Advances in Radiation Oncology最新文献

{"title":"Comparative Outcomes of Standard Radiation Therapy and 5-Fraction Adaptive Stereotactic Radiation Therapy in Newly Diagnosed Glioblastoma: A Propensity Score–Matched Analysis","authors":"Michael Dohopolski MD ,&nbsp;Luiza Giuliani Schmitt MD ,&nbsp;Jill de Vis MD, PhD ,&nbsp;Thomaz Rodrigues Mostardeiro MD ,&nbsp;Soummitra Anand BS ,&nbsp;Michael Youssef MD ,&nbsp;Evan Noch MD ,&nbsp;Elizabeth Maher MD ,&nbsp;Matthew Sun MD ,&nbsp;Toral Patel MD ,&nbsp;Ankur Patel MD ,&nbsp;Sam Barnett MD ,&nbsp;MinJae Lee PhD ,&nbsp;Viktor Iakovenko PhD ,&nbsp;Tsuicheng Chiu PhD ,&nbsp;Fan-Chi Su PhD ,&nbsp;Arnold Pompos PhD ,&nbsp;Mu-Han Lin PhD ,&nbsp;Xin Cai MD, PhD ,&nbsp;Robert Timmerman MD ,&nbsp;Zabi Wardak MD","doi":"10.1016/j.adro.2025.101813","DOIUrl":"10.1016/j.adro.2025.101813","url":null,"abstract":"<div><h3>Purpose</h3><div>Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults, with poor survival despite advancements in treatment. Adaptive stereotactic radiation therapy (RT) using a magnetic resonance imaging linear accelerator is an emerging approach for patients with newly diagnosed GBM eligible for conventional fractionation. We hypothesize that adaptive stereotactic RT can provide comparable outcomes with conventional fractionation while reducing treatment burden.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively reviewed 96 adults with newly diagnosed GBM treated at our institution between 2018 and 2024. Inclusion criteria included the age of 18 years, confirmed GBM diagnosis, and completed treatment. Patients with prior brain irradiation or incomplete treatment were excluded. Propensity score matching was performed to balance demographics, tumor characteristics, and treatment protocols across 5-fraction, 15-fraction, and 30-fraction groups. Statistical analyses included the Fisher exact test, Mann-Whitney <em>U</em> test, Cox proportional hazards models, and Kaplan-Meier survival curves.</div></div><div><h3>Results</h3><div>After propensity score matching, 17 pairs were matched for 5 versus 30 fractions and 14 pairs for 5 versus 15 fractions. Median overall survival was 21.1 versus 18.2 months (5 vs 15 fractions, <em>P</em> = .77) and 11.7 versus 14.6 months (5 vs 30 fractions, <em>P</em> = .5). Median progression-free survival was 9.0 versus 7.9 months (5 vs 15 fractions, <em>P</em> = .89) and 8.9 versus 9.7 months (5 vs 30 fractions, <em>P</em> = .97). Local failure and grade 3 toxicity rates were similar across groups. O6-methylguanine-DNA-methyltransferase unmethylated status, higher Eastern Cooperative Oncology Group scores, and age 60 years were associated with worse progression-free survival and overall survival. Median travel distances were lower in the 5-fraction group, with a median of 220 miles compared with 877.5 (15 fractions) and 1638 miles (30 fractions). Adaptive RT allowed for real-time tumor monitoring but volumetric changes did not correlate with clinical outcomes.</div></div><div><h3>Conclusions</h3><div>Adaptive 5-fraction RT demonstrates comparable survival outcomes with conventional fractionation while reducing treatment-related travel burden. Further prospective studies are needed to validate its role in GBM management.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101813"},"PeriodicalIF":2.2,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Volumetric-Modulated Arc Therapy for Refractory, Corticosteroid-Resistant Orbital Inflammatory Diseases","authors":"Yan Ma MD ,&nbsp;Hai-Yang Chen MD ,&nbsp;Fu-Jing Huang MD ,&nbsp;Xiao-Lin Pang MD ,&nbsp;Jian Zheng MD ,&nbsp;Fang He MD","doi":"10.1016/j.adro.2025.101811","DOIUrl":"10.1016/j.adro.2025.101811","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the efficacy and safety of volumetric-modulated arc therapy (VMAT) in treating corticosteroid-resistant orbital inflammatory diseases, with a focus on radiation therapy (RT) plan design, clinical outcomes, and the incidence of treatment-related side effects.</div></div><div><h3>Methods and Materials</h3><div>A retrospective analysis was conducted on 57 patients with refractory, corticosteroid-resistant orbital inflammatory diseases treated with orbital VMAT from November 2019 to July 2022. The primary endpoint was the reduction or cessation of corticosteroid use following RT, with secondary endpoints, including improvements in ocular clinical symptoms (diplopia, proptosis, visual acuity, and extraocular movement) and long-term side effects.</div></div><div><h3>Results</h3><div>The median target dose was 20 Gy, with an average lens irradiation dose of 5.4 Gy. Initially, all 57 patients received corticosteroids. After a median follow-up of 27.5 months, 89.5% (51 of 57) of patients responded positively to RT; in particular, 56.1% (32 of 57) completely tapered off corticosteroids, whereas 33.3% (19 of 57) reduced their dosage. Symptomatic improvements were observed in diplopia (67.3%), proptosis (64.7%), visual acuity (56.1%), and extraocular movements (65.9%). Regarding the long-term side effects of RT, incidences of dry eye syndrome and lens opacities were reported at 3.5% and 1.8%, respectively.</div></div><div><h3>Conclusions</h3><div>Orbital VMAT is an effective treatment for refractory, corticosteroid-resistant orbital inflammatory diseases, reducing corticosteroid use and improving ocular symptoms with minimal side effects. Further prospective clinical trials are warranted to validate more appropriate VMAT doses and planning models, enhancing treatment outcomes without increasing RT side effects.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101811"},"PeriodicalIF":2.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon-Ion Radiotherapy as a Local Treatment Option for Hepatocellular Carcinoma With Child-Pugh Class B Cirrhosis","authors":"Shintaro Shiba MD, PhD ,&nbsp;Keisuke Tsuchida MD, PhD ,&nbsp;Nobutaka Mizoguchi MD, PhD ,&nbsp;Shohei Kawashiro MD, PhD ,&nbsp;Satoshi Shima MD ,&nbsp;Kio Kano MD ,&nbsp;Kohei Okada MD, PhD ,&nbsp;Hiroaki Koge MD ,&nbsp;Tatsuya Okuda MD ,&nbsp;Riho Kuzuu MD ,&nbsp;Daisaku Yoshida MD, PhD ,&nbsp;Hiroyuki Katoh MD, PhD","doi":"10.1016/j.adro.2025.101812","DOIUrl":"10.1016/j.adro.2025.101812","url":null,"abstract":"<div><h3>Purpose</h3><div>The local treatment strategy for fragile patients with hepatocellular carcinoma (HCC) with Child-Pugh class B (CP-B) remains unclear. In this study, we evaluated the safety and efficacy of carbon-ion radiation therapy (CIRT) for HCC with CP-B.</div></div><div><h3>Methods and Materials</h3><div>Fifteen consecutive patients with HCC with CP-B who received CIRT between March 2017 and June 2023 were analyzed. Survival and local control probabilities were calculated using the Kaplan-Meier method. Treatment-related liver toxicities were defined as a ≥2-point increase in CP score within 6 months of CIRT.</div></div><div><h3>Results</h3><div>The median follow-up duration after CIRT was 18.7 months. The median age of patients at the time of registration for CIRT was 71 years. The median tumor size was 51 mm. Eleven patients had a CP score of 7, 3 had a score of 8, and 1 had a score of 9. The number of patients with treatment-naïve and recurrent HCC was 6 and 9, respectively. The 1- and 2-year overall survival rates were 67% and 50%, respectively. The 1- and 2-year local control rates were both 94%. The 1- and 2-year progression-free survival rates were 67% and 11%, respectively. Four patients (27%) experienced treatment-related liver toxicities. No patient developed grade 3 or higher toxicities during the acute and late phases.</div></div><div><h3>Conclusions</h3><div>Overall, this study showed the safety and efficacy of CIRT for HCC with CP-B. CIRT is a local treatment option for HCC with CP-B.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101812"},"PeriodicalIF":2.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography Scan Planning in Radiation Oncology: Prospective Evaluation of the “Mini-CT Scan” Procedure Prior to a Routine Immediate Planning Computed Tomography Scan Practice. Results of the OPTIMAL Study","authors":"Kamel Debbi ,&nbsp;Sarah Witmeyer ,&nbsp;Alexander Bennassi ,&nbsp;Chahrazed Boukhobza ,&nbsp;Gloria Fonteneau ,&nbsp;Nhu Hanh To ,&nbsp;Gabriele Coraggio ,&nbsp;Wassim Ksouri ,&nbsp;Noémie Grellier ,&nbsp;Mohamed Aziz Cherif ,&nbsp;Gokoulakrichenane Loganadane ,&nbsp;Yazid Belkacemi ,&nbsp;AROME (Association of Radiotherapy and Oncology of the Mediterranean Area; www.aromecancer.org) and Transatlantic Radiation Oncology Network (TRONE)","doi":"10.1016/j.adro.2025.101808","DOIUrl":"10.1016/j.adro.2025.101808","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the benefit/risk in terms of radioprotection of performing a mini-computed tomography (CT) scan prior to the planning CT scan in patients requiring pelvic irradiation. The study population included patients who received curative intent external beam radiation therapy for pelvic malignancies. The results are applicable to all supine pelvic external beam radiation therapy patients.</div></div><div><h3>Methods and Materials</h3><div>Between April 9, 2021, and October 5, 2021, 53 patients were included in the study. A mini-CT scan was performed for each patient to determine whether they were properly prepared with a full bladder and empty rectum for the planning CT scan. Depending on the result, it was decided to either perform the planning CT scan or repeat a mini scan after rectal enema and drinking to better empty the rectum and fill the bladder. Up to 3 mini scans could be performed, after which a new CT appointment was scheduled if the patient was considered not sufficiently prepared.</div></div><div><h3>Results</h3><div>Among the 53 patients included in the study, 64 wide CT scans were performed (average, 1.2 scans per patient). A total of 47, 3, 2, and 1 patients were treated for prostate, rectal, bladder, and anal canal cancers, respectively. The median age was 75 years (range, 57-94), with 51 men and 2 women. For 29 patients, a single mini-CT scan was performed prior to the wide CT scan, corresponding to an additional mean effective dose of 2.3 mSv to the mini-CT scan. For 25 patients, multiple wide CT scans and mini-CT scans were performed. For these patients, the mini-CT scan allowed us to decrease patient exposure by reducing the average effective dose by 22.1 mSv per patient. The systematic use of a mini-CT scan in the whole cohort allowed reducing the mean effective dose by 9.44 mSv based on a paired <em>t</em> test (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>We demonstrated that the effective dose delivered to the patient was significantly lower if we carried out 1 or more mini-CT scans to avoid doing iterative planning CT scans that deliver a higher dose to the patient.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101808"},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable Relative Biological Effectiveness of Protons in the Rat Spinal Cord: Measurements and Comparison With Model Calculations","authors":"Christin Glowa PhD ,&nbsp;Maria Saager PhD ,&nbsp;Lisa Hintz MSc ,&nbsp;Rosemarie Euler-Lange BSc ,&nbsp;Peter Peschke PhD ,&nbsp;Stephan Brons PhD ,&nbsp;Kaya Hilt MSc ,&nbsp;Thomas Friedrich PhD ,&nbsp;Michael Scholz PhD ,&nbsp;Hans Liew PhD ,&nbsp;Andrea Mairani PhD ,&nbsp;Christian P. Karger PhD","doi":"10.1016/j.adro.2025.101809","DOIUrl":"10.1016/j.adro.2025.101809","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the relative biological effectiveness (RBE) in the rat spinal cord after 6 fractions of protons as a function of linear energy transfer (LET) and dose.</div></div><div><h3>Methods and Materials</h3><div>The rat spinal cord was irradiated at 4 different positions of a 6 cm spread-out Bragg peak using 6 fractions of protons (LET: 1.4, 2.7, 3.9, and 5.5 keV/µm). Dose-response curves were established for the endpoint paresis grade 2, and the RBE was calculated based on the dose at 50% effect probability. Including data with single and split doses, the measured RBE values were compared with predictions from 4 mechanistic, 3 phenomenological, and 2 patient-derived variable RBE models.</div></div><div><h3>Results</h3><div>With increasing LET, the dose at 50% effect probability decreased from 51.3 Gy to 43.3 Gy, resulting in a rise in the RBE from 1.11 to 1.32. The biologically equivalent dose decreased markedly between the 2 proximal and 2 distal spinal cord positions, resulting in extrapolated maximum RBE values of up to 1.87 in the limit of zero dose per fraction. The α/β values ranged between 1.5 Gy and 4.2 Gy. At 3.9 and 5.5 keV/µm, the RBE increased with decreasing dose, and at 1.8 Gy per fraction, the RBE was extrapolated to 1.40 and 1.42, respectively. The agreement between predicted and measured RBE varied between the different models.</div></div><div><h3>Conclusions</h3><div>A fixed RBE of 1.1 provides a good approximation up to the center of the spread-out Bragg peak; however, at 3 mm from the distal end, the RBE increases markedly and may reach values above 1.4 at clinical fraction schedules. Using predictions from a variable RBE model may, therefore, be reasonable; however, the model and model parameters should be carefully selected, ideally as a consensus among the proton therapy centers.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101809"},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144502251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Novel Data-Driven Algorithm to Detect Atypical Prescriptions in Radiation Therapy","authors":"Connor Thropp MS ,&nbsp;Jaroslaw Hepel MD ,&nbsp;Timothy Leech ,&nbsp;Eric E. Klein PhD ,&nbsp;Qiongge Li PhD","doi":"10.1016/j.adro.2025.101804","DOIUrl":"10.1016/j.adro.2025.101804","url":null,"abstract":"<div><h3>Purpose</h3><div>Erroneous radiation therapy (RT) prescriptions (Rx) can lead to injury or death of patients. A novel data-driven model that uses similarity learning to identify atypical Rx was recently published. In that study, prototype analysis was conducted within a single institution with a single treatment site. The present study sets out to validate the robustness of the model by applying the model to multiple disease sites using a different institution’s data.</div></div><div><h3>Methods and Materials</h3><div>A query was conducted of Brown University Health RT treatment records for thoracic and brain cancer patients from 1995 to 2021 to create historical databases used for training. The query included records containing data on the Rx and patient-specific features. Simulated anomalies were created to mimic potential errors and were used in the training and testing of the model. Model performance was evaluated using F1 score.</div></div><div><h3>Results</h3><div>F1 scores for the brain site are 99% for intensity modulated RT, 90% for stereotactic radiation therapy/ radiosurgery/SRT, and 94% for 3-dimensional RT. F1 scores for the thoracic site are 95%, 90%, and 95% for the 3 techniques, respectively. Statistical analysis shows no significant differences between the model’s prediction and ground truth.</div></div><div><h3>Conclusions</h3><div>The model performance shows feasibility for application to various disease sites across different institutions. This model can be used alongside physicians and physicists during peer review chart rounds to aid in the detection of potential RT Rx errors.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101804"},"PeriodicalIF":2.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-institutional Outcomes after Stereotactic Radiosurgery for Gastrointestinal Brain Metastases","authors":"Jamiluddin J. Qazi MD ,&nbsp;David J. Carpenter MD, MS ,&nbsp;Jim Leng MD ,&nbsp;Christina C. Huang MD, MS ,&nbsp;Steven J. Chmura MD, PhD ,&nbsp;Muzamil Arshad MD, PhD ,&nbsp;Zachary J. Reitman MD, PhD ,&nbsp;John P. Kirkpatrick MD, PhD ,&nbsp;Julian C. Hong MD, MS ,&nbsp;Scott R. Floyd MD, PhD ,&nbsp;Trey C. Mullikin MD ,&nbsp;Joseph K. Salama MD","doi":"10.1016/j.adro.2025.101795","DOIUrl":"10.1016/j.adro.2025.101795","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare outcomes between gastrointestinal and nongastrointestinal patients with brain metastases after radiosurgery.</div></div><div><h3>Methods and Materials</h3><div>Retrospective cohort study identifying patients completing an initial course of radiosurgery between January 2015 and December 2020, with follow-up data collected through November 2022. Multi-institutional, academic referral centers. The primary outcomes were overall survival and intracranial progression-free survival, calculated by the Kaplan–Meier method. Progression was defined as concern on postradiosurgery imaging for recurrence determined by clinical multidisciplinary consensus. Cox proportional hazard models were used to assess associations between outcomes and covariates.</div></div><div><h3>Results</h3><div>This study included 1281 nongastrointestinal patients and 102 gastrointestinal patients, of which 45.1% were colorectal, 33.3% esophageal, and the remaining 21.6% comprising other sites. Gastrointestinal patients were more likely to be younger (mean 59.1 vs 63.5 years, <em>P</em> = .001), male (56.9% vs 44.3%, <em>P</em> = 0.014), have received systemic therapy (73.5% vs 63.9%, <em>P</em> = .049), and have resection of brain metastases (45.1% vs 25.0%, <em>P</em> &lt; .001) prior to radiosurgery. Median overall survival was lower for gastrointestinal patients at 5.4 months (95% CI, 3.8-7.7) versus nongastrointestinal patients at 10.6 months (95% CI, 9.3-11.6, <em>P</em> &lt; 0.0001). In a multivariate model, gastrointestinal patients had worse overall survival compared to nongastrointestinal patients (hazard ratio, 1.92; <em>P</em> &lt; .0001; 95% CI, 1.53-2.41). Median intracranial progression-free survival was lower for gastrointestinal patients at 6.2 months (95% CI, 4.0-9.6) versus nongastrointestinal patients at 12.3 months (95% CI, 10.8-13.9; <em>P</em> = 0.0002). In a multivariate model, gastrointestinal patients had worse intracranial progression-free survival compared to nongastrointestinal patients (hazard ratio, 1.60; 95% CI, 1.20-2.14; <em>P</em> = 0.0013). There were no significant differences between colorectal primary patient or esophageal primary patient outcomes compared to all other gastrointestinal primary patients.</div></div><div><h3>Conclusions</h3><div>Across a multi-institutional stereotactic radiosurgery cohort, brain metastases of gastrointestinal origin demonstrated inferior overall survival and intracranial progression-free survival to those of nongastrointestinal origin. These data may help inform treatment decisions and postradiosurgery surveillance.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101795"},"PeriodicalIF":2.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Image Analysis to Select Patients for Prostate Specific Membrane Antigen Radioligand Therapy and Assess Treatment Response","authors":"John M. Floberg MD, PhD ,&nbsp;Christos E. Kyriakopoulos MD ,&nbsp;Steve Y. Cho MD","doi":"10.1016/j.adro.2025.101805","DOIUrl":"10.1016/j.adro.2025.101805","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101805"},"PeriodicalIF":2.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Instability Neoplastic Score as a Predictor of Vertebral Fracture in Patients Undergoing Radiation Therapy for Spinal Metastases: A Single-Institution Study","authors":"Patrick Doyle MS ,&nbsp;Sarah Caplan MS ,&nbsp;Neil Klinger MD ,&nbsp;Kee-Young Shin MS ,&nbsp;Michael Groff MD ,&nbsp;Maeve Dillon-Martin BS ,&nbsp;Thomas Johnson MS ,&nbsp;Heejoo Kang BS ,&nbsp;Teresia Perkins BS ,&nbsp;Claire Novack BS ,&nbsp;Alexander Spektor MD ,&nbsp;Mai Anh Huynh MD, PhD ,&nbsp;Ellen Kim MPH ,&nbsp;Shyam Tanguturi MD ,&nbsp;Cara Richards MSPAS, PA-C ,&nbsp;Wenxin (Vincent) Xu MD ,&nbsp;David Kozono MD, PhD ,&nbsp;Ron Alkalay PhD ,&nbsp;David Hackney MD ,&nbsp;Tracy Balboni MD, MPH","doi":"10.1016/j.adro.2025.101803","DOIUrl":"10.1016/j.adro.2025.101803","url":null,"abstract":"<div><h3>Purpose</h3><div>The Spinal Instability Neoplastic Score (SINS) is the most common method of assessing spine stability in the setting of spinal metastases. We sought to assess (1) the SINS score as a predictor of vertebral compression fracture (VCF), (2) the risk contributions of the 6 SINS individual factors, and (3) other contributors to fracture risk.</div></div><div><h3>Methods and Materials</h3><div>In total, 194 patients with 391 spinal lesions that had not previously been treated with vertebroplasty/kyphoplasty, radiation therapy (RT), or surgery were enrolled before RT and followed for new or worsened fracture.</div></div><div><h3>Results</h3><div>A total of 187 patients who were treated to 361 vertebral levels underwent post-RT follow-up. Average follow-up time for patients on study was 9.4 months (range, 0.2-38.8 months). A total of 33 new or worsened fractures (9.1% of lesions followed) were observed, with an average time to fracture of 4.4 months (range, 0.1-27.8 months). Of all 6 SINS factors, 3 were found to be individually significantly associated with increased risk of fracture, these were: lesion location in L2-L4 [hazard ratio (HR) = 2.78, <em>P</em> = .04], mixed or lytic appearance on computed tomography (mixed HR = 3.87, <em>P</em> = .01, lytic HR = 2.68, <em>P</em> = .02), and &lt;50% vertebral collapse (HR = 3.52, <em>P</em> &lt; .01). SINS as a summated score was significantly associated with increased risk of fracture on multivariable analysis (<em>P</em> &lt; .01). Use of bone-strengthening medications such as bisphosphonates was also significantly associated with decreased risk of fracture in multivariable analysis in stable (SINS ≤6) (HR = 0.10, <em>P</em> = .03) and potentially unstable (SINS, 7-12) lesions (HR: 0.18, <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>These findings support that SINS is a useful tool for estimating VCF risk, with lesion location, metastasis bone morphology, and presence of &lt;50% collapse being the strongest predictors. Additionally, findings suggest that bone-strengthening medications such as bisphosphonates may mitigate the risk of developing VCF after RT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 7","pages":"Article 101803"},"PeriodicalIF":2.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144239961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening Colonoscopy Association With Gastrointestinal Toxicity and Quality of Life After Prostate Stereotactic Body Radiation Therapy","authors":"Jonathan W. Lischalk MD ,&nbsp;Vianca F. Santos MPH ,&nbsp;Brianna Vizcaino BA ,&nbsp;Astrid Sanchez MS ,&nbsp;Christopher Mendez MA ,&nbsp;Kathleen Maloney-Lutz RN ,&nbsp;Sam Serouya MD ,&nbsp;Seth R. Blacksburg MD, MBA ,&nbsp;Todd Carpenter MD ,&nbsp;Moses Tam MD ,&nbsp;Scott Niglio MD ,&nbsp;William Huang MD ,&nbsp;Samir Taneja MD ,&nbsp;Michael J. Zelefsky MD ,&nbsp;Jonathan A. Haas MD","doi":"10.1016/j.adro.2025.101747","DOIUrl":"10.1016/j.adro.2025.101747","url":null,"abstract":"<div><h3>Purpose</h3><div>Screening colonoscopies (CS) performed before prostate stereotactic body radiation therapy (SBRT) allow for identifying synchronous malignancies and comorbid gastrointestinal (GI) conditions. Performing these procedures prior to radiation precludes the necessity of post-SBRT pelvic instrumentation, which may lead to severe toxicity and fistulization. We review compliance of CSs, incidence of GI pathology, and the impact of pretreatment CS findings on subsequent physician-reported toxicity and patient-reported quality of life (QoL).</div></div><div><h3>Methods and Materials</h3><div>We reviewed an institutional database of patients treated for prostate cancer with SBRT including toxicity and QoL outcomes. A detailed review of pretreatment CS findings was reviewed including identification of diverticulosis, location of polyp resection, and presence of hemorrhoids. Pretreatment CS findings were then correlated with outcomes following SBRT.</div></div><div><h3>Results</h3><div>Identification of comorbid GI conditions was a common event, with the presence of diverticulosis in 49.5% (n = 100), hemorrhoids in 67% (n = 136), and polyps in 48% (n = 98). More than half of patients with polyps removed had at least 1 removed from the rectosigmoid. Pretreatment CS did not introduce a delay in SBRT start date. Grade 1 toxicity was significantly lower in patients who underwent CS closer to the initiation of SBRT. There was no increased risk of physician-graded toxicity in the presence of diverticulosis, hemorrhoids, or polyps. Patient-reported GI QoL pattern in our screening cohort mimicked that seen in the previously published nonscreened population. There was no overt QoL detriment observed in patients who had GI pathology identified before SBRT.</div></div><div><h3>Conclusions</h3><div>GI pathology identified in our elderly patient population was commonly identified on pretreatment CS. Screening CS may optimize bowel health for patients heading into radiation therapy. Toxicity and QoL for patients with GI pathologies identified on pretreatment CS do not preclude the delivery of prostate SBRT. We advocate for pretreatment CS in patients eligible prior to SBRT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101747"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143941146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}