Advances in Radiation Oncology最新文献

{"title":"Prospective Evaluation of a Novel Unidirectional Permanent Device for Intraoperative Brachytherapy","authors":"Abraham J. Wu MD ,&nbsp;Irini Youssef MD ,&nbsp;Gil’ad N. Cohen MS ,&nbsp;Paul B. Romesser MD ,&nbsp;Neil K. Taunk MD ,&nbsp;Karen Episcopia MS ,&nbsp;Christopher H. Crane MD ,&nbsp;Philip Paty MD ,&nbsp;Julio Garcia-Aguilar MD, PhD ,&nbsp;Martin Weiser MD ,&nbsp;J. Joshua Smith MD, PhD ,&nbsp;Garrett M. Nash MD ,&nbsp;Eugene Cha MD ,&nbsp;Aman Taggar MD ,&nbsp;Zhigang Zhang PhD ,&nbsp;Antonio L. Damato PhD","doi":"10.1016/j.adro.2025.101788","DOIUrl":"10.1016/j.adro.2025.101788","url":null,"abstract":"<div><h3>Purpose</h3><div>The CivaSheet is a novel radiation delivery device consisting of unidirectionally shielded Pd-103 sources embedded in a bioabsorbable polymer sheet. This facilitates intraoperative placement of permanent brachytherapy seeds in a surgical tumor bed, while minimizing dose to overlying structures. No clinical trial data have yet been published for this device. We prospectively investigated its feasibility as an alternative to standard intraoperative radiation therapy (IORT).</div></div><div><h3>Methods and Materials</h3><div>This was a prospective study in patients with abdomopelvic malignancies undergoing surgery with an indication for IORT. Prior external beam radiation was allowed. The primary endpoint was feasibility, defined as technically satisfactory placement of CivaSheet in ≥7 of 10 patients. Secondary endpoints were adverse events, local control, and implant stability.</div></div><div><h3>Results</h3><div>Ten patients were enrolled and underwent surgery. Eight patients successfully underwent CivaSheet implantation. The 2 feasibility exclusions were technically unfavorable based on intraoperative assessment of tumor bed configuration. All implanted patients were treated to the pelvic sidewall or presacral space with a median prescription dose of 100 Gy. Median follow-up from the date of implant was 25 months. One patient had a marginal recurrence 3 months after implant, and 1 patient recurred at implant site after 13 months. One and 2-year estimates of local control were 86% and 69%, respectively. No device-related grade 4-5 adverse events were observed. Postimplant stability was deemed satisfactory in all patients.</div></div><div><h3>Conclusions</h3><div>This is the first published clinical trial of a novel unidirectional brachytherapy device. CivaSheet proved to be a feasible technique to deliver intraoperative radiation to patients with high-risk pelvic malignancies after surgical resection, and warrants further study and clinical consideration, particularly in settings where other IORT options are not available.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101788"},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195102","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":"Quantification and Dosimetric Impact of Normal Organ Motion During Adaptive Radiation Therapy Planning Using a 1.5 Tesla Magnetic Resonance–Equipped Linear Accelerator (MR-Linac)","authors":"David Wittmann MD ,&nbsp;Eric S. Paulson PhD ,&nbsp;Anjishnu Banerjee PhD ,&nbsp;Leou Ismael Banla MD, PhD ,&nbsp;Christopher Schultz MD ,&nbsp;Musaddiq Awan MD ,&nbsp;Xinfeng Chen PhD ,&nbsp;Eenas A. Omari PhD ,&nbsp;Michael Straza MD, PhD ,&nbsp;X. Allen Li PhD ,&nbsp;Beth Erickson MD ,&nbsp;William A. Hall MD","doi":"10.1016/j.adro.2025.101758","DOIUrl":"10.1016/j.adro.2025.101758","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients receiving adaptive magnetic resonance guided radiation therapy (MRgRT) undergo contour modification prior to treatment delivery, which takes 15 to over 60 minutes. We hypothesized that during the time required to create an adaptive MRgRT plan, organ movement will result in dosimetric changes to regional organs at risk (OARs). This study quantifies the dosimetric impact of OAR motion during the time required to perform adaptive MRgRT.</div></div><div><h3>Methods and Materials</h3><div>Thirty-one patients with pancreatic adenocarcinoma, prostate adenocarcinoma, hepatocellular carcinoma, and oligo-metastases who received MRgRT using a 1.5 Tesla MR-Linac were prospectively enrolled in an open registry imaging trial (NCT03500081). Two magnetic resonance imaging (MRI) studies were acquired predelivery for each MRgRT treatment fraction: an initial “pretreatment” MRI (input to the adaptive evaluation with or without recontouring and replanning process), and a second “verification MRI” (acquired after the recontouring and adaption process and immediately before treatment delivery or “beam-on”). On the verification MRI, normal organs were recontoured offline. Recontoured normal organs included the colon, duodenum, small bowel, and stomach. Differences in OARs between organ positions represented the normal organ movement during the time required for plan adaption. Maximum dose (Dmax), volumetric (V) 0.5 cubic centimeter dose (D0.5cc), 3000 cGy (V30), and 2000 cGy (V20) were calculated from the recontoured verification MRI.</div></div><div><h3>Results</h3><div>Differences in Dmax, per fraction, for the listed normal organs were as follows: colon/rectum 239.50 cGy (<em>P</em> = .09), duodenum 136.40 cGy (<em>P</em> = .05), small bowel 488.27 cGy (<em>P</em> &lt; .01), and stomach 95.92 (<em>P</em> = .17). Small bowel demonstrated a significant difference in Dmax, D0.5cc, and V30.</div></div><div><h3>Conclusions</h3><div>Statistically significant differences in small bowel doses are demonstrated as a result of motion during the timing required for adaptive MRgRT. These results reflect the importance of verifying MRI acquisition during adaptive MRgRT to confirm the location of OARs. They also identify the necessity of strategies to account for the dynamic nature of regional OARs.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101758"},"PeriodicalIF":2.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816868","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":"How Much Can Optimization of Hypofractionation Help to Reduce Carbon Equivalent Emissions? A Single-Center Modeling Study","authors":"Dimitri Vanmarcke MD ,&nbsp;Olena Holubowska MSc ,&nbsp;Ate Poorthuis MSc, PhD ,&nbsp;Bram Mangelschots MSc ,&nbsp;Jean-François Daisne MD, PhD","doi":"10.1016/j.adro.2025.101781","DOIUrl":"10.1016/j.adro.2025.101781","url":null,"abstract":"<div><h3>Purpose</h3><div>Climate change poses a major threat to public health. The health care sector paradoxically contributes significantly to greenhouse gas emissions. In radiation therapy, increased hypofractionation could reduce both patient transport and linear accelerator (LINAC) use, but the size of the impact remains largely undocumented. We estimated department-wide CO₂ equivalent (CO₂e) emissions of patient transport and LINAC energy consumption both in a real-world scenario and in a hypothetical maximized hypofractionation scenario.</div></div><div><h3>Methods and Materials</h3><div>We performed a retrospective exploratory study of all patients treated with external beam radiation therapy in 2019 (pre-COVID-19 year) at the University Hospitals Leuven (Belgium). CO₂e emissions of patient transport were modeled by considering the kilometers traveled by car between the patient’s home and the hospital as well as the number of visits necessary for the treatment. Second, the hypothetical impact of implementing the most hypofractionated schedules according to the current (December 2024) best scientific evidence was calculated using the model. Finally, energy consumption of our Varian TrueBeam and Halcyon LINAC was measured to calculate the related CO₂e emissions.</div></div><div><h3>Results</h3><div>In 2019, there were 43,433 patient visits over 2625 external beam radiation therapy courses with an estimated total of 2.67 million km traveled, resulting in an estimated 394 t of CO₂e emissions. Implementation of hypothetical maximalized hypofractionation would decrease emissions by 18.3% (95% CI, 17.7%-20.0%) on average. The reduction was much larger for early breast cancer (–32.4%) and prostate cancer (–48.5%) than for all the other pathologies (–7.0%). Comparing a prostate treatment in 16 (<em>n</em> = 2 patients) and 5 (<em>n</em> = 2) fractions on the TrueBeam and 16 (<em>n</em> = 2) fractions on the Halcyon, energy use was, respectively, 47.1, 23.6, and 9.2 kWh over the total course, or 6.17, 3.10, and 1.21 kg of CO₂e emissions.</div></div><div><h3>Conclusions</h3><div>In our hypothetical scenario, maximal optimization of hypofractionation schedules significantly reduces CO₂e emissions by decreasing patient transport and, to a much lesser extent, energy consumption.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101781"},"PeriodicalIF":2.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937128","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":"Long-Lasting Recovery From Recurrent Brain Radionecrosis Following TRICO Treatment in 2 Head and Neck Cancer Survivors","authors":"Sylvie Delanian MD, PhD ,&nbsp;Florian Chatelet MD ,&nbsp;Philippe Herman MD, PhD","doi":"10.1016/j.adro.2025.101785","DOIUrl":"10.1016/j.adro.2025.101785","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101785"},"PeriodicalIF":2.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950462","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":"Induction of Cytoplasmic dsDNA and cGAS-STING Immune Signaling After Exposure of Breast Cancer Cells to X-ray or High-Energetic Carbon Ions","authors":"Cristina Totis MSc ,&nbsp;Nicole B. Averbeck PhD ,&nbsp;Burkhard Jakob PhD ,&nbsp;Maik Schork PhD ,&nbsp;Gaia Volpi MSc ,&nbsp;Dennis F. Hintze BSc ,&nbsp;Marco Durante PhD ,&nbsp;Claudia Fournier PhD ,&nbsp;Alexander Helm PhD","doi":"10.1016/j.adro.2025.101783","DOIUrl":"10.1016/j.adro.2025.101783","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy can trigger activation of the cyclic GMP-AMP synthase (cGAS)- Stimulator of interferon genes (STING) axis via cytoplasmic dsDNA fragment induction. The activation of cGAS-STING initiates innate immune signaling mediated by interferon type I that can contribute to eradicate the malignancy. The effect was shown to depend on the fractionation scheme employed. We hypothesized that the innate immune response can also depend on radiation quality because densely ionizing radiation, such as carbon ions, have different effects on DNA lesion quality.</div></div><div><h3>Methods and Materials</h3><div>We exposed an in vitro 4T1 breast cancer model to either photons or carbon ions and measured the clonogenic survival of cells with the colony-forming assay. The occurrence of cytosolic dsDNA fragments was assessed via immunofluorescence, whereas the expression and release of interferon-β by quantitative reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay. Bulk RNA sequencing was used to investigate global radiation-induced changes in gene expression.</div></div><div><h3>Results</h3><div>We show here that carbon ions induced a significantly higher yield of cytosolic dsDNA fragments per unit dose as compared to photons. The higher efficiency also translated in expression and release of interferon-β by the tumor cells. The rate of cytoplasmic dsDNA foci as well as interferon-β release increased with doses up to 20 Gy and no differences for a fractionation scheme (3 × 8 Gy) were found as compared to the single high doses (20 or 24 Gy) of photons.</div></div><div><h3>Conclusions</h3><div>In conclusion, we found that the release of interferon-β after radiation increases with the radiation dose up to 20 Gy and that carbon ions have the potential to elicit a strong innate immune signaling.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101783"},"PeriodicalIF":2.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950463","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":"Factors Associated With Early Discontinuation of Radiation Therapy: An Analysis of the National Cancer Database","authors":"Jie Yin MD,&nbsp;Muhammad M. Qureshi MBBS, MPH,&nbsp;Daniel Huang MD,&nbsp;Minh T. Truong MD,&nbsp;Kimberley S. Mak MD, MPH,&nbsp;Sherry Yan MD,&nbsp;Ariel E. Hirsch MD","doi":"10.1016/j.adro.2025.101784","DOIUrl":"10.1016/j.adro.2025.101784","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) often involves multiple visits over weeks and may be discontinued before planned treatment completion. This analysis aims to identify clinical and socioeconomic factors that could serve as predictors of RT discontinuation.</div></div><div><h3>Methods and Materials</h3><div>Using National Cancer Database data from 2018 to 2019, we identified 749,135 cases treated with RT, chemoradiation (CRT), surgery with RT, or surgery with CRT that had information on radiation discontinuation. All patients were treated with curative intent. The variables assessed include age (18-&lt;50, 50-&lt;70, and ≥70), sex (male and female), race (White, Black, and Other), insurance status (private, Medicare/government, and Medicaid/uninsured), income level (&lt;$46,277, $46,277-$57,856, $57,856-$74,062, and ≥$74,062), facility type (community, comprehensive community, academic/research, and integrated cancer network), Charlson-Deyo Comorbidity Score (0, 1, and ≥2), treatment type (RT, CRT, surgery with RT, and surgery with CRT), and primary tumor site. Reasons for RT discontinuation were evaluated. Univariable and multivariable logistic regression modeling was used to calculate the adjusted odds of RT discontinuation by clinical and socioeconomic factors.</div></div><div><h3>Results</h3><div>Of the 749,135 patients, RT was discontinued in 25,072 (3.3%) patients. The primary tumor sites include breast (36.6%), thorax (18.1%), genitourinary tract (13.2%), head and neck (11.4%), gastrointestinal system (10.9%), gynecologic system (6.0%), central nervous system (3.9%), musculoskeletal system (1.3%), and skin (0.7%). On multivariable analysis, older age, female sex, nonprivate insurance, lower income, treatment at community program facilities, multiple comorbidities, and CRT were independently associated with RT discontinuation. The reasons for RT discontinuation were patient decision (35.5%), contraindication because of patient risk factors (20.0%), toxicity (19.7%), patient expiration (13.8%), and family decision (3.0%).</div></div><div><h3>Conclusions</h3><div>This National Cancer Database analysis showed RT discontinuation rates correlated with clinical factors, including older age, multiple comorbidities, and CRT, and socioeconomic factors, including nonprivate insurance and lower household income.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101784"},"PeriodicalIF":2.2,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898712","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":"FLASH Stereotactic Body Radiation Therapy for Spine Tumors Using a Single-Energy Proton Pristine Bragg Peak Delivery Technique","authors":"Balaji Selvaraj PhD ,&nbsp;Xingyi Zhao MS ,&nbsp;Haibo Lin PhD ,&nbsp;Jiajian Shen PhD ,&nbsp;Chingyun Cheng PhD ,&nbsp;Alex Bookbinder BS ,&nbsp;Hui Wu MD ,&nbsp;Huifang Zhai MS ,&nbsp;J. Isabelle Choi MD ,&nbsp;Arpit M. Chhabra MD ,&nbsp;Shaakir Hasan DO ,&nbsp;Charles B. Simone II MD ,&nbsp;Yoshiya Yamada MD ,&nbsp;Minglei Kang PhD","doi":"10.1016/j.adro.2025.101776","DOIUrl":"10.1016/j.adro.2025.101776","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the dosimetric performance and dose rate of Bragg peak FLASH (BP-FLASH) for spinal cord stereotactic body radiation therapy (SBRT).</div></div><div><h3>Methods and Materials</h3><div>Ten consecutive patients with spinal tumors treated with conventional intensity modulated proton therapy (CONV-IMPT) SBRT (40 Gy in 5 fractions) were selected for this study. These patients were reoptimized using an in-house FLASH algorithm and a single-energy Bragg peak approach. The dose distributions and dose metrics for target coverage and critical organs-at-risk (OARs) were compared. BP-FLASH plans dose rates were calculated using an average-dose-rate. The FLASH ratios (V_40Gy/s) were assessed with dose thresholds at 0.2, 2, and 5 Gy. The doses and dose rates for the 10 patients were averaged, and a <em>t</em> test was performed comparing CONV-IMPT and BP-FLASH.</div></div><div><h3>Results</h3><div>Dosimetric analysis revealed that the BP-FLASH plans deliver a similar dose as CONV-IMPT plans to critical OARs. However, in BP-FLASH, the clinical target volume received a higher maximum dose than CONV-IMPT (115.1% versus 108.9%, <em>P</em> = .001). No notable differences were observed in the maximum doses to the spinal cord (<em>P</em> = .122) or esophagus (<em>P</em> = .327). FLASH dose rates for all the OARs exceeded 80% with 2 Gy dose threshold. When increased to 5 Gy, V_40Gy/s increased to &gt;95% for composite plan doses.</div></div><div><h3>Conclusions</h3><div>BP-FLASH SBRT is a promising treatment for challenging spinal cord cancers, which achieved ultra-high-dose rates for FLASH effect and maintained the same dosimetry quality as the CONV-IMPT plans.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101776"},"PeriodicalIF":2.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890549","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":"Representation of Radiation Oncologists on National Comprehensive Cancer Network Guideline Committees","authors":"Bismarck C. Odei MD ,&nbsp;Temitope Agabalogun MD ,&nbsp;Erika Bello-Pardo BS ,&nbsp;Christina Huang MD, MS ,&nbsp;Daniel Vanderbilt MD, PhD ,&nbsp;Seyi Omeh MD, MPH ,&nbsp;Benjamin Sterling ,&nbsp;Fumiko Chino MD","doi":"10.1016/j.adro.2025.101773","DOIUrl":"10.1016/j.adro.2025.101773","url":null,"abstract":"<div><h3>Purpose</h3><div>The National Comprehensive Cancer Network (NCCN) guideline committees (GCs) play a vital role in defining the standard of care for cancer management. Equitable specialty representation is crucial for unbiased recommendations and perspectives. This study examines the specialty and leadership representation on NCCN GCs, with a focus on radiation oncologists (ROs).</div></div><div><h3>Methods and Materials</h3><div>This cross-sectional observational study evaluated committee member characteristics on NCCN treatment GCs available in 2020 and subset of committees with guidelines containing category 1 or 2A radiation therapy recommendations. Collected data included member characteristics and committee roles. Interspecialty variance was evaluated via χ² tests.</div></div><div><h3>Results</h3><div>A total of 1768 NCCN committee members were identified, representing 54 NCCN GCs with a median committee size of 33 (range, 22-38). Among all members: 47.6% were medical oncologists (MOs), 20.9% were surgical oncologists (SOs), and 8.9% were RO; 22.6% were other specialists. Women accounted for 37.6% (316/841) of MO, 34.2%(54/158) of RO and 22.8% (84/369) of SO members (<em>P</em> &lt; .001). RO representation varied based on disease site (2.4%-29.9%; 15 individual committees had no RO representation) and in leadership roles (3% chairs, 23% vice chairs). On 38 committees with guidelines containing category 1 or 2A radiation therapy recommendations, the pattern of low representation persisted (8.4%). Although 39% of individuals on all committees were women, only 23% of committee chairs were women (<em>P</em> = .048).</div></div><div><h3>Conclusion</h3><div>There is low representation of ROs on NCCN GCs and in leadership roles, which may limit the discussion during guideline development and negatively impact the diversity of perspectives in management recommendations.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101773"},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143950461","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":"Optimizing Dose Reduction to the Left Anterior Descending Artery in Patients With Locally Advanced Lung Cancer Treated With Definitive Radiation Therapy: A Feasibility Study of Coplanar Treatments Using Double-Stacked Multileaf Collimator","authors":"Joshua P. Kim PhD ,&nbsp;Justine M. Cunningham MS ,&nbsp;Emily Moats CMD ,&nbsp;Ahmed I. Ghanem MD, PhD ,&nbsp;Benjamin Movsas MD ,&nbsp;Kenneth Levin MD ,&nbsp;Aharon M. Feldman MD ,&nbsp;Kundan Thind PhD","doi":"10.1016/j.adro.2025.101779","DOIUrl":"10.1016/j.adro.2025.101779","url":null,"abstract":"<div><h3>Purpose</h3><div>Recent studies have shown that cardiac substructures and particularly left anterior descending artery (LAD) dose strongly correlates with the incidence of late adverse cardiac events. We evaluated whether greater cardiac and, importantly, LAD dose sparing could be achieved using a newly introduced closed bore (O-ring gantry) linac with a double-stacked multileaf collimator (Varian Ethos) relative to conventional linacs.</div></div><div><h3>Methods and Materials</h3><div>Twenty patients with locally advanced non-small cell lung cancer previously treated with definitive chemoradiotherapy were retrospectively evaluated. Volumetric modulated arc therapy plans were retrospectively generated for the Ethos system using optimization criteria focused on reducing overall heart and LAD doses (Heart_Ethos). Plans were also reoptimized using the same optimization criteria on a conventional C-arm linac (Heart_TB). Investigational plans were compared with the original plans and with each other using standard dose-volume histogram metrics such as percentage (V) volume receiving a specific dose (x) in Gy (Vx) or mean dose (Dmean) in Gy.</div></div><div><h3>Results</h3><div>Statistically significant decreases existed between the Heart_Ethos and original plans for mean heart dose (11.3 vs 14.8 Gy; <em>P</em> &lt; .001) and V5, V30, and V50 (63.6% vs 75.2%; <em>P</em> &lt; .001, 7.1% vs 12.3%; <em>P</em> &lt; .001, 2.1% vs 2.9%; <em>P</em> = .03, respectively) and also for LAD mean dose (4.8 Gy vs 12.0 Gy [<em>P</em> &lt; .001]) and V15 (4.9% vs 21.5%; <em>P</em> &lt; .001). Compared with Heart_TB, Heart_Ethos plans had significantly less mean heart dose (11.6 vs 12.2 Gy; <em>P</em> = .006), and less heart V5 (64.4% vs 67.2%; <em>P</em> = .049) and V30 (7.7% vs 8.8%; <em>P</em> = .03), whereas other parameters were not significant. Optimal target coverage and other organs at risk constraints were maintained for all generated plans.</div></div><div><h3>Conclusions</h3><div>Heart_Ethos plans showed significant reduction in cardiac and LAD doses in comparison to the original plans while maintaining target and organ at risk goals. Our findings suggest that Ethos technology has the potential for better cardiac toxicity safety because Heart_Ethos plans were still able to reduce cardiac dose compared with Heart_TB plans.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 6","pages":"Article 101779"},"PeriodicalIF":2.2,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888277","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":"In Regard to Niazi et al","authors":"Erkan Topkan MD ,&nbsp;Efsun Somay PhD ,&nbsp;Ugur Selek MD","doi":"10.1016/j.adro.2024.101707","DOIUrl":"10.1016/j.adro.2024.101707","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101707"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834115","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}