences between the 3 contouring support techniques were observed.</div></div><div><h3>Conclusions</h3><div>Our results show larger GTV changes by PPs for most tumor sites with little impact from contouring support resources. Observed differences might be related to higher contouring confidence of PPs who are more familiar with the case. Further investigation into enhancing contouring support methods is warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101765"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777152","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":"HyperSHArc: Single-Isocenter Stereotactic Radiosurgery of Multiple Brain Metastases Using Proton, Helium, and Carbon Ion Arc Therapy","authors":"Lennart Volz PhD ,&nbsp;Peilin Liu MSc ,&nbsp;Thomas Tessonnier PhD ,&nbsp;Xiaoda Cong MSc ,&nbsp;Marco Durante PhD ,&nbsp;Andrea Mairani PhD ,&nbsp;Wenbo Gu PhD ,&nbsp;Amir Abdollahi MD, PhD ,&nbsp;Xuanfeng Ding PhD ,&nbsp;Christian Graeff PhD ,&nbsp;Taoran Li PhD ,&nbsp;Stewart Mein PhD","doi":"10.1016/j.adro.2025.101763","DOIUrl":"10.1016/j.adro.2025.101763","url":null,"abstract":"<div><h3>Purpose</h3><div>This work presents a proof-of-concept study of HyperSHArc, spot-scanning hadron arc (SHArc) therapy for single-isocenter stereotactic radiosurgery of multiple brain metastases (MBMs). HyperSHArc plans using proton, helium, and carbon ions were compared with state-of-the-art volumetric modulated photon arc therapy.</div></div><div><h3>Methods and Materials</h3><div>Treatment design and optimization procedures were devised using commercial and in-house treatment planning systems. Planning and delivery methods considered dedicated energy, spot, and multiarc selection strategies. Proton, helium, and carbon HyperSHArc plans were generated for patients with MBM exhibiting 3 to 11 intracranial lesions with gross tumor volumes (GTVs) between 0.03 and 19.8 cc, at prescribed doses between 19 and 21Gy in a single-fraction. Planning target volumes (PTVs) considered a 1-mm isotropic margin around the GTV, and robust optimization with 2.5%/1 mm criteria for range and position uncertainty was applied. Photon hyper-arc volumetric modulated arc therapy (HA-VMAT) plans were optimized for the PTVs using the HyperArc® single-isocenter stereotactic radiosurgery platform (Varian, Palo Alto, CA, USA).</div></div><div><h3>Results</h3><div>HyperSHArc plans were comparable between particle species, achieving highly conformal target doses and satisfying clinical coverage criteria. Particle arc plans reduced V_2Gy and V_4Gy in the healthy brain compared with HA-VMAT, while intermediate doses (V_8Gy-V_16Gy) were similar or reduced depending on the number of lesions. Particularly for the case with 11 targets, a considerable reduction in V_12Gy was observed that could be relevant for reducing the risk of treatment-induced radionecrosis. HyperSHArc using carbon ions boosted dose-averaged linear energy transfer inside the target relevant to overcoming radioresistance factors (&gt;100 keV/μm).</div></div><div><h3>Conclusions</h3><div>We present the first particle arc therapy strategies for MBM. Results demonstrate that with HyperSHArc, dose conformity comparable or superior to HA-VMAT is achievable while reducing the low-dose bath and increasing mean dose-averaged linear energy transfer in the GTV. Our findings suggest that HyperSHArc using light and heavy ions could be an effective and efficient means of treating MBM. Further development of HyperSHArc optimization and delivery is justified.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101763"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820759","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":"Comparison of Energy Consumption Between Single Energy O-Gantry and Dual Energy C-Arm Linear Accelerator","authors":"Vibhor Gupta MBBS, MBA ,&nbsp;Suresh Chaudhary MSc ,&nbsp;Olajide Fadare PhD ,&nbsp;Shilpa Senapati MSc ,&nbsp;Sushil Beriwal MD, MBA","doi":"10.1016/j.adro.2025.101762","DOIUrl":"10.1016/j.adro.2025.101762","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101762"},"PeriodicalIF":2.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816867","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":"Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials","authors":"Xu-Ran Zhao MD ,&nbsp;Hui Fang MD ,&nbsp;Hao Jing MD ,&nbsp;Qiu-Zi Zhong MD ,&nbsp;Hong-Fen Wu MD ,&nbsp;Xiao-Rong Hou MD ,&nbsp;Li-Hua Dong MD ,&nbsp;Ya-Hua Zhong MD ,&nbsp;Jing Jin MD ,&nbsp;Li-Na Zhao MD ,&nbsp;Xiao-Hong Wang MD ,&nbsp;Wei-Fang Yang MD ,&nbsp;Jian Tie MD ,&nbsp;Yu-Fei Lu MD ,&nbsp;Guang-Yi Sun MD ,&nbsp;Dan-Qiong Wang MD ,&nbsp;Yu Tang MD ,&nbsp;Shu-Nan Qi MD ,&nbsp;Yong-Wen Song MD ,&nbsp;Yue-Ping Liu MD ,&nbsp;Shu-Lian Wang MD","doi":"10.1016/j.adro.2025.101750","DOIUrl":"10.1016/j.adro.2025.101750","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation-induced lymphopenia (RIL) correlates with poor prognoses in solid tumors. This study aimed to investigate the post–radiation therapy (RT) longitudinal lymphocyte changes and the impact of different RT techniques on RIL in breast cancer patients.</div></div><div><h3>Methods and Materials</h3><div>We prospectively assessed 607 breast cancer patients who received hypofractionated postmastectomy RT in 8 hospitals. Radiation therapy techniques included integrated photon-based intensity modulated technique (integrated RT) and a combination of photon irradiation of supraclavicular nodes and electron irradiation of the chest wall and/or the internal mammary node (hybrid RT). Peripheral lymphocyte counts (PLC) were determined before RT, weekly during RT, at 1 and 2 weeks, 3 and 6 months post–RT, and then every 6 months. The primary outcome was the nadir PLC during RT, for which associated factors were analyzed. Univariate, multivariable linear regression and propensity score matching analyses were performed to evaluate the effect of different RT techniques on nadir PLC.</div></div><div><h3>Results</h3><div>During RT, 121 (19.9%) patients had grade ≥3 RIL with a nadir PLC of 0.75 ± 0.33 × 10⁹/L. The PLC started to recover at 1 week and reached pre–RT levels 1 year after RT and higher than pre–RT levels 2 years later. Multivariate analysis identified young age, low body mass index, radiation therapy targets involving multiple regions, integrated RT, and low pre–radiation therapy PLC as independent risk factors for nadir PLC (<em>P</em> &lt; .005). The PLC at each time point during and after radiation therapy was lower in patients receiving integrated RT than in those receiving hybrid RT (<em>P</em> &lt; .05). Before and after propensity score matching, integrated RT was significantly associated with lower nadir PLC after adjusting for radiation therapy targets and age (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Breast cancer patients had prolonged lymphopenia post–RT. Integrated RT increased the risk of RIL and adversely affected recovery. Therefore, an appropriate RT technique should be considered to minimize RIL.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101750"},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768703","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":"Deep Learning-Based Heterogeneity Correction of the Homogeneous Dose Distribution for Single Brain Tumors in Gamma Knife Radiosurgery","authors":"Sangyoon Lee BA,&nbsp;Shubhendu Mishra MD,&nbsp;Yoichi Watanabe PhD","doi":"10.1016/j.adro.2025.101757","DOIUrl":"10.1016/j.adro.2025.101757","url":null,"abstract":"<div><h3>Purpose</h3><div>Heterogeneity correction is vital in radiation therapy treatment planning to ensure accurate dose delivery. Brain cancer stereotactic treatments, like Gamma Knife radiosurgery (GKRS), often rely on homogeneous water-based calculations despite the potential heterogeneity impact near bony structures. This study aims to develop a method for generating synthetic dose plans incorporating heterogeneity effects without additional computed tomography (CT) scans.</div></div><div><h3>Methods and Materials</h3><div>Magnetic resonance imaging and CT images, TMR10-based, and convolution-based dose distributions were used from 100 retrospectively collected and 22 prospectively collected GKRS patients. A conditional Generative Adversarial Network was trained to translate TMR10 into synthetic convolution (sConv) doses.</div></div><div><h3>Results</h3><div>The generated sConv dose demonstrated qualitative and quantitative similarity to the actual convolution (Conv) dose, showcasing better agreement of dose distributions and improved isodose volume similarity with the Conv dose in comparison to the TMR10 dose (γ pass rate; sConv dose, 92.43%; TMR10 dose, 74.18%. Prescription isodose dice; sConv dose, 91.7%; TMR10 dose, 89.7%). Skull-induced scatter and attenuation effects were accurately reflected in the sConv dose, indicating the usefulness of the new dose prediction model as an alternative to the time-consuming convolution dose calculations.</div></div><div><h3>Conclusions</h3><div>Our deep learning approach offers a feasible solution for heterogeneity-corrected dose planning in GKRS, circumventing additional CT scans and lengthy calculation times. This method's effectiveness in preserving dose distribution characteristics in a heterogeneous medium while only requiring a homogeneous dose plan highlights its utility for including the process in the routine treatment planning workflows. Further refinement and validation with diverse patient cohorts can enhance its applicability and impact in clinical settings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101757"},"PeriodicalIF":2.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768704","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":"A Feasibility Study for Clinical Implementation of hypo fractionated SBRT Program at a Clinic in an LMIC Using Locally Designed Lung Phantom","authors":"Abigail N.M. Quaye MPhil ,&nbsp;Eric C.D.K. Addison PhD ,&nbsp;Ernest Osei PhD ,&nbsp;Afua A. Yorke PhD","doi":"10.1016/j.adro.2025.101752","DOIUrl":"10.1016/j.adro.2025.101752","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This study aims to assess the feasibility of implementing a hypofractionated radiation therapy (HFRT) program at the Oncology Directorate of Komfo Anokye Teaching Hospital in Ghana, addressing specific infrastructure limitations that hinder patient care and treatment efficiency. Hence, we conducted a feasibility study to start a HFRT lung stereotactic body radiation therapy (SBRT) program using currently available resources. The goal is to alleviate the burden on patients and health care providers, particularly in the context of limited resources.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and Materials&lt;/h3&gt;&lt;div&gt;A lung phantom was designed from locally sourced materials consisting of wood slabs to mimic the lung, a perspex tank filled with water for tissue equivalence, and a 3-cm diameter acrylic ball to simulate the tumor. A motion platform was also designed for the phantom to simulate patients breathing in the superior-inferior direction. We acquired 3 computed tomography (CT) scan data sets using a slow CT scan technique for target motions of 0 cm (no_target_motion), 0.5 cm (0.5-cm_target_motion), and 1 cm (1-cm_target_motion) displacements. Treatment plans were generated for each phantom CT image data set using 9-field 6-Mega-Voltage (MV) photon beams in the eclipse treatment planning system. We also generated a treatment plan using an actual patient CT data set to assess the doses to target in the lung and critical organs at risk during a typical lung SBRT treatment. The quality of each treatment plan was evaluated using the near maximum (D&lt;sub&gt;2%&lt;/sub&gt;), near minimum (D&lt;sub&gt;98%&lt;/sub&gt;), mean (D&lt;sub&gt;mean&lt;/sub&gt;), V&lt;sub&gt;100&lt;/sub&gt;, V&lt;sub&gt;95&lt;/sub&gt;, V&lt;sub&gt;90&lt;/sub&gt;, heterogeneity index (HI), conformity index (CI), the ratio of 50% prescription isodose volume to the PTV volume, (R&lt;sub&gt;50%&lt;/sub&gt;), maximum dose (in % of dose prescribed) at 2 cm from PTV in any direction (D&lt;sub&gt;2cm&lt;/sub&gt;, Gy) and dose-volume-histograms for the planning target volume (PTV). The near maximum (D&lt;sub&gt;2%&lt;/sub&gt;), mean, V&lt;sub&gt;5&lt;/sub&gt;, V&lt;sub&gt;10&lt;/sub&gt;, V&lt;sub&gt;15&lt;/sub&gt;, and V&lt;sub&gt;20&lt;/sub&gt; values were used as the dose metrics to evaluate the dose to the lung. Maximum dose was used to evaluate the dose to the spinal cord, and the maximum and mean doses were used to evaluate doses to the esophagus, heart, trachea, and ribs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We quantitatively assessed the quality of the phantom treatment plans by calculating the CI, HI, R&lt;sub&gt;50%,&lt;/sub&gt; and D&lt;sub&gt;2cm&lt;/sub&gt; for each plan. The CI values for the PTV for the no_target_motion, 0.5-cm_target_motion, and 1-cm_target_motion are 1.07, 1.08, and 1.06, respectively. The HIs for the PTV for no_target_motion, 0.5-cm_target_motion, and 1-cm_target_motion are 1.20, 1.10, and 1.20 respectively. The R&lt;sub&gt;50%&lt;/sub&gt; for the no_target_motion, 0.5-cm_target_motion, and 1-cm_target_motion are 3.98, 3.86, and 3.82, respectively, and the corresponding D&lt;sub&gt;2cm&lt;/sub&gt; values are 27.30, 31.64, and 30.47, respec","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101752"},"PeriodicalIF":2.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916744","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":"Tolerance of Adjuvant Ultrahypofractionated Whole-Breast Radiation Therapy Employing Moderately Hypofractionated Sequential Boost: A Single Institution Analysis","authors":"Olga Unterkirhere MD, PhD ,&nbsp;Tino Streller PhD ,&nbsp;David Jeller MSc ,&nbsp;Philippe Logaritsch PhD ,&nbsp;Susanne Bucher MD ,&nbsp;Peter Dubsky MD, PhD ,&nbsp;Christoph Glanzmann MD, PhD ,&nbsp;Gabriela Studer MD, PhD","doi":"10.1016/j.adro.2025.101756","DOIUrl":"10.1016/j.adro.2025.101756","url":null,"abstract":"<div><h3>Purpose</h3><div>This analysis evaluates early and intermediate treatment tolerance in a prospective observational cohort study of patients who underwent adjuvant ultrahypofractionated whole-breast radiation therapy (uhWBRT), with or without moderately hypofractionated sequential boost, following breast-conserving surgery.</div></div><div><h3>Methods and Materials</h3><div>uhWBRT was introduced in our department in March 2020. Data from 436 patients with breast tumors not requiring lymphatic irradiation were analyzed, including 376 with invasive carcinomas (pT1-pT3) and 60 with ductal carcinoma in situ. The mean age was 62 years (range, 26-85). Acute reactions (Common Terminology Criteria for Adverse Events v4.03) were assessed at radiation therapy completion and after 2 to 3 weeks. Late effects and patient-reported outcomes (Late Effects in Normal Tissues–Subjective, Objective, Management and Analytic and Harvard for Cosmesis) were evaluated at 6 months after radiation therapy and annually thereafter. The prescribed uhWBRT dose was 26 Gy in 5 daily fractions. A sequential boost of 10.0 to 12.5 Gy in 4 to 5 daily fractions was administered to 338 patients (77.5%), while 98 (22.5%) did not receive a boost.</div></div><div><h3>Results</h3><div>Acute toxicity grades 0, 1, and 2 were observed in 29.8%, 59.9%, and 10.3% of patients, respectively, at radiation therapy completion and 52.1%, 40.8%, and 7.2% of patients at 2 to 3 weeks after radiation therapy. Grade 2 late effects were identified in 5.3%, 2.0%, 1.8%, 1.1%, and 0%, and grade 3 late effects were identified in 1.5%, 2.3%, 0.9%, 0%, and 0% of patients at 6 months, 1 years, 2 years, 3 years, and 4 years. Patient-reported outcomes for cosmesis were rated as good or excellent in 97.7% of patients. After a mean follow-up of 18 months (median 14, range, 0-48), 1 local failure, 2 nodal failures, and 9 distant relapses were detected. Three deaths were reported, all nontumor-related.</div></div><div><h3>Conclusions</h3><div>Early and intermediate results indicate that the treatment schedules, including the moderately hypofractionated boost, are safe and well tolerated, with acute toxicity rates comparable to those in the FAST-Forward trial. Although our study follow up is relatively short, our findings indicate that uhWBRT, with or without a moderately hypofractionated boost, is safe and well tolerated.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101756"},"PeriodicalIF":2.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768702","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":"Planning Automation for Treatment Techniques Comparison and Robustness Analysis: Tangential Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Whole Breast Irradiation","authors":"Livia Marrazzo MSc ,&nbsp;Deborah Chilà MSc ,&nbsp;Immacolata Vanore MSc ,&nbsp;Roberto Pellegrini MSc ,&nbsp;Peter Voet PhD ,&nbsp;Vanessa Di Cataldo MD ,&nbsp;Icro Meattini MD ,&nbsp;Margherita Zani MSc ,&nbsp;Chiara Arilli MSc ,&nbsp;Silvia Calusi PhD ,&nbsp;Marta Casati MSc ,&nbsp;Antonella Compagnucci MSc ,&nbsp;Cinzia Talamonti PhD ,&nbsp;Lorenzo Livi MD ,&nbsp;Stefania Pallotta MSc","doi":"10.1016/j.adro.2025.101719","DOIUrl":"10.1016/j.adro.2025.101719","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the use of the mCycle automated planning system integrated into the Monaco Treatment Planning System for step-and-shoot intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in whole breast irradiation (WBI). The aim was to assess whether automation can standardize plan quality across a diverse patient cohort and compare dosimetric outcomes and robustness of the 2 techniques against setup errors and anatomical variations.</div></div><div><h3>Methods and Materials</h3><div>A total of 65 patients with breast cancer who underwent postoperative WBI were selected for the study. Treatment plans were generated using mCycle, which employs multicriteria optimization with no manual intervention. Two automated planning techniques—IMRT and VMAT—were implemented and evaluated based on dosimetric outcomes, physician review, planning time, and plan robustness. The plan deliverability was verified through γ index and point dose measurements.</div></div><div><h3>Results</h3><div>The mCycle system produced clinically acceptable plans for both IMRT and VMAT across all patient cohorts. VMAT showed superior target coverage (V95% = 97.9%) and better sparing of ipsilateral organs at risks (OARs), whereas IMRT demonstrated enhanced sparing of contralateral OARs and greater robustness to anatomical changes such as breast swelling. Planning times were reduced with VMAT because of complete automation. Plan deliverability was confirmed with high γ passing rates and acceptable point dose deviations.</div></div><div><h3>Conclusions</h3><div>The use of mCycle in WBI planning successfully standardized plan quality and improved workflow efficiency. VMAT provided superior target coverage and ipsilateral OAR sparing but was more sensitive to anatomical changes. IMRT showed better contralateral OAR sparing and robustness. Both techniques are viable, with advantages depending on clinical scenarios.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101719"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509333","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":"Local Therapy for Isolated Central Nervous System Progression Among Patients Receiving Antibody-Drug Conjugate Therapy","authors":"Emily S. Lebow MD ,&nbsp;Jordan Eichholz MS ,&nbsp;Zhigang Zhang PhD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Brandon Imber MD, MA ,&nbsp;Linda Chen MD ,&nbsp;Quincey LaPlant MD, PhD ,&nbsp;Josh Yamada MD ,&nbsp;Luke R.G. Pike MD, DPhil ,&nbsp;Shanu Modi MD ,&nbsp;Andrew D. Seidman MD ,&nbsp;Kathryn Beal MD ,&nbsp;Nelson S. Moss MD ,&nbsp;Yao Yu MD","doi":"10.1016/j.adro.2025.101714","DOIUrl":"10.1016/j.adro.2025.101714","url":null,"abstract":"<div><h3>Purpose</h3><div>Antibody drug conjugates (ADCs) are an increasingly important class of therapeutics among patients with breast, lung, urothelial, and other malignancies. Guidelines recommend local therapy and continuation of current systemic therapy among patients with isolated brain relapse. We describe the clinical outcomes of this approach among patients receiving ADCs.</div></div><div><h3>Methods and Materials</h3><div>We queried our institutional database for patients receiving radiation therapy (RT) in the setting of isolated brain progression on ADCs with a plan to continue same-line therapy after radiation. Patients with ≤3 brain metastases at the time of recurrence were categorized as oligoprogressive. Study endpoints included overall survival, progression-free survival (PFS), and the cumulative incidence of next therapy from the start of local therapy.</div></div><div><h3>Results</h3><div>We identified 17 patients receiving ADC therapy with isolated brain progression treated with radiation (stereotactic radiosurgery [SRS]: n = 13, whole brain radiation: n = 4). All patients received concurrent ADC and RT. The median follow-up from local therapy was 29.5 months (95% CI, 21.4-not reached). The median overall survival was 19 months (95% CI, 16-not reached), and the median PFS was 8.1 months (range, 6.7-19 months). One lesion treated with SRS had local failure 21 months after treatment, and the 24-month cumulative incidence of local failure across the entire cohort was 1.6% (95% CI, 0.13%-7.7%). The 6-month cumulative incidence of radiation necrosis was 12% (95% CI, 1.8%-32%). The cumulative incidence of next therapy at 6 and 12 months was 47% (95% CI, 22%-69%) and 71% (95% CI, 41%-87%), respectively, and was significantly lower among patients with oligoprogressive brain recurrence. After SRS, 2 patients were without evidence of disease, discontinued systemic therapy, and were stable on observation at last follow-up.</div></div><div><h3>Conclusions</h3><div>To the best of our knowledge, this is the first clinical report of outcomes using the guideline-recommended approach of local therapy for isolated brain relapse among patients receiving ADCs. Local therapy may delay the need for next line systemic therapy, particularly among patients with oligoprogressive brain relapse.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101714"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509331","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}