Advances in Radiation Oncology最新文献

{"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}

{"title":"Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy","authors":"Avani D. Rao MD ,&nbsp;Alexander Goughenour CS, CMD ,&nbsp;Betelehem Kebede BS ,&nbsp;Caroline Bamberger BS ,&nbsp;Grayden MacLennan MS, CMD ,&nbsp;Jackeline Castro BS, CMD ,&nbsp;Lisa Stephenson MS, CMD ,&nbsp;Amanuel Negussie MS, CMD ,&nbsp;Sydney Seracino CMD ,&nbsp;Hongkun Wang PhD ,&nbsp;Stella Hetelekidis MD ,&nbsp;Sarah J. Gao MD ,&nbsp;Lonika Majithia MS, MD ,&nbsp;Ashish Chawla MD ,&nbsp;Ashkan Parniani MBA, CMD ,&nbsp;Peng Wang PhD, DABR ,&nbsp;Jiajin Fan PhD, DABR","doi":"10.1016/j.adro.2024.101653","DOIUrl":"10.1016/j.adro.2024.101653","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).</div></div><div><h3>Methods and Materials</h3><div>In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally &lt; 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.</div></div><div><h3>Results</h3><div>A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, <em>P</em> &lt; .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all <em>P</em> ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, <em>P</em> = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, <em>P</em> = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, <em>P</em> = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, <em>P</em> = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.</div></div><div><h3>Conclusions</h3><div>The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101653"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969302","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":"First-in-Men Online Adaptive Robotic Stereotactic Body Radiation Therapy: Toward Ultrahypofractionation for High-Risk Prostate Cancer Patients","authors":"Victor J. Brand MD,&nbsp;Maaike T.W. Milder PhD,&nbsp;Miranda E.M.C. Christianen MD, PhD,&nbsp;Kim C. de Vries MD,&nbsp;Mischa S. Hoogeman PhD,&nbsp;Luca Incrocci MD, PhD,&nbsp;Femke E. Froklage MD, PhD","doi":"10.1016/j.adro.2024.101701","DOIUrl":"10.1016/j.adro.2024.101701","url":null,"abstract":"<div><h3>Purpose</h3><div>Ultrahypofractionation presents challenges for a subset of high-risk prostate cancer patients due to the large planning target volume (PTV) margin required for the seminal vesicles. Online adaptive radiation therapy could potentially reduce this margin. This paper focuses on the development, preclinical validation, and clinical testing of online adaptive robotic stereotactic body radiation therapy for this patient group.</div></div><div><h3>Methods and Materials</h3><div>An online adaptive workflow was developed for the CyberKnife with integrated in-room CT-on-rails. Preclinical validation involved comparing deep learning–based auto-contouring with deformable or rigid contour propagation in terms of subsequent editing time. A fast treatment planning method was implemented and compared with the conventional method in terms of optimization time and adherence to planning constraints. Clinical testing was conducted in the first study patients of the UPRATE trial, which investigates the feasibility of seminal vesicle PTV margin reduction in low-volume metastasized prostate cancer patients. Treatment time and patient experience were recorded.</div></div><div><h3>Results</h3><div>Rigid registration for prostate and deep-learning auto-contouring for seminal vesicles and organs at risk were selected based on editing time and robustness for anatomic changes. The fast treatment planning method reduced the optimization time from 10 to 3.5 minutes (<em>P</em> = .005). No significant differences in dose parameters were observed compared with the conventional plans. During clinical testing, 53 of 60 fast treatment plans adhered to the planning constraints, and all 60 were clinically accepted and delivered. The average total treatment time was 67.7 minutes, showing a downward trend. The treatment was well-experienced overall.</div></div><div><h3>Conclusions</h3><div>Online adaptive stereotactic body radiation therapy using CyberKnife with integrated CT-on-rails is clinically feasible for prostate cancer patients with seminal vesicles included in the target volume. The UPRATE trial outcome will reveal the extent to which online adaptation can reduce the PTV margin of the seminal vesicles.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101701"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045460","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":"Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients","authors":"Sanjeev Sreenivasan MD, MCh ,&nbsp;Salem Najjar BA ,&nbsp;Daniel Ma MD ,&nbsp;Sabrina L. Begley BS ,&nbsp;Yen-Ruh Wuu MD ,&nbsp;Zaker Rana MD ,&nbsp;Emile Gogineni DO ,&nbsp;Michael Schulder MD ,&nbsp;Anuj Goenka MD","doi":"10.1016/j.adro.2024.101709","DOIUrl":"10.1016/j.adro.2024.101709","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We aimed to conduct a comprehensive review of a consecutive cohort of patients diagnosed with high-risk atypical meningioma who underwent SRS, either as a single-fraction SRS or in the hypofractionated SRS (hf-SRS), and evaluate the LC rates (LCR) with a specific emphasis on patterns of treatment failure.</div></div><div><h3>Methods and Materials</h3><div>We identified consecutive patients diagnosed with high-risk World Health Organization grade 2 meningioma treated with SRS at a single institution between 2014 and 2021. High-risk meningioma was defined as a residual disease or recurrence after initial gross total resection. Follow-up data were analyzed to evaluate LCRs and patterns of treatment failure. We defined local failure as tumor recurrence wthin the prescription isodose line, marginal failure as recurrence within 5 mm but outside the prescription isodose line, and distant/regional failure as recurrence beyond 5 mm of the prescription isodose line but within 2 cm of the surgical cavity.</div></div><div><h3>Results</h3><div>We identified 45 pathologically confirmed atypical meningiomas in 25 patients. Thirty-three tumors underwent single-fraction SRS, and 12 tumors received hf-SRS. The median follow-up was 36 months (range, 2-86 months). The 3-year LCR was 84.6%, and overall survival was 96.0%. Four patients with a total of 7 tumors experienced treatment failure. Failures were either local (3 patients and 3 lesions) or marginal (3 patients and 4 lesions). Patients treated with hf-SRS did not exhibit local, marginal, or distant failures.</div></div><div><h3>Conclusions</h3><div>Our institutional data on atypical patients with meningioma treated with radiosurgery compare favorably to existing literature using fractionated radiation therapy. SRS offers a promising strategy to improve LC in this patient population, and the occurrence of marginal failure plays a role in creating clinical target volume margins.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101709"},"PeriodicalIF":2.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093657","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":"Why is Volumetric Modulated Arc Therapy Not Considered the Standard of Care for Locoregional Radiation Therapy for Breast Cancer Patients?","authors":"Robin Kendall MD, MS,&nbsp;Tiffany Robinson BS,&nbsp;Valerie Reed MD,&nbsp;James Kanke BS,&nbsp;Alan Sosa MD,&nbsp;Christopher Nelson PhD,&nbsp;David Swanson PhD,&nbsp;Mark Villa MD,&nbsp;Elizabeth Bloom MD","doi":"10.1016/j.adro.2025.101728","DOIUrl":"10.1016/j.adro.2025.101728","url":null,"abstract":"<div><div>We quantify dosimetric differences between 3-dimensional (3D) planning and volumetric modulated arc therapy (VMAT) in breast cancer patients requiring comprehensive regional nodal irradiation (CRNI). Target volume dose, prescription isodose conformality to target volumes, plan hotspots, normal tissue dose-volume metrics, and back and shoulder dose were compared for VMAT and 3D plans of 50 patients. Metrics used to compare VMAT plans with 3D plans included the percentage of primary clinical target volumes (CTVs) receiving 98% of a prescription dose of 5000 cGy, CTV dose hotspots, the extra treatment volume (ETV), and the portion of the patient's body receiving 90% of the CTV prescription dose (excluding the primary target volume). Superior values for these metrics were found for VMAT plans when compared to 3D plans. The mean percentage of the target volume receiving 98% of the prescription dose of 3D plans was 95.4% versus 98.9% among VMAT plans (<em>P</em> &lt; .01). The mean target volume hotspot of 3D plans was 7200 cGy versus 5450 cGy for VMAT plans (<em>P</em> &lt; .01). A mean ETV found for 3D plans was nearly double that found among VMAT plans (5.3% vs 2.7%, <em>P</em> &lt; .01). VMAT plans resulted in lower doses to the shoulder and back. Mean total body volumes of VMAT plans were lower for dose thresholds of 100% to 130% of the prescription. VMAT plans generally had superior values for institutional normal tissue dose constraints. VMAT is superior to 3D planning across multiple metrics for breast cancer patients requiring CRNI. Insurance coverage for VMAT should not require 3D comparison plans.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101728"},"PeriodicalIF":2.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799443","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":"Toxicities Associated with Adjuvant Radiation Therapy in Atypical Meningioma","authors":"Grace Lee MD ,&nbsp;Audrey Aitelli BS ,&nbsp;Andrzej Niemierko PhD ,&nbsp;Nayan Lamba MD ,&nbsp;Daniel W. Kim MD, MBA ,&nbsp;William T. Curry MD ,&nbsp;Kevin S. Oh MD ,&nbsp;Frederick G. Barker II MD ,&nbsp;Helen A. Shih MD, MS, MPH","doi":"10.1016/j.adro.2025.101726","DOIUrl":"10.1016/j.adro.2025.101726","url":null,"abstract":"<div><h3>Purpose</h3><div>While adjuvant radiation therapy (RT) may prolong progression-free survival in resected atypical meningiomas, whether such progression-free survival benefit outweighs potential treatment toxicities remains controversial. Here, we compare the acute and late toxicity outcomes of atypical meningiomas managed with upfront adjuvant RT versus surveillance.</div></div><div><h3>Methods and Materials</h3><div>In our prior single-institution retrospective study of 230 patients with resected atypical meningiomas between 2000 and 2015, adjuvant RT was associated with a significantly lower risk of progression/recurrence compared with surveillance (hazard ratio, 0.21; <em>P</em> &lt; .01), with 36% of surveillance patients eventually requiring salvage RT. In this study, the acute (≤6 months) and late (&gt;6 months) RT toxicities from the same patient cohort for those who received adjuvant (<em>n</em> = 51) versus salvage RT (<em>n</em> = 64) were compared. Additionally, treatment toxicity at the last follow-up was compared between the adjuvant RT (n = 51) and the surveillance (<em>n</em> = 179) groups. Toxicities were graded per the Common Terminology Criteria for Adverse Events v5.0.</div></div><div><h3>Results</h3><div>RT in the adjuvant compared with the salvage setting was generally associated with greater RT toxicities both in the acute (90% vs 69%, <em>P</em> &lt; .01) and late (57% vs 33%, <em>P</em> = .01) setting. While there was no significant difference in grade 3 to 4 acute toxicities, late grade 3 to 4 toxicities were present in 14% of the adjuvant group versus 3% of the salvage RT group (<em>P</em> = .04). Radionecrosis was present in 18% of adjuvant RT versus 8% of salvage RT group (<em>P</em> = .11). Between the adjuvant RT and surveillance groups, any treatment-related toxicity at the last follow-up was greater in the adjuvant RT group (31% vs 15%, <em>P</em> &lt; .01), with a trend toward greater grade 3 to 4 toxicities (8% vs 3%, <em>P</em> = .10). There was no difference in the rate of cerebrovascular accident (4% vs 4%, <em>P</em> = .99).</div></div><div><h3>Conclusions</h3><div>Adjuvant RT may be associated with greater acute and late treatment toxicities, which can significantly impact the quality of life of patients with atypical meningioma. Potential RT toxicity should be carefully weighed against tumor control benefits in deciding the optimal use and timing of RT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101726"},"PeriodicalIF":2.2,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419406","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":"In Vitro α/β Ratio Variations in Cervical Cancer, with Consequent Effects on Equivalent Dose in 2 Gy Fraction in High-Dose-Rate Brachytherapy","authors":"Cameron Thayer-Freeman MS ,&nbsp;Brien Washington PhD ,&nbsp;Denise Fabian MD ,&nbsp;Dennis Cheek PhD ,&nbsp;William St Clair MD ,&nbsp;Mark Bernard MD ,&nbsp;Wei Luo PhD","doi":"10.1016/j.adro.2025.101725","DOIUrl":"10.1016/j.adro.2025.101725","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the distributions of published α/β values measured in vitro and the resulting uncertainties in the equivalent dose in 2 Gy fractions (EQD₂) when applied to high-dose-rate brachytherapy (HDR-BT) for cervical cancer.</div></div><div><h3>Methods and Materials</h3><div>An analysis of 98 published α/β values from 31 papers was conducted, spanning 23 cervical cancer cell lines. Values were further divided into squamous cell carcinoma and adenocarcinoma histologies. Probability distributions were fit to histograms using the bootstrapped Kolmogorov-Smirnov goodness-of-fit test. Both average and most probable α/β values for cervical cancer were determined. The probability distributions were then applied to three representative external beam therapy (EBT) plus HDR brachytherapy prescriptions to determine the potential impact they would have on the equivalent dose in 2 Gy fractions (EQD₂) for each prescription.</div></div><div><h3>Results</h3><div>Published results of α/β values ranged from 1.06 to 34.3 Gy. A right-skewed log-normal distribution was shown to be the best fit for overall α/β values as well as for squamous cell carcinoma and adenocarcinoma subtypes.. Average α/β values were determined to be 8.05, 8.47, and 6.60 Gy for the total, squamous cell carcinoma, and adenocarcinoma groups, respectively. The most probable values were 4.25, 4.34, and 4.22 Gy, respectively. The variations in α/β values led to uncertainties of −8.0 to 46.4 Gy in EQD₂. Average α/β values resulted in EQD₂ deviations of up to 4.3 Gy for the 83.9 Gy EQD₂ prescription, whereas most probable values resulted in disparities as significant as 10 Gy. We used our α/β value distributions to create uncertainty distributions for EQD₂ and discovered that the 83.9 Gy prescription in EQD₂ had average variations of up to 8% from the intended dose.</div></div><div><h3>Conclusion</h3><div>There was large variation in <em>in vitro</em> α/β values which presented as a right-skewed log-normal distribution with a most probable value of ∼4.3 Gy for cervical cancer. Adenocarcinoma showed somewhat lower average α/β values compared with squamous cell carcinoma, but the difference was not substantial enough to draw definitive conclusions. Lower α/β values resulted in higher EQD₂ for HDR-BT compared with α/β values at 10 Gy. This suggests that more accurate and potentially lower α/β values should be used for cervical cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101725"},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445301","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":"Reduced Treatment Volumes for Glioblastoma Associated With Lower Rates of Radionecrosis and Lymphopenia: A Pooled Analysis","authors":"Jennifer K. Matsui MD, PhD ,&nbsp;David Swanson PhD ,&nbsp;Pamela Allen PhD ,&nbsp;Haley K. Perlow MD ,&nbsp;Jared Bradshaw BS ,&nbsp;Thomas H. Beckham MD, PhD ,&nbsp;Martin C. Tom MD ,&nbsp;Chenyang Wang MD, PhD ,&nbsp;Subha Perni MD ,&nbsp;Debra N. Yeboa MD ,&nbsp;Amol J. Ghia MD ,&nbsp;Mary Frances McAleer MD, PhD ,&nbsp;Jing Li MD, PhD ,&nbsp;Joshua D. Palmer MD ,&nbsp;Susan L. McGovern MD, PhD","doi":"10.1016/j.adro.2025.101717","DOIUrl":"10.1016/j.adro.2025.101717","url":null,"abstract":"<div><h3>Purpose</h3><div>There is marked variability in treatment fields for glioblastoma. We performed a retrospective study comparing outcomes of patients treated according to MD Anderson Cancer Center (MDACC) or Radiation Therapy Oncology Group (RTOG) guidelines and identified differences in treatment-related toxicity.</div></div><div><h3>Methods and Materials</h3><div>Adult patients with glioblastoma treated with surgery and adjuvant radiation treatment were included in this study. Primary outcomes were local control, progression-free survival (PFS), overall survival (OS), and radiation-related toxicity. PFS and OS were estimated using the Kaplan-Meier estimator. Univariate and multivariate analyses were conducted using Cox regression models.</div></div><div><h3>Results</h3><div>In total, 257 patients met the inclusion criteria with a median age of 60.1 years at diagnosis. There were 162 and 95 patients treated according to the MDACC or RTOG guidelines, respectively. Despite having similar gross tumor volumes, the RTOG cohort had a larger median planning target volume (303.2 cm³ vs 430.7 cm³, <em>P</em> &lt; .001) and worse PFS (6 months vs 9 months, <em>P</em> = .031). There was no difference in OS between treatment techniques. Patients treated according to RTOG guidelines experienced higher rates of radionecrosis (34% vs 21%, <em>P</em> = .024) and severe lymphopenia (15% vs 7%, <em>P</em> = .044).</div></div><div><h3>Conclusions</h3><div>Patients treated according to MDACC guidelines had smaller treatment volumes, improved PFS, and lower rates of radionecrosis and severe lymphopenia. However, when adjusting for prognostic factors, treatment type was not associated with PFS in multivariate analysis. Prospective investigation is warranted to confirm these differences in outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101717"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143419502","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":"National Trends in Radiation Treatment for Small Cell Lung Cancer Brain Metastases in the Modern Era","authors":"Jay Desai BA ,&nbsp;Sujay Rajkumar BS ,&nbsp;Matthew J. Shepard MD ,&nbsp;Rodney E. Wegner MD","doi":"10.1016/j.adro.2025.101720","DOIUrl":"10.1016/j.adro.2025.101720","url":null,"abstract":"<div><h3>Purpose</h3><div>Small cell lung cancer (SCLC) is a highly aggressive form of lung cancer that often leads to brain metastases. Traditional treatment has largely relied on whole brain radiation therapy (WBRT). However, concerns about neurocognitive side effects have led to the adoption of advanced techniques such as hippocampal avoidance WBRT (HA-WBRT) and stereotactic radiosurgery (SRS).</div></div><div><h3>Methods and Materials</h3><div>This retrospective study used data from the National Cancer Database spanning from 2010 to 2021. The study included adult patients diagnosed with brain metastases from SCLC who received primary radiation therapy directed at the brain. Patients were categorized into 3 treatment groups: WBRT, HA-WBRT, and SRS. Statistical analyses, including logistic regression, Kaplan–Meier survival analysis, and Cox regression, were performed to identify predictors of treatment type and survival outcomes.</div></div><div><h3>Results</h3><div>The study analyzed 24,858 patients with a median age of 65 years. Over time, there was a significant increase in the use of advanced radiation techniques (HA-WBRT and SRS). SRS and HA-WBRT were associated with longer median survival (10.6 and 10.1 months, respectively) than WBRT (7.3 months). Factors such as advanced age, extracranial disease, and higher comorbidity scores were linked to poorer survival, whereas the use of chemotherapy, immunotherapy, and higher socioeconomic status were associated with improved outcomes.</div></div><div><h3>Conclusions</h3><div>From 2010 to 2021, there has been an increase in the use of more advanced techniques to treat brain metastasis from SCLC. These advanced techniques were associated with improved survival outcomes, although selection bias and the retrospective nature of the study limit definitive conclusions.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101720"},"PeriodicalIF":2.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143430225","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}