Advances in Radiation Oncology最新文献

{"title":"Boswellia serrata for the Management of Radiation-Induced Cerebral Edema and Necrosis: A Systematic Meta-Narrative Review of Clinical Evidence","authors":"Cas Stefaan Dejonckheere MD ,&nbsp;Davide Scafa MD ,&nbsp;Lukas Käsmann MD ,&nbsp;Thomas Zeyen MD ,&nbsp;Anna-Laura Potthoff MD ,&nbsp;Niklas Schäfer MD ,&nbsp;Johannes Weller MD ,&nbsp;Ulrich Herrlinger MD ,&nbsp;Matthias Schneider MD ,&nbsp;Hartmut Vatter MD ,&nbsp;Anca-Ligia Grosu MD ,&nbsp;Stefanie Brehmer MD ,&nbsp;Frank Anton Giordano MD ,&nbsp;Gustavo Renato Sarria MD ,&nbsp;Eleni Gkika MD ,&nbsp;Julian Philipp Layer MD","doi":"10.1016/j.adro.2025.101732","DOIUrl":"10.1016/j.adro.2025.101732","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic radiosurgery (SRS) yields excellent local control in patients with a limited number of brain metastases (BMs), but radiation-induced cerebral edema and radiation necrosis (RN) in particular may cause dose-limiting late toxicity, with the same holding true after fractionated radiation therapy for glioma. In symptomatic patients, the first-line standard of care includes corticosteroids, which may, however, be counterproductive in the evolving era of immunotherapy. Boswellic acid (BA), available as an over-the-counter dietary supplement, has been suggested as a potential corticosteroid-sparing alternative because of its anti-inflammatory and antiangiogenic effects.</div></div><div><h3>Methods and Materials</h3><div>We performed a comprehensive literature search of the MEDLINE, Embase, Scopus, and Cochrane databases, identifying publications reporting on the use of BA during or after brain irradiation in humans. Using the Realist and Meta-Narrative Evidence Syntheses: Evolving Standards framework, relevant data are summarized using a meta-narrative approach.</div></div><div><h3>Results</h3><div>Six records (3 for edema reduction in large irradiated volumes and 3 for RN after SRS) were identified, encompassing 130 patients. Roughly half of patients benefited from BA (radiographically or clinically) and about one third could successfully taper dexamethasone or prevent its long-term intake. Tolerability of BA was favorable, with mild gastrointestinal discomfort being reported most frequently. Current drawbacks include unknown optimal formulation as well as timing and dosing, a considerably large number of required daily capsules, and uncertain interactions with other drugs.</div></div><div><h3>Conclusions</h3><div>Overall, the clinical evidence on the use of BA for radiation-induced cerebral edema and RN is lacking and well-designed prospective trials are warranted to further investigate this potential low-cost corticosteroid-sparing option.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101732"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463731","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":"Effect of External Beam Radiation Therapy and Brachytherapy on Circulating Myeloid-Derived Suppressor Cell Populations in Patients Treated Definitively for Cervical Cancer","authors":"Kelsey M. Wanhainen MD, PhD ,&nbsp;Matthew Berkseth PhD ,&nbsp;Nicole Sando BS ,&nbsp;Lydia Golden BS ,&nbsp;Amy Techam RN, PHN ,&nbsp;Jennifer Wieworka DNP ,&nbsp;Kyra M. Boorsma Bergerud BS ,&nbsp;Peter Argenta MD ,&nbsp;Andrea O'Shea MD ,&nbsp;Britt K. Erickson MD ,&nbsp;Sally Mullany MD ,&nbsp;Colleen Rivard MD ,&nbsp;Rahel Ghebre MD, MPH ,&nbsp;Deanna Teoh MD, MS ,&nbsp;Margaret Reynolds MD ,&nbsp;Stephanie Terezakis MD ,&nbsp;Jianling Yuan MD, PhD ,&nbsp;Lindsey Sloan MD, PhD","doi":"10.1016/j.adro.2024.101677","DOIUrl":"10.1016/j.adro.2024.101677","url":null,"abstract":"<div><h3>Purpose</h3><div>The immunosuppressive function of myeloid-derived suppressor cells (MDSCs) has been implicated in the regulation of immune responses against cancer and is associated with poor prognosis. Radiation treatment is known to alter immune cell populations within the tumor; however, whether this results in the recruitment of immunosuppressive MDSC populations is not well understood. Here we evaluate the response of circulating MDSC populations in patients treated per standard-of-care cisplatin chemoradiation therapy (CRT) for locally invasive cervical cancer.</div></div><div><h3>Methods and Materials</h3><div>Newly diagnosed, treatment-naïve patients with locally advanced cervical cancer were enrolled. Blood samples were collected from patients prior to starting CRT (T₀), after external beam radiation therapy (T₁), and after high-dose-rate brachytherapy (T₂). Samples from each time point were processed, and the prevalence of MDSC subsets was determined using flow cytometry. MDSC populations were identified using Live/Dead-CD11b+CD33+HLA-DR- staining. MDSC subsets were further subdivided into granulocytic (g-, CD15+CD14-), monocytic (m-, CD15-CD14+), or early-MDSCs (e-, CD15-CD14-).</div></div><div><h3>Results</h3><div>Most patients in our study were Caucasian nonsmokers with human papillomavirus-associated squamous cell carcinoma of the cervix. We saw a trend for increased MDSC frequency in patients with more advanced-stage disease at the time of initiating treatment. MDSCs increase in response to CRT and peak after brachytherapy (T₂). In particular, the g-MDSC subset increases by 6.44 times relative to the baseline. There was no correlation between MDSC expansion and response to therapy.</div></div><div><h3>Conclusion</h3><div>Our study confirms other reports that circulating MDSCs in patients with cervical cancer increase in response to CRT and are associated with more advanced stages. Additionally, we show that MDSC expansion is driven by the g-MDSC subset. We did not see any correlation between MDSC expansion and treatment response, though this may be because of the limited sample size for this study.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101677"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863142","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":"Volumetric Modulated Arc Therapy for 26 Gy in 5 Fractions Whole Breast Irradiation for Breast Cancer","authors":"Seo Hee Choi MD,&nbsp;Jin Sung Kim PhD,&nbsp;Ho Jin Kim PhD,&nbsp;Ryeong Hwang Park RTT,&nbsp;Ik Jae Lee MD, PhD,&nbsp;Yong Bae Kim MD, PhD,&nbsp;Jee Suk Chang MD, PhD","doi":"10.1016/j.adro.2025.101733","DOIUrl":"10.1016/j.adro.2025.101733","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the dosimetric and toxicity outcomes of patients treated with 26 Gy in 5 fractions ultrahypofractionated (uHF) whole breast irradiation (WBI) using volumetric arc therapy (VMAT).</div></div><div><h3>Methods and Materials</h3><div>We identified 476 consecutive patients who underwent WBI using VMAT-uHF between 2020 and 2021. Study endpoints included acute toxicity and dosimetric parameters for target volume and organs at risk. The dosimetric results were compared with a historical cohort at the same institution who were treated with moderately hypofractionated WBI using 3-dimensional (3D)-conformal radiation therapy (3D-CRT, n = 392), with the total dose rescaled to 26 Gy.</div></div><div><h3>Results</h3><div>VMAT-uHF achieved a mean D95% and Dmax of the planning target volume of 96.2% and 102.8% of the prescribed dose, respectively. The VMAT-uHF group demonstrated significantly superior planning target volume coverage and improved dose homogeneity, with a 30.6% higher D95 and a 0.7% lower Dmax compared with the 3D-CRT group (both <em>P</em> &lt; .05). Mean doses for the ipsilateral lung and heart were 3.12 ± 4.59 Gy and 0.92 ± 0.25 Gy, respectively, showing differences of &lt; 0.3 Gy compared with the 3D-CRT group. The VMAT-uHF group exhibited a significantly lower left anterior descending artery Dmax (−3.73 Gy), while the contralateral breast showed a higher Dmean (+1.43 Gy), compared with the 3D-CRT group. Acute toxicity following VMAT-uHF was predominantly mild, with grade 1 toxicity observed in 114 out of 120 patients. No additional toxicities were reported after a median follow-up of 21.2 months.</div></div><div><h3>Conclusions</h3><div>The application of VMAT in ultrahypofractionation can enhance target coverage while maintaining radiation doses to organs at risk low, albeit with an increase in contralateral breast dose compared with 3D-CRT. Given the low toxicity profile observed in our cohort with VMAT-uHF, the clinical significance of these dosimetric differences requires further investigation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101733"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619975","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":"Noninvasive Mechanical Ventilation Is a Promising Way to Improve Lung Cancer Radiation Therapy","authors":"Johannes K. Veldman-Landegent MS ,&nbsp;Zdenko van Kesteren PhD ,&nbsp;Mike J. Parkes PhD ,&nbsp;Markus F. Stevens MD PhD ,&nbsp;Joost G. van den Aardweg MD, PhD ,&nbsp;Edith M.T. Dieleman MD ,&nbsp;Eva Versteijne MD, PhD ,&nbsp;Geertjan van Tienhoven MD, PhD ,&nbsp;Arjan Bel PhD ,&nbsp;Irma W.E.M. van Dijk PhD","doi":"10.1016/j.adro.2024.101679","DOIUrl":"10.1016/j.adro.2024.101679","url":null,"abstract":"<div><h3>Purpose</h3><div>Accurate radiation therapy (RT) for lung cancer is challenging because of the respiratory motion of the tumor and surrounding organs at risk. Recently, non-invasive mechanical ventilation (NIMV) has been investigated as a novel respiratory motion management strategy. Using NIMV, respiratory motion can be minimized, while a larger lung volume yields less overall lung dose. The purpose of this study was to determine the potential benefit of NIMV to improve lung cancer RT using magnetic resonance imaging (MRI) data of healthy volunteers.</div></div><div><h3>Methods and Materials</h3><div>Twelve healthy volunteers practiced NIMV at 60 breaths per minute (NIMV₆₀) with added positive end-expiratory pressure (PEEP) in 2 sessions and subsequently underwent NIMV₆₀ in 2 MRI sessions. We acquired single-slice sagittal 2-dimensional MRI images at 2.6 Hz for 6 minutes during free breathing and NIMV₆₀. We quantified the motion of all visible cross-sections of lung arteries, as a surrogate for lung tumors, in cranio-caudal and anterior-posterior directions using deformable image registration, distinguishing between 4 quadrants in the lungs (posterior-cranial, posterior-caudal, anterior-caudal, and anterior-cranial). Also, we analyzed average lung area, as a surrogate for lung volume, on the sagittal images using automatic segmentation.</div></div><div><h3>Results</h3><div>All volunteers were successfully trained to be ventilated with NIMV₆₀, and completed all sessions. The reduction of the median lung artery motion in each of the quadrants varied from 61% to 67% (from 10.7-29.9 to 3.8-11.7 mm) in cranio-caudal direction and from 51% to 68% (from 8.0-13.7 to 3.0-5.1 mm) in anterior-posterior direction using NIMV₆₀. NIMV₆₀ increased the sagittal lung area by 35% compared with free breathing.</div></div><div><h3>Conclusions</h3><div>NIMV₆₀ with added PEEP is a promising way to improve lung cancer RT because of reduced respiratory motion and increased lung area compared with free breathing.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101679"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863145","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":"Investigating the Uptake of Hypofractionation for Breast and Prostate Cancer in Sub-Saharan Africa: A Qualitative Study of Physician and Medical Physicist Perspectives","authors":"Rohini K. Bhatia MD ,&nbsp;Suzanne M. Grieb PhD ,&nbsp;Katharine A. Rendle PhD, MPH ,&nbsp;Wilfred Ngwa PhD, MSc ,&nbsp;Surbhi Grover MD, MPH","doi":"10.1016/j.adro.2024.101683","DOIUrl":"10.1016/j.adro.2024.101683","url":null,"abstract":"<div><h3>Purpose</h3><div>In prostate and breast cancer, moderate hypofractionation (HF) has demonstrated comparable, if not greater, efficacy than conventional fractionation. There is a stark disparity in the uptake of HF between North America and Africa. Using the Consolidative Framework for Implementation Research, we evaluated barriers and facilitators for implementing HF in Sub-Saharan Africa (SSA).</div></div><div><h3>Methods and Materials</h3><div>Radiation oncologists and medical physicists working in SSA were recruited via the AORTIC Radiation Oncology Special Interest Group and subsequent snowball sampling. Interviews were conducted virtually between November 2022 and January 2023. Transcripts were analyzed using directed content analysis guided by a Consolidative Framework for Implementation of research interview domains and constructs.</div></div><div><h3>Results</h3><div>In total, 19 interviewees (17 radiation oncologists and 2 medical physicists) from 11 SSA countries participated, of which 94% noted the use of HF (40.05 Gy/15fx or 42.67 Gy/16fx) in breast cancer clinics and 38% in prostate cancer clinics (60-66 Gy/20fx). While nearly all participants identified the benefits of HF for both clinics and patients, many also noted that the lack of long-term data within an African population created discomfort in using HF. Many participants believed in the utility of HF but expressed a lack of confidence in its use caused by uncertainty about the safety of the technique, especially in centers with cobalt or 3-dimensional conformal radiation therapy-only capabilities. In breast HF, participants expressed concern regarding breast size and ideal eligibility criteria for patients. In prostate HF, on-treatment imaging and lack of fiducials were identified as barriers. Key facilitators in adopting HF included hands-on training, partnerships with disease-site-specific individuals with HF experience, and consensus on patient eligibility and technique requirements.</div></div><div><h3>Conclusions</h3><div>HF is regarded as a valuable tool for breast and prostate cancer in SSA, and breast HF is widely used. Attention to the use of 3-dimensional conformal radiation therapy with HF, long-term toxicity data in African populations, and training sessions may facilitate further use of HF for prostate cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101683"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942549","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":"Patterns of Care in Adjuvant Radiation Therapy for Stage II Endometrioid Endometrial Adenocarcinoma: A National Cancer Database Analysis","authors":"Jessica Cruttenden MD ,&nbsp;Christopher Weil MD ,&nbsp;Danae Byer BS ,&nbsp;Lindsay Burt MD ,&nbsp;Gita Suneja MD ,&nbsp;David Gaffney MD, PhD ,&nbsp;Cristina DeCesaris MD","doi":"10.1016/j.adro.2024.101698","DOIUrl":"10.1016/j.adro.2024.101698","url":null,"abstract":"<div><h3>Purpose</h3><div>Treating stage II endometrial cancer involves total hysterectomy, bilateral salpingo-oophorectomy, and risk-adapted adjuvant therapy. Professional guidelines support various adjuvant treatments, but high-level data supporting specific options are conflicting. We sought to evaluate adjuvant radiation therapy (RT) trends for these patients, hypothesizing increased utilization of pelvic external beam RT (EBRT) over time.</div></div><div><h3>Methods and Materials</h3><div>Patients diagnosed in 2004-2019 with stage II endometrioid endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and surgical staging were identified in the National Cancer Database. Patient characteristics per adjuvant RT received were compared using Wilcoxon rank sum and analysis of variance testing. Multivariable regression analysis (MVA) identified variables associated with EBRT, vaginal brachytherapy (VBT), or RT omission. A <em>P</em> value &lt; .05 was significant, except in MVA, where Bonferroni correction was employed (<em>p</em> value &lt; .017).</div></div><div><h3>Results</h3><div>Patients meeting criteria totaled 18,798; 19% received adjuvant EBRT alone, 25% VBT alone, 24% EBRT + VBT, and 32% no RT. Adjuvant RT use increased from 2004 to 2019, particularly EBRT + VBT (<em>p</em> &lt; .05). In MVA, community hospital treatment (odds ratio [OR], 1.8; <em>p</em> &lt; .001), Midwest location (OR, 1.2; <em>p</em> = .02), single-agent chemotherapy receipt (OR, 6.9; <em>p</em> &lt; .001), lymphovascular space invasion (OR, 1.4; <em>p</em> &lt; .001), and positive surgical margins (OR, 1.8; <em>p</em> &lt; .001) were positively associated with EBRT. No variables were positively associated with VBT. Black race (OR, 1.2; <em>p</em> = .03), community hospital treatment (OR, 1.4; <em>p</em> = .04), South (OR, 2.2; <em>p</em> &lt; .001) or West (OR, 2.1; <em>p</em> &lt; .001) location, distance &gt;50 miles from the treatment center (OR, 1.5; <em>p</em> &lt; .001), and grade 2 (OR, 1.2; <em>p</em> &lt; .001) or 3 (OR, 1.3; <em>p</em> = .01) disease were associated with RT omission.</div></div><div><h3>Conclusions</h3><div>Adjuvant RT for stage II endometrial cancer increased over time, particularly EBRT + VBT. Patient-related factors such as race, region, and distance from the treatment center were associated with RT omission, suggesting sociodemographic barriers to care. Tumor-related factors such as positive surgical margins and lymphovascular space invasion were associated with EBRT receipt, suggesting consideration of high-risk factors for locoregional recurrence in adjuvant RT approaches.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101698"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982436","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":"Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series","authors":"Danielle N. Burner BS ,&nbsp;Peter G. Hendrickson MD, PhD ,&nbsp;Diana M. Cardona MD ,&nbsp;Dan G. Blazer III MD ,&nbsp;James B. Mullins CMD ,&nbsp;David G. Kirsch MD, PhD","doi":"10.1016/j.adro.2024.101689","DOIUrl":"10.1016/j.adro.2024.101689","url":null,"abstract":"<div><h3>Purpose</h3><div>Optimal treatment of retroperitoneal sarcoma (RPS) remains undefined. Here, we report the feasibility of using high-dose boost radiation (3-4 Gy) to the central part of the tumor in patients with unresectable RPS.</div></div><div><h3>Methods and Materials</h3><div>Five patients with unresectable RPS were treated with radiation therapy using a central boost technique with intensity modulated radiation therapy. On average, doses of 25 Gy to 45 Gy were delivered to the outer part of the tumor (planning target volume 1), while the central part of the tumor (planning target volume 2) received a 56 Gy to 75 Gy physical dose, which translates to a 62.67 Gy to 87.5 Gy equivalent dose in 2 Gy fractions (EQD2). To minimize radiation toxicity to the adjacent bowel and other organs, we used sequential, interdigitated, or simultaneous integrated boost (SIB) techniques.</div></div><div><h3>Results</h3><div>In this case series of variable RPS histology, the median survival postradiation therapy was 30 months. Three of the 5 patients had clinically stable local disease on follow-up scans, and none of the patients experienced clinically significant toxicity.</div></div><div><h3>Conclusions</h3><div>In summary, in this small case series of 5 patients, treatment was tolerated well, and excellent local responses were observed regardless of the timing of the central boost. Given the high rates of metastatic disease that developed in responding patients, effective systemic therapy will likely be needed for unresectable RPS treated with aggressive radiation therapy to the central part of the tumor.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101689"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric Predictors of Acute Radiation Pneumonitis and Esophagitis in Hypofractionated Thoracic Irradiation of Non-Small Cell Lung Cancer Patients With Poor Prognostic Factors","authors":"Saskia Kenndoff BSc, MD ,&nbsp;Alexander Nieto MD ,&nbsp;Julian Elias Guggenberger MD ,&nbsp;Julian Taugner MD ,&nbsp;Sina Mansoorian MD ,&nbsp;Lukas Käsmann MD, MHBA ,&nbsp;Nina-Sophie Schmidt-Hegemann MD ,&nbsp;Farkhad Manapov MD ,&nbsp;Claus Belka MD ,&nbsp;Chukwuka Eze MD","doi":"10.1016/j.adro.2024.101682","DOIUrl":"10.1016/j.adro.2024.101682","url":null,"abstract":"<div><h3>Purpose</h3><div>The proliferation rates of non-small cell lung cancer (NSCLC) and associated radiation resistance highlight the potential of hypofractionated radiation therapy (hypoRT). However, radiation pneumonitis and esophagitis remain dose-limiting adverse events. This study investigates dosimetric factors influencing the risk of pneumonitis and esophagitis in highly multimorbid patients undergoing moderately hypoRT.</div></div><div><h3>Methods and Materials</h3><div>Forty-seven NSCLC patients with poor performance status treated between January 2014 and July 2021 were included. Dosimetric parameters including mean lung dose (MLD), percentage of normal (ipsi-/contralateral) lung volume (Vx) receiving ≥x Gy (x = 20, 18, 10, and 5 Gy); mean heart dose (MHD), percentage of the heart volume (HVx) receiving ≥x Gy (x = 20, 10, and 5 Gy); and mean esophageal dose (MED), percentage of esophagus volume (EVx) receiving ≥x Gy (x = 40, 30, 20, 18, 10, and 5 Gy) were analyzed retrospectively. Acute radiation pneumonitis/esophagitis events were assessed within 6/3 months posttreatment. Statistical analyses included random forests, binary logistic regression, and linear regression.</div></div><div><h3>Results</h3><div>Among the 47 patients with compromised lung function and poor prognostic factors, 8 (17%) and 26 (55%) patients developed all-grade pneumonitis or esophagitis, while 4 (9%) and 10 (21%) patients developed CTCAE grade ≥2 pneumonitis and esophagitis, respectively. Exploratory analyses suggest that V10, V18, and MLD values are associated with an increased risk of pneumonitis. Linear regressions confirmed this for MLD values greater than 9.2 Gy (<em>P</em> = .050). Additionally, higher V5 and V10 values in the contralateral lung were associated with a greater risk of pneumonitis (<em>P</em> = .013/<em>P</em> = .032). Dmax proved to be a significant predictor of esophagitis (<em>P</em> = .020). Moreover, evidence suggests that EV5 and EV40 may portend esophagitis onset.</div></div><div><h3>Conclusions</h3><div>This study provides insights into dosimetric factors influencing pneumonitis/esophagitis development in NSCLC patients undergoing hypoRT. While MLD and Dmax emerged as significant predictors of pneumonitis and esophagitis, the small sample size limited the depth of conclusions. Further research with larger cohorts is warranted to validate these observations, potentially optimizing treatment planning and outcomes in this challenging patient population.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101682"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078319","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":"Early Outcomes from Proton Craniospinal Irradiation for Leptomeningeal Metastasis From Solid Tumors","authors":"Keng Lam MD ,&nbsp;Lewis F. Nasr MD ,&nbsp;Clark R. Andersen MS ,&nbsp;Kathryn E. Marqueen MD ,&nbsp;Jing Li MD, PhD ,&nbsp;Chenyang Wang MD ,&nbsp;Thomas H. Beckham MD, PhD ,&nbsp;Nazanin K. Majd MD, PhD ,&nbsp;Ashley E. Aaroe MD ,&nbsp;Monica Loghin MD ,&nbsp;Barbara J. O'Brien MD ,&nbsp;Susan L. McGovern MD, PhD","doi":"10.1016/j.adro.2024.101697","DOIUrl":"10.1016/j.adro.2024.101697","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment options for leptomeningeal metastasis (LM) are limited. A recent phase 2 study found that proton craniospinal irradiation (pCSI) was well-tolerated and improved survival. We report our experience with pCSI for solid-tumor LM.</div></div><div><h3>Methods and Materials</h3><div>This is a retrospective review of patients treated with pCSI for solid-tumor LM from December 2020 to January 2024 at our center. Patient characteristics were summarized using descriptive statistics. Median overall survival and median central nervous system progression-free survival from the first day of pCSI were estimated using Kaplan-Meier survival curves.</div></div><div><h3>Results</h3><div>We identified 45 patients who completed pCSI. The median age was 54 years (range, 23-79); 73% were female, and 53% lived more than 100 miles from our center. Breast cancer (53%), lung cancer (20%), and melanoma (9%) were the most common primary cancers; 51% of patients had stable systemic disease at LM diagnosis. All had imaging evidence of LM, and 64% of cases were confirmed using cytologic examination of the cerebrospinal fluid. Eighty percent had symptomatic LM, and the median Karnofsky performance scale at LM diagnosis was 80. The median time from primary cancer diagnosis to LM detection was 23.1 months (range, 0-221.3). Fifty-three percent of patients had active brain metastasis at LM diagnosis; 33% of all patients had received prior intracranial radiation. The median time from simulation to pCSI start was 12 days. At the first visit following pCSI, the median Karnofsky performance scale score was 70. During or right after radiation, 76% of patients reported nausea, 51% headache, and 31% fatigue. Following pCSI, 4% received intrathecal chemotherapy, 67% systemic therapy, and 9% hospice care; 18% were observed and 2% lost to follow-up. Median overall survival was 13.7 months (95% confidence interval [CI], 11.2 to not reached), and median progression-free survival was 6.5 months (95% CI, 4.9-12.8).</div></div><div><h3>Conclusions</h3><div>The outcomes in our cohort are comparable to those recently reported in a phase 2 trial. Further study is indicated to determine the optimal candidates for pCSI and sequential therapies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101697"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045457","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":"Comprehensive Image Quality Evaluation and Motion Phantom Studies of an Ultra-Fast (6-Second) Cone-Beam Computed Tomography Imaging System on a Ring Gantry Linear Accelerator","authors":"Hui Zhao PhD ,&nbsp;Geoff Nelson PhD ,&nbsp;Vikren Sarkar PhD ,&nbsp;Courtney Oare PhD ,&nbsp;Martin Szegedi ,&nbsp;Sara St. James PhD ,&nbsp;Jeremy Kunz PhD ,&nbsp;Ryan Price PhD ,&nbsp;Y. Jessica Huang PhD","doi":"10.1016/j.adro.2024.101681","DOIUrl":"10.1016/j.adro.2024.101681","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the image quality of an ultrafast cone-beam computed tomography (CBCT) system—Varian HyperSight.</div></div><div><h3>Methods and Materials</h3><div>In this evaluation, 5 studies were performed to assess the image quality of HyperSight CBCT. First, a HyperSight CBCT image quality evaluation was performed and compared with Siemens simulation-CT and Varian TrueBeam CBCT. Second, a visual comparison of image quality among simulation-CTs, HyperSight CBCT, and TrueBeam CBCT was performed for a patient with head and neck cancer and patients with metal dental fillings and prostheses. Third, the Hounsfield unit (HU) versus electron density curve of HyperSight CBCT was compared with GE and Siemens simulation CTs. Fourth, Siemens simulation-CT and HyperSight CBCT scans were acquired on the Catphan set-up at different locations inside the bore (±10 cm in all 3 principal directions from the center), and the HU variations for different materials were evaluated. Fifth, a 4-dimensional lung tumor phantom study was performed to assess moving tumor alignment during image registration.</div></div><div><h3>Results</h3><div>Significant improvement of image contrast, HU constancy, and noise level on HyperSight CBCT was observed compared with TrueBeam CBCT. Significant image quality improvement was observed on HyperSight CBCT for patients with dental fillings and prostheses compared with simulation-CT without metal artifact reduction. The linear fit trendline of HU versus electron density curves for GE simulation-CT, Siemens simulation-CT, and HyperSight CBCT showed a 0.6% difference for HU values below 2000. The maximum HU difference for HyperSight CBCT when Catphan was positioned within ±10 cm in all 3 principal directions was ≤ 98 on bone 50%, ≤ 29 other than bone, and was ≤ 31 on bone 50%, and ≤ 17 other than bone for Siemens simulation-CT. Both tumor shape and tumor alignment discrepancies on CBCT scans were observed in a 4-dimensional phantom study.</div></div><div><h3>Conclusions</h3><div>This evaluation shows significant image improvement of HyperSight CBCT over conventional CBCT on image contrast, HU constancy, and noise level with scatter correction and metal artifact reduction reconstruction methods. HyperSight CBCT has similar image quality to simulation-CTs and shows the potential application for treatment planning. The rapid acquisition of HyperSight CBCT showed both tumor shape and tumor alignment discrepancies of moving targets. Careful considerations of patient respiratory motion monitoring and target matching are highly recommended.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101681"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881104","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}