Advances in Radiation Oncology最新文献

{"title":"Impact of the Number of Administered Systemic Treatment Lines on Local Response to Radiation Therapy for Multiple Myeloma","authors":"Andrea Emanuele Guerini MD ,&nbsp;Eneida Mataj MD ,&nbsp;Paolo Borghetti MD ,&nbsp;Luca Triggiani ,&nbsp;Ludovica Pegurri MD ,&nbsp;Stefania Nici ,&nbsp;Stefano Riga ,&nbsp;Alessandra Tucci MD ,&nbsp;Angelo Belotti MD ,&nbsp;Marco Lorenzo Bonù MD ,&nbsp;Giorgio Facheris MD ,&nbsp;Stefano Maria Magrini ,&nbsp;Luigi Spiazzi ,&nbsp;Michela Buglione","doi":"10.1016/j.adro.2024.101696","DOIUrl":"10.1016/j.adro.2024.101696","url":null,"abstract":"<div><h3>Purpose</h3><div>Multiple myeloma (MM) tends to develop resistance to systemic therapy through multiple mechanisms that might as well induce radioresistance, as suggested by preclinical studies. The aim of the present analysis was to elucidate whether the number of systemic treatment lines received prior to radiation therapy (RT) might confer radioresistance and influence local response.</div></div><div><h3>Methods and Materials</h3><div>This single-center retrospective study enrolled patients who received RT for MM at our institution between January 1, 2005, and January 31, 2023. Information regarding RT, systemic therapy, and characteristics of the patients and disease were retrieved from medical records. The primary outcome for this analysis was radiologic local response at 6 months after RT, according to RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) or PERCIST 1.0 (Positron Emission Tomography Response Criteria in Solid Tumors) criteria. The secondary outcome was toxicity reported during the RT course.</div></div><div><h3>Results</h3><div>Data from 665 MM lesions from 366 patients were analyzed. Data regarding local response at 6 months were available for 217 lesions, reporting 29 complete responses (13.4%), 141 partial responses (65%), 42 stable diseases (19.4%), and only 5 disease progressions (2.3%). The number of previous systemic treatment lines had no impact on radiologic response at 6 months (<em>p</em> = .721). RT BED₁₀ (Biologically Effective Dose) had a significant impact on response at 6 months (<em>p</em> = .007). The toxicity profile was optimal, as grade &gt; 2 events during RT were reported only in 0.9% of cases.</div></div><div><h3>Conclusions</h3><div>In this large retrospective cohort of MM patients, the number of systemic treatment lines administered before RT had no impact on the local response, confuting concerns of cross-resistance raised by multiple preclinical studies. Disease control after RT was optimal, and instances of severe toxicities during treatment were rare.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101696"},"PeriodicalIF":2.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094117","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":"Image Guidance is Associated with Improved Freedom From Recurrence After Superficial Radiation Therapy for Nonmelanoma Skin Cancer","authors":"Erin M. McClure MD ,&nbsp;Geoffrey Sedor MD ,&nbsp;Mairead Moloney BS ,&nbsp;Yuxuan Jin MS ,&nbsp;Lio Yu MD ,&nbsp;Michael W. Kattan PhD","doi":"10.1016/j.adro.2024.101463","DOIUrl":"10.1016/j.adro.2024.101463","url":null,"abstract":"<div><h3>Purpose</h3><div>This is the first study to quantify the 2-year freedom from recurrence for individuals with nonmelanoma skin cancer (NMSC) such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and squamous carcinoma in situ (SCCIS) treated with image guided superficial radiation therapy (IGSRT) versus SRT without image guidance.</div></div><div><h3>Methods and Materials</h3><div>This retrospective cohort study evaluates the 2-year freedom recurrence rate of NMSCs treated by IGSRT (March 2016 to January 2022) and compares it to existing data on NMSCs treated by SRT via 1 sample proportion tests. Individuals &gt;18 years old with biopsy-proven SCC, SCCIS, and/or BCC treated with IGSRT were included in the study, and 1602 patients/2880 treated lesions were followed until January 14, 2022. SRT literature was identified through an Ovid Medline search.</div></div><div><h3>Results</h3><div>All NMSCs treated by IGSRT in this cohort had an aggregate 2-year freedom from recurrence of 99.23%. The recurrence rate for BCC (N = 1382) was 1.1%, for SCC (N = 904) 0.8%, and for SCCIS (N = 594) 0.0%. These recurrence rates are significantly improved compared with a pooled study that evaluated NMSCs across histology and BCCs alone treated without image guidance (standard SRT) (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>IGSRT offers a paradigm-shifting treatment option for patients with NMSCs – offering statistically significantly improved outcomes compared with standard SRT and a more desirable toxicity profile to surgical options. This study demonstrates that IGSRT is associated with remarkably low recurrence rates, which are statistically significantly improved from the previous generation of SRT and in line with modern outcomes for Mohs micrographic surgery.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101463"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139873758","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":"Cardiopulmonary Substructure Doses are Not Correlated With Cardiorespiratory Fitness Among Breast Cancer Survivors Treated With Contemporary Radiation Therapy","authors":"Maria Thor PhD ,&nbsp;Jessica M. Scott PhD ,&nbsp;Anne S. Reiner MPH ,&nbsp;Linda Hong PhD ,&nbsp;Anthony F. Yu MD ,&nbsp;Aditya Apte PhD ,&nbsp;Beryl McCormick MD ,&nbsp;Angelica Perez-Andujar PhD ,&nbsp;Catherine P. Lee BS ,&nbsp;Laura Cervino PhD ,&nbsp;Jenna Harrison BS ,&nbsp;Xiaolin Liang MA ,&nbsp;Prusha Patel MPH ,&nbsp;Lawrence T. Dauer PhD ,&nbsp;Chaya S. Moskowitz PhD ,&nbsp;Jonine L. Bernstein PhD","doi":"10.1016/j.adro.2024.101613","DOIUrl":"10.1016/j.adro.2024.101613","url":null,"abstract":"<div><h3>Purpose</h3><div>Breast cancer radiation therapy (RT) techniques have historically delivered mean heart doses (MHDs) in the range of 5 Gy, which have been found to predispose patients to cardiopulmonary toxicities. The purpose of this study was to apply artificial intelligence (AI) cardiac substructure auto-segmentation to evaluate the corresponding substructure doses, whether there are laterality- and technique-specific differences in these doses, and if the doses are significantly associated with cardiorespiratory fitness after state-of-the-art RT planning and delivery for breast cancer.</div></div><div><h3>Methods and Materials</h3><div>Cardiopulmonary substructures were AI auto-segmented. Cardiorespiratory fitness was evaluated at a median of 2.3 (range, 1.1-9.8) years following RT from 2007 to 2021 among 65 breast cancer survivors. The associations between the mean dose to each of the 9 AI auto-segmented cardiopulmonary substructures, the contralateral, and the ipsilateral lung with cardiorespiratory fitness were evaluated using linear regression.</div></div><div><h3>Results</h3><div>The median MHD was 0.64 Gy (range, 0.12-7.1). Among the auto-segmented substructures, the highest mean doses were observed for the left ventricle (median, 0.88 Gy). The mean dose to each of the 11 structures was significantly higher for women treated with volumetric modulated arc therapy (MHD median, 3.8 Gy vs 0.57 Gy; <em>P</em> &lt; .0001). Women with left-sided breast cancer had significantly higher MHDs (0.97 vs 0.38 Gy; <em>P</em> &lt; .0001) due to higher doses in 3 of 4 cardiac chambers and also due to significantly higher pulmonary artery doses (median, 0.93 vs 0.32 Gy; <em>P</em> = .0003); women with right-sided breast cancer had significantly higher vena cava and right atrium doses (eg, right atrium median, 0.74 vs 0.29 Gy; <em>P</em> = .0002). No cardiopulmonary structure dose was significantly associated with reduced cardiorespiratory fitness after adjusting for age, chemotherapy agent, volumetric modulated arc therapy, RT position, and RT extent.</div></div><div><h3>Conclusions</h3><div>State-of-the-art breast cancer RT reduces cardiopulmonary dose, and there is a technique and cancer laterality RT dose dependence throughout the cardiopulmonary system.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101613"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942546","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":"Advances in Radiation Oncology in 2023","authors":"Rachel B. Jimenez MD","doi":"10.1016/j.adro.2024.101578","DOIUrl":"10.1016/j.adro.2024.101578","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101578"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942540","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":"ASTRO's Advances in Radiation Oncology Outstanding Reviewers for 2023","authors":"Rachel B. Jimenez MD","doi":"10.1016/j.adro.2024.101686","DOIUrl":"10.1016/j.adro.2024.101686","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101686"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942545","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":"Time to Next Systemic Therapy After Stereotactic Body Radiation Therapy for Oligoprogressive Metastatic Castrate-Resistant Prostate Cancer","authors":"Corbin J. Eule MD ,&nbsp;Nellowe Candelario MD ,&nbsp;Sameer K. Nath MD ,&nbsp;Tyler P. Robin MD, PhD","doi":"10.1016/j.adro.2024.101655","DOIUrl":"10.1016/j.adro.2024.101655","url":null,"abstract":"<div><h3>Purpose</h3><div>Patients with metastatic castrate-resistant prostate cancer (CRPC) with progressive disease generally require a change or escalation in systemic therapy. For patients with limited (1-3) sites of progressive disease (oligoprogression), metastasis-directed therapy with stereotactic body radiation therapy (SBRT) may allow a longer interval before next-line systemic therapy.</div></div><div><h3>Methods and Materials</h3><div>This is a retrospective study of patients with oligoprogressive metastatic CRPC (mCRPC) treated with SBRT at a single center between 2011 and 2022. The primary endpoint was time to next systemic therapy (TTNST) after SBRT stratified by the presence/absence of untreated nonprogressing metastases. Secondary endpoints included TTNST of the overall cohort and median overall survival (OS) after SBRT.</div></div><div><h3>Results</h3><div>Thirty-two patients with oligoprogressive mCRPC received SBRT to 38 metastases. Patients had a median age of 72.5 years (range, 50.6-84.3) and a median PSA of 6.85 ng/mL (range, 0.39-922.0) at the time of SBRT. The most commonly used SBRT regimen was 3000 cGy in 5 fractions (18 metastases, 47.4%). Sixteen patients were treated to all known sites of disease, whereas 16 patients received SBRT to oligoprogressive metastases but had at least 1 untreated nonprogressing metastasis at the time of SBRT. Patients had received a median of 1.0 prior line of androgen receptor signaling inhibitors and were predominantly (26 patients, 81.3%) chemotherapy naïve. Following SBRT, the median TTNST was 10.1 months and the median OS was 41.3 months. For patients with 0 versus ≥1 untreated nonprogressing metastasis, TTNST was 11.3 versus 8.7 months, respectively (HR, 0.67; 95% CI, 0.33-1.36, logrank <em>P</em> = .24). There was no grade ≥3 toxicities because of SBRT.</div></div><div><h3>Conclusions</h3><div>In this cohort, patients with oligoprogressive mCRPC treated with SBRT delayed the next line of systemic therapy for a median of 10.1 months. SBRT in patients with oligoprogressive mCRPC may delay initiation of the next-line systemic therapy in well-selected patients, including those with ≥1 untreated nonprogressing metastasis.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101655"},"PeriodicalIF":2.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765504","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":"Patient Perceptions of Radiation Therapy Prior to Initial Consultation With a Radiation Oncologist","authors":"Jennifer Novak MD, MS ,&nbsp;Colton Ladbury MD ,&nbsp;Tariq Abuali BS ,&nbsp;Andrew Tam MD ,&nbsp;Jeffrey Brower MD, PhD ,&nbsp;Brett Evans BS ,&nbsp;Virginia Sun PhD, RN ,&nbsp;Matthew J. Loscalzo LCSW ,&nbsp;Arya Amini MD","doi":"10.1016/j.adro.2024.101676","DOIUrl":"10.1016/j.adro.2024.101676","url":null,"abstract":"<div><h3>Purpose</h3><div>There are currently limited data regarding patient perceptions and fears related to radiation therapy (RT). This study sought to identify and quantify patient concerns regarding RT and to determine the potential value of assessing these expectations prior to initial consultation.</div></div><div><h3>Methods and Materials</h3><div>Patients with no prior history of RT were invited to complete an investigator-developed anonymous electronic survey prior to consultation. Patients were queried about their perceptions of RT and potential fears/concerns. The content validity index for survey items were scored with adequate construct validity. Survey items were scored descriptively through summary statistics. Relationships between respondent variables and responses to survey questions were analyzed by univariate and multivariate logistic regression.</div></div><div><h3>Results</h3><div>From September 2020 through June 2022, 214 patients completed the survey and were included in the analysis. Fifty percent of respondents reported a complete lack of knowledge regarding RT. Twenty-seven percent of patients reported that RT is their most worrisome cancer treatment, compared to chemotherapy or surgery. The most common self-reported fears of RT included general side effects, skin burns, not knowing what to expect regarding RT, pain, and organ damage. The most frequently reported concerns of physical side effects of RT included pain (67%), memory loss (62%), nausea/vomiting (60%), and skin reactions (58%). Sixty-two percent of respondents reported being either moderately or very concerned about their ability to perform daily activities. Thirty-six percent of respondents reported at least moderate concern over the financial cost of RT. Twenty-six percent of respondents reported at least moderate concern regarding transportation to RT. Forty-eight percent of respondents reported concern about emitting radiation to others.</div></div><div><h3>Conclusions</h3><div>Patient concerns related to RT toxicities and impact on daily life were common, as were misconceptions of RT. Pre-consultation assessment of patient expectations regarding RT is feasible and may be helpful in addressing patients concerns early and in real-time.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101676"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748520","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":"Perceptions, Uses, and Information Sources of Medical Cannabis Among Patients With Cancer","authors":"Vera Qu BA ,&nbsp;Caressa Hui MD ,&nbsp;Jennifer Hall BA ,&nbsp;Kekoa Taparra MD, PhD ,&nbsp;Tanaya Kollipara BA ,&nbsp;Sandy Trieu MD ,&nbsp;Beth Beadle MD, PhD ,&nbsp;Scott Soltys MD ,&nbsp;Erqi L. Pollom MD","doi":"10.1016/j.adro.2024.101678","DOIUrl":"10.1016/j.adro.2024.101678","url":null,"abstract":"<div><h3>Purpose</h3><div>Although medical cannabis (MC) has been shown to relieve cancer- and treatment-related symptoms, there is increasing misinformation regarding its antitumor efficacy. We aimed to identify opportunities for oncologists to communicate evidence-based guidance to patients regarding its use.</div></div><div><h3>Methods and Materials</h3><div>Patients with cancer seen in radiation oncology clinic between June 2022 and July 2023 were surveyed with a questionnaire regarding their perceptions and information sources of MC. Associations between survey responses and demographic and disease variables were evaluated. Qualitative thematic analysis was performed on narrative responses in search of common themes.</div></div><div><h3>Results</h3><div>Eighty-four patients (84% completion rate) were included in the analysis. Most (83.3%) strongly agreed or agreed that MC can provide symptom relief, whereas a subset of patients (15.5%) strongly agreed or agreed that MC can cure cancer. This latter subcohort was significantly more likely to identify as Hispanic/Latino (38.5% vs 9.9%, <em>P</em> = .009) and less likely to be up to date on COVID-19 vaccinations (30.8% vs 8.5%, <em>P</em> = 0.044). Identifying as Hispanic/Latino remained significantly associated with strongly agreeing or agreeing that MC can cure cancer on bivariate analysis (odds ratio, 6.528; 95% CI, 1.477-28.715; <em>P</em> = .012). Education level, other sociodemographic characteristics, and sources for information about MC were not significantly different between these patients. Thematic analysis revealed that patients hoped to learn more about MC from their oncologists but perceived them to be unknowledgeable on the subject.</div></div><div><h3>Conclusions</h3><div>Although most patients consider MC to be a valuable addition to conventional therapies for managing refractory symptoms, a subset believed it had potential as an anticancer therapy. Many patients rely on unregulated sources, highlighting the need for providers to address misinformation, bridge knowledge gaps, and clarify its use.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101678"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093659","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":"The Impact of Synchrotron Microbeam Radiation Therapy Combined With Broad Beam in a Preclinical Breast Cancer Model","authors":"Elette Engels PhD ,&nbsp;Helen Forrester PhD ,&nbsp;Mitzi Klein VMD ,&nbsp;Caroline Bell BSc ,&nbsp;Indi Balderstone MD ,&nbsp;Kirsty Brunt ,&nbsp;Micah J. Barnes MSc ,&nbsp;Matthew Cameron PhD ,&nbsp;Jeffrey C. Crosbie PhD ,&nbsp;Ryan Middleton PhD ,&nbsp;Cristian Fernandez-Palomo PhD ,&nbsp;Bettina de Breuyn Dietler BSc ,&nbsp;Verdiana Trappetti PhD ,&nbsp;Jennifer M. Fazzari PhD ,&nbsp;Daniel Hausermann PhD ,&nbsp;Robin L. Anderson PhD ,&nbsp;Valentin G. Djonov MD ,&nbsp;Olga A. Martin PhD","doi":"10.1016/j.adro.2024.101680","DOIUrl":"10.1016/j.adro.2024.101680","url":null,"abstract":"<div><h3>Purpose</h3><div>Both local tumor control and distant metastasis are important indicators of the efficacy of radiation therapy treatment. Synchrotron microbeam radiation therapy (MRT), spatially fractionated radiation delivered at ultrahigh dose rates, shows remarkable normal tissue sparing with excellent local control in some models. Some MRT regimens trigger an antitumor immune response that contributes not only to the local but also to systemic treatment efficacy. Despite recent advances in the treatment of primary breast cancer, metastatic disease is still the major cause of treatment failure in the clinic. Here, in an aggressive preclinical triple-negative breast cancer model, we compared local tumor response and metastasis following different MRT treatment programs.</div></div><div><h3>Methods and Materials</h3><div>4T1.2 mouse mammary tumors were treated with 300 Gy peak/7 Gy valley dose MRT and/or 8 Gy broad beam (BB) radiation, all delivered as daily fractionated programs (3 consecutive daily sessions of either MRT or BB or 1 MRT combined with 2 BB sessions, the first or last of the 3 fractions). The mice were euthanized on day 9 post last irradiation, when unirradiated control animals reached an ethical endpoint. Primary tumors were collected to evaluate immune cell prevalence, while lungs, spinal cords, and locoregional lymph nodes were collected to measure metastatic burden. In parallel, local tumor growth and survival were monitored.</div></div><div><h3>Results</h3><div>The combined MRT/BB treatment shifted the balance between pro- and antitumorigenic macrophages toward the accumulation of antitumorigenic macrophages in the tumor. Monitoring of the tumor volume and animal health indicated the benefit of the combined MRT/BB treatment for local control and treatment tolerance, while animal survival was only marginally longer for one combined schedule. The metastatic burden was similar for all 4 treatment schedules.</div></div><div><h3>Conclusions</h3><div>The addition of a single MRT to BB treatment improved the primary tumor response. This provides a basis for future experiments incorporating adjuvant immunotherapy or chemotherapy to improve local and systemic treatment outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101680"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757093","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 Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy","authors":"Garrett K. Harada MD ,&nbsp;Steven N. Seyedin MD ,&nbsp;Olivia Heutlinger BS ,&nbsp;Armon Azizi BS ,&nbsp;Audree Hsu BS ,&nbsp;Arash Rezazadeh MD ,&nbsp;Michael Daneshvar MD, MS ,&nbsp;Greg E. Gin MD ,&nbsp;Edward M. Uchio MD ,&nbsp;Giovanna A. Giannico MD ,&nbsp;Jeremy P. Harris MD ,&nbsp;Aaron B. Simon MD, PhD ,&nbsp;Jeffrey V. Kuo MD ,&nbsp;Nataliya Mar MD","doi":"10.1016/j.adro.2024.101671","DOIUrl":"10.1016/j.adro.2024.101671","url":null,"abstract":"<div><h3>Purpose</h3><div>Pelvic lymph node metastases (ypN+) after multiagent neoadjuvant chemotherapy (NAC) is a poor prognostic sign in nonmetastatic muscle-invasive bladder cancer (nmMIBC). We sought to create a nomogram predicting probability of ypN+ after NAC for cN0 nmMIBC and determine association with overall survival (OS).</div></div><div><h3>Methods and Materials</h3><div>We reviewed the National Cancer Database for patients with cT2-4N0M0 urothelial carcinoma of the bladder receiving multiagent NAC and surgery from 2004 to 2020. Following a data split, univariate logistic regression identified variables associated with ypN+ at <em>P</em> &lt; .05. Eligible variables were used for multivariate logistic regression and nomogram generation. A threshold for 95% sensitivity defined high- and low-risk groups for ypN+. Fine–Gray models assessed ypN+ risk group and OS, accounting for competing risks of surgical mortality.</div></div><div><h3>Results</h3><div>A total of 6194 patients were identified with a median follow-up of 39.5 months (interquartile range [IQR], 20.5-67.2 months). Most patients had high-grade (97.7%) cT2 disease (70.8%) with nonpapillary urothelial histology (67.3%) and initiated NAC at a median of 41.0 days after diagnosis (IQR, 28.0-59.0 days).The nomogram included age in decades (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.87–1.03; <em>P</em> = .172), weeks from diagnosis to NAC (OR, 1.02; 95% CI, 1.01-1.04; <em>P</em> = .004), nonpapillary histology (OR, 1.17; 95% CI, 0.99-1.39; <em>P</em> = .068), and clinical T-stage. Within the testing cohort, ypN+ was found in 392 (22.8%) high-risk and 12 (8.0%) low-risk patients (<em>P</em> &lt; .001), with median OS of 36.1 and 74.0 months, respectively (<em>P</em> &lt; .001). High-risk patients had worse OS despite competing risks of 30-day (subdistribution hazard ratio [SHR], 1.80; 95% CI, 1.49-2.18; <em>P</em> &lt; .001) and 90-day surgical mortality (SHR, 1.68; 95% CI, 1.39-2.04; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>This is the first study to provide a tool for predicting ypN+ and prognosticate worse OS in primarily high-grade nmMIBC and could select patients for alternative neoadjuvant therapy and facilitate future study.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101671"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722500","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}