Advances in Radiation Oncology最新文献

{"title":"Erratum to: Zheng D, Yoon J, Jung H, et al. Does the Number of Brain Metastases Correlate With Normal Brain Exposure in Single-Isocenter Multitarget Multifraction Stereotactic Radiosurgery. Adv Radiat Oncol. 2024; 9(6):101499.","authors":"","doi":"10.1016/j.adro.2024.101556","DOIUrl":"10.1016/j.adro.2024.101556","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101556"},"PeriodicalIF":2.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001192/pdfft?md5=aa21fc412f829fca379b09ab2866f7b7&pid=1-s2.0-S2452109424001192-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141991208","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":"Laterality of Radiation Therapy in Breast Cancer is Not Associated With Increased Risk of Coronary Artery Disease in the Contemporary Era","authors":"Lakshya Seth BA ,&nbsp;Omar Makram MD, MPH ,&nbsp;Amr Essa MD ,&nbsp;Vraj Patel BS ,&nbsp;Stephanie Jiang BS ,&nbsp;Aditya Bhave BS ,&nbsp;Sandeep Yerraguntla BS ,&nbsp;Gaurav Gopu BS ,&nbsp;Sarah Malik MD ,&nbsp;Justin Swaby BS ,&nbsp;Johnathon Rast MD ,&nbsp;Caleb A. Padgett BS, MS, PhD ,&nbsp;Ahmed Shetewi BS ,&nbsp;Priyanshu Nain MBBS ,&nbsp;Neal Weintraub MD ,&nbsp;Eric D. Miller MD, PhD ,&nbsp;Susan Dent MD ,&nbsp;Ana Barac MD, PhD ,&nbsp;Rakesh Shiradkar PhD ,&nbsp;Anant Madabhushi PhD ,&nbsp;Avirup Guha MBBS, MPH","doi":"10.1016/j.adro.2024.101583","DOIUrl":"10.1016/j.adro.2024.101583","url":null,"abstract":"<div><h3>Purpose</h3><p>External beam radiation therapy (EBRT) is a critical component of breast cancer (BC) therapy. Given the improvement in technology in the contemporary era, we hypothesized that there is no difference in the development of or worsening of existing coronary artery disease (CAD) in patients with BC receiving left versus right-sided radiation.</p></div><div><h3>Methods and Materials</h3><p>For the meta-analysis portion of our study, we searched PubMed, Web of Science, and Scopus and included studies from January 1999 to September 2022. CAD was identified using a homogenous metric across multiple studies included. We computed the risk ratio (RR) for included studies using a random effects model. For the institutional cohort portion of our study, we selected high cardiovascular-risk patients who received diagnoses of BC between 2010 and 2022 if they met our inclusion criteria. We performed a Cox proportional hazards model with stepwise adjustment.</p></div><div><h3>Results</h3><p>A pooled random effects model with 9 studies showed that patients with left-sided BC receiving EBRT had a 10% increased risk of CAD when compared with patients with right-sided BC receiving EBRT (RR, 1.10; 95% CI, 1.02-1.18; <em>P</em> = .01). However, subgroup analysis of 6 studies that included patients diagnosed after 1980 did not show a significant difference in CAD based on BC laterality (RR, 1.07; 95% CI, 0.95-1.20; <em>P</em> = .27). For the institutional cohort portion of the study, we found that patients with left-sided BC who received EBRT did not have a significantly higher risk of CAD when compared with their right-sided counterparts (hazard ratios [HR], 0.73; 95% CI, 0.34-1.54; <em>P</em> = .402).</p></div><div><h3>Conclusions</h3><p>Our study suggests a historical trend of increased CAD in BC patients receiving left-sided EBRT. Data from patients diagnosed after 2010 in our institutional cohort did not show a significant difference<strong>,</strong> emphasizing that modern EBRT regimens are safe, and laterality of BC does not affect CAD outcomes in the short term after a BC diagnosis.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101583"},"PeriodicalIF":2.2,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001465/pdfft?md5=e908916277c36e28869dd8a4ad4866e1&pid=1-s2.0-S2452109424001465-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040596","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":"Impact of Dosimetric Compromises on Early Outcomes of Chordomas and Chondrosarcomas Treated With Image-guided Pencil Beam Scanning Proton Beam Therapy","authors":"Srinivas Chilukuri MD ,&nbsp;Nagarjuna Burela MD ,&nbsp;Sham Sundar MD ,&nbsp;Ramakrishna Kamath MD ,&nbsp;Sapna Nangia MD ,&nbsp;Manikandan Arjunan MSc, PhD ,&nbsp;Roopesh Kumar MS, MCh ,&nbsp;Vishnu Ramanujam MS ,&nbsp;Ari Chacko ,&nbsp;Dayananda Shamurailatpam Sharma MSc, PhD ,&nbsp;Rakesh Jalali MD","doi":"10.1016/j.adro.2024.101582","DOIUrl":"10.1016/j.adro.2024.101582","url":null,"abstract":"<div><h3>Purpose</h3><p>To critically review the clinical factors, dosimetry, and their correlation with early outcomes in patients with chordomas and chondrosarcomas treated with pencil beam scanning (PBS) proton beam therapy (PBT).</p></div><div><h3>Methods and Materials</h3><p>Consecutive 64 patients diagnosed with chordoma or chondrosarcoma treated at our center were studied. Patient, tumor, and treatment-related factors including dosimetry were captured. Early and late toxicities and early outcomes were evaluated and correlated with clinical and dosimetric factors using standard statistical tools.</p></div><div><h3>Results</h3><p>The median age of patients was 39 years (range, 4-74 years), and most common site was skull base (47%), followed by sacrum (31%) and mobile spine (22%). The median prescription dose to the high-risk clinical target volumes for chordoma and chondrosarcoma was 70.4 cobalt gray equivalent (CGE) and 66 CGE at 2.2 CGE per fraction, respectively. At presentation, 55% presented after a recurrence/progression of which 17% had received previous radiation and 32% had a significant neural compression. At the time of PBT, 25% of patients had suboptimal neural separation. Three-fourths of patients had at least an acceptable target coverage. Although 11% had a tier 1 compromise (gross tumor volume [GTV] D98 &lt; 90%), 14% had a tier 2 compromise (GTVD98 &lt; 59 CGE). With a median follow-up of 27.5 months, 2-year local control and progression-free survival was 86.7% and 81.8% for chordomas and 87.5% and 77.1% for chondrosarcomas, respectively. Residual GTV of &gt;25 cm³ and a tier 2 compromise were associated with inferior local control (hazard ratio [HR], 0.19; <em>P</em> = .019; HR, 0.061; <em>P</em> = .022, respectively) and progression-free survival (HR, 0.128; <em>P</em> = 0.014; HR, 0.194; <em>P</em> =.025, respectively) on multivariate analysis. Despite multiple surgeries, a majority presented with recurrent disease and previous radiations and grade 3 acute and late toxicities were limited and comparable with others in the literature.</p></div><div><h3>Conclusions</h3><p>Despite multiple surgeries, adequate neural separation was challenging to achieve. Severe dosimetric compromise (GTV D98 &lt; 59 CGE) led to inferior early outcomes. Adequate neural separation is key to avoiding dosimetric compromise and achieving optimal local control.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101582"},"PeriodicalIF":2.2,"publicationDate":"2024-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001453/pdfft?md5=046bb758839ce8dfda1ffa7c2fcb3b88&pid=1-s2.0-S2452109424001453-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851321","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":"Personalized Deep Learning Model for Clinical Target Volume on Daily Cone Beam Computed Tomography in Breast Cancer Patients","authors":"Joonil Hwang MS ,&nbsp;Jaehee Chun PhD ,&nbsp;Seungryong Cho PhD ,&nbsp;Joo-Ho Kim MS ,&nbsp;Min-Seok Cho MS ,&nbsp;Seo Hee Choi MD ,&nbsp;Jin Sung Kim PhD","doi":"10.1016/j.adro.2024.101580","DOIUrl":"10.1016/j.adro.2024.101580","url":null,"abstract":"<div><h3>Purpose</h3><p>Herein, we developed a deep learning algorithm to improve the segmentation of the clinical target volume (CTV) on daily cone beam computed tomography (CBCT) scans in breast cancer radiation therapy. By leveraging the Intentional Deep Overfit Learning (IDOL) framework, we aimed to enhance personalized image-guided radiation therapy based on patient-specific learning.</p></div><div><h3>Methods and Materials</h3><p>We used 240 CBCT scans from 100 breast cancer patients and employed a 2-stage training approach. The first stage involved training a novel general deep learning model (Swin UNETR, UNET, and SegResNET) on 90 patients. The second stage used intentional overfitting on the remaining 10 patients for patient-specific CBCT outputs. Quantitative evaluation was conducted using the Dice Similarity Coefficient (DSC), Hausdorff Distance (HD), mean surface distance (MSD), and independent samples <em>t</em> test with expert contours on CBCT scans from the first to 15th fractions.</p></div><div><h3>Results</h3><p>IDOL integration significantly improved CTV segmentation, particularly with the Swin UNETR model (<em>P</em> values &lt; .05). Using patient-specific data, IDOL enhanced the DSC, HD, and MSD metrics. The average DSC for the 15th fraction improved from 0.9611 to 0.9819, the average HD decreased from 4.0118 mm to 1.3935 mm, and the average MSD decreased from 0.8723 to 0.4603. Incorporating CBCT scans from the initial treatments and first to third fractions further improved results, with an average DSC of 0.9850, an average HD of 1.2707 mm, and an average MSD of 0.4076 for the 15th fraction, closely aligning with physician-drawn contours.</p></div><div><h3>Conclusion</h3><p>Compared with a general model, our patient-specific deep learning-based training algorithm significantly improved CTV segmentation accuracy of CBCT scans in patients with breast cancer. This approach, coupled with continuous deep learning training using daily CBCT scans, demonstrated enhanced CTV delineation accuracy and efficiency. Future studies should explore the adaptability of the IDOL framework to diverse deep learning models, data sets, and cancer sites.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101580"},"PeriodicalIF":2.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S245210942400143X/pdfft?md5=fa284c9d2a447b04df74792bf283ebdb&pid=1-s2.0-S245210942400143X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840631","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":"Radiation-Induced Lymphopenia is a Causal Mediator of Survival After Chemoradiation Therapy for Esophagus Cancer","authors":"Yiqing Chen MSc ,&nbsp;Yan Chu PhD ,&nbsp;Peter S.N. van Rossum MD, PhD ,&nbsp;Clemens Grassberger PhD ,&nbsp;Steven H. Lin MD, PhD ,&nbsp;Radhe Mohan PhD ,&nbsp;Brian P. Hobbs PhD","doi":"10.1016/j.adro.2024.101579","DOIUrl":"10.1016/j.adro.2024.101579","url":null,"abstract":"<div><h3>Purpose</h3><p>Radiation-induced lymphopenia (RIL) is common during chemoradiation therapy. Severe lymphopenia is associated with reduced survival. Proton beam therapy (PBT), with its substantially more compact dose distributions, spares circulating lymphocytes and immune organs at risk to a greater extent than photon therapy. Recent studies comparing PBT to photon radiation therapy, specifically intensity-modulated radiation therapy (IMRT) for esophageal cancer (EC), showed that the incidence of grade 4 RIL (G4RIL) is significantly reduced among patients receiving PBT for EC. However, whether the extent of this reduction has a direct causative link with improved survival is unknown. This study applies causal mediation analysis to answer this question.</p></div><div><h3>Methods and Materials</h3><p>We retrospectively assessed 734 patients treated with concurrent chemoradiation therapy for biopsy-proven EC from 2004 to 2017. To address the potential for bias in the choice of radiation modality, propensity score analysis was used to evaluate and reduce imbalances between the PBT and IMRT cohorts. Causal mediation analysis was applied to decompose the total effect of radiation modality on overall survival (OS) into indirect (mediated through G4RIL) and direct effects.</p></div><div><h3>Results</h3><p>We found that PBT was associated with a significantly lower incidence of G4RIL and prolonged OS compared with IMRT (odds ratio, 0.41; 95% CI, 0.28-0.60; <em>P</em> &lt; .001). In the propensity-matched cohort of 506 patients (253 PBT, 253 IMRT), G4RIL risk reduction with PBT versus IMRT translated into a 5% reduction in the relative rate of death (<em>P</em> = .032). Mediation of G4RIL explained ∼14.5% of the difference in OS.</p></div><div><h3>Conclusions</h3><p>G4RIL was found to mediate survival; however, a statistically significant direct effect of PBT on survival was not observed. In other words, the statistical significance of survival benefit from protons over photons in this EC cohort was lost in the absence of G4RIL risk reduction.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101579"},"PeriodicalIF":2.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001428/pdfft?md5=8700e3d1bb3a630172295360a8a952bf&pid=1-s2.0-S2452109424001428-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843498","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":"Echocardiographic Functional Outcomes Following Regional Nodal Irradiation for Breast Cancer Using Volumetric Modulated Arc Therapy","authors":"Anthony F. Yu MD, MS ,&nbsp;Charlie White PhD ,&nbsp;Zhigang Zhang PhD ,&nbsp;Jennifer E. Liu MD ,&nbsp;Erin F. Gillespie MD ,&nbsp;Beryl McCormick MD ,&nbsp;Atif J. Khan MD ,&nbsp;Richard M. Steingart MD ,&nbsp;Simon N. Powell MD, PhD ,&nbsp;Oren Cahlon MD ,&nbsp;Lior Z. Braunstein MD","doi":"10.1016/j.adro.2024.101581","DOIUrl":"10.1016/j.adro.2024.101581","url":null,"abstract":"<div><h3>Purpose</h3><p>Regional nodal irradiation (RNI) for breast cancer yields improvements in disease outcomes, yet comprehensive target coverage often increases cardiac radiation therapy (RT) dose. Volumetric modulated arc therapy (VMAT) may mitigate high-dose cardiac exposure, although it often increases the volume of low-dose exposure. The cardiac implications of this dosimetric configuration (in contrast to historic 3D conformal techniques) remain uncertain.</p></div><div><h3>Methods and Materials</h3><p>Eligible patients receiving adjuvant RNI using VMAT for locoregional breast cancer were prospectively enrolled in an IRB-approved study. Echocardiograms were performed prior to RT, at the conclusion of RT, and 6 months following RT. Echocardiographic parameters were measured by a single reader and measures were compared pre- and post-RT via the signed-rank test. Changes in echocardiographic parameters over time were compared to mean and max heart doses via the Spearman correlation test.</p></div><div><h3>Results</h3><p>Among 19 evaluable patients (median age 38 years), 89% (n = 17) received doxorubicin and 37% (n = 7) received trastuzumab/pertuzumab combination therapy. All patients received VMAT-based whole-breast/chest wall and RNI. The average mean heart dose was 456 cGy (range, 187-697 cGy) and the average max heart dose was 3001 cGy (1560-4793 cGy). Among salient echocardiographic parameters, no significant decrement in cardiac function was observed when comparing pre-RT to 6 months post-RT: mean left ventricular ejection fraction (LVEF) was 61.8% (SD 4.4%) pre-RT and 62.7% (SD 3.8%) 6 months post-RT (<em>P</em> = .493); mean global longitudinal strain (GLS) was –19.3% (SD 2.2%) pre-RT and –19.6% (SD 1.8%) 6 months post-RT (<em>P</em> = .627). No individual patient exhibited reduced LVEF or sustained decrement in GLS. No correlations were observed for changes in LVEF or GLS when compared to mean or maximum heart doses (<em>P</em> &gt; .1 for all).</p></div><div><h3>Conclusions</h3><p>VMAT for left-sided RNI yielded no significant early decrement in echocardiographic parameters of cardiac function, including LVEF and GLS, within this limited cohort. No patient exhibited significant LVEF changes, and none exhibited sustained decrements in GLS. VMAT may be a reasonable approach to cardiac avoidance in patients requiring RNI, including those receiving anthracyclines and HER2-directed therapy. Larger cohorts with longer follow-ups will be needed to validate these findings.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101581"},"PeriodicalIF":2.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001441/pdfft?md5=f086438632f3ea7e61ec0506485e2fd3&pid=1-s2.0-S2452109424001441-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844368","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":"Preoperative Ultrahypofractionated Radiation Therapy for Soft Tissue Sarcomas: Low Rate of Wound Complications","authors":"Alexander Mattmann MMed ,&nbsp;Christoph Glanzmann MD ,&nbsp;Bruno Fuchs MD, PhD ,&nbsp;Beata Bode MD ,&nbsp;Gabriela Studer MD ,&nbsp;Swiss Sarcoma Network","doi":"10.1016/j.adro.2024.101562","DOIUrl":"10.1016/j.adro.2024.101562","url":null,"abstract":"<div><h3>Purpose</h3><p>Normofractionated preoperative radiation therapy (nRT) with 50 Gy applied in 25 fractions represents the most widely used radiation therapy (RT) regimen in combined local treatment of soft tissue sarcomas (STSs). STSs are characterized by a low <em>α/β</em> ratio of 4 to 5 Gy, which may translate into a higher sensitivity for hypofractionation. Increasing data from cohorts and phase 2 trials on ultrahypofractionated RT (uhRT) regimens are available. We prospectively assessed our preoperative uhRT sarcoma patient cohort with a focus on short-term wound complications (WCs).</p></div><div><h3>Methods and Materials</h3><p>This is a prospective registry analysis of a single-center patient cohort, treated from 03.2020 to 10.2023 with uhRT (25 Gy in 5 fractions in 1 week). The same radiation oncologists (G.S./C.G.) and surgeon (B.F.) performed the treatment (61/61 and 58/60), as well as the same reference pathologist (B.B.) confirmed all histopathologic diagnoses. WC (according to CAN-NCIC-SR2 trial) and intermediate local control (LC) rates were assessed and compared with outcome data of a previously published cohort of 67 extremity/trunk sarcoma patients treated with nRT by the same authors (7% WC, 98% LC at 3 years).</p></div><div><h3>Results</h3><p>After a mean/median follow-up of 19/19 months (range, 0-46), LC at 1.5 years was 94%. Surgery was performed at a mean/median of 20/16 days (range, 4-60) after uhRT completion. WC were observed in 7/60 operated patients (12%), and in 5/51 (10%) extremity/trunk lesions. Early tolerance was excellent, limited to G0 to G1, even in 3 patients with prior RT to the same region. Clear resection margins were achieved in 55/60 patients (92%). Pathologic necrosis of ≥95% was reported in 5% and 75% achieved less than 50% necrosis.</p></div><div><h3>Conclusions</h3><p>These results show low rates of WC and high LC for uhRT and are comparable with our previously published nRT data. This study supports the routine use of preoperative uhRT for STS.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101562"},"PeriodicalIF":2.2,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001258/pdfft?md5=13ab9f5fbdaeaf3249732d9525070fdb&pid=1-s2.0-S2452109424001258-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842726","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":"Stereotactic Magnetic Resonance–Guided Daily Adaptive Radiation Therapy for Localized Prostate Cancer: Acute and Late Patient-Reported Toxicity Outcomes","authors":"Killian Nugent FFR, RCSI ,&nbsp;Prantik Das FRCR ,&nbsp;Dan Ford FRCR ,&nbsp;Ami Sabharwal FRCR ,&nbsp;Carla Perna FRCR ,&nbsp;Nicola Dallas FRCR ,&nbsp;Jason Lester FRCR ,&nbsp;Philip Camilleri FRCR","doi":"10.1016/j.adro.2024.101574","DOIUrl":"10.1016/j.adro.2024.101574","url":null,"abstract":"<div><h3>Purpose</h3><p>To report acute and late bowel, urinary, and sexual dysfunction patient-reported outcome measures, among patients with localized prostate cancer who underwent stereotactic magnetic resonance–guided daily adaptive radiation therapy (SMART).</p></div><div><h3>Methods and Materials</h3><p>All patients who completed a baseline 12-item Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events questionnaire, before undergoing SMART with 36.25 Gy in 5 fractions, were subsequently followed up with the same graded questionnaire at set time points. Latest prostate-specific antigen levels were recorded. The percentage of patients who reported no change from their baseline adverse event (AE) or reported a new ≥ “frequent or almost constant” or “severe grade or higher” AE grade during follow-up was calculated. The maximum 12-item Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events grade for each item was recorded for each patient. The percentage of toxicity levels for each separate AE item at set time points was calculated.</p></div><div><h3>Results</h3><p>The total number of patients was 69 with a median follow-up of 27 months. Median age of the cohort was 73 years (range, 54-85 years). The median pretreatment prostate-specific antigen level, T stage, and Gleason score were 7.5 mmol/L (range, 4.5-32 mmol/L), T2b (range, T2-T3b), and 7 (3 + 4; range, 6-9), respectively. No patient had biochemical failure during follow-up. Regarding bowel symptoms, &gt;80% of men reported no change from baseline toxicity during follow-up. New ≥ frequent or almost constant diarrhea was reported in 9% of patients. “Almost constant” diarrhea peaked at 1 month but was absent at &gt;33 months. Regarding urinary symptoms, increased urinary urgency was the most common complaint (39%). Twenty percent of men reported new ≥ frequent or almost constant urinary urgency incidence peaking at 1 month but absent at &gt;33 months. New “severe” sexual dysfunction was seen in 26% of patients and was persistent at &gt;33 months.</p></div><div><h3>Conclusions</h3><p>Our study is one the largest patient-reported outcomes study after prostate SMART. It shows acceptable levels of toxicity even up to 2 years after treatment.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101574"},"PeriodicalIF":2.2,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001374/pdfft?md5=2f27057ef5715b14ca7d268453995e9f&pid=1-s2.0-S2452109424001374-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850364","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":"Carbon Ion Beam Radiation Therapy as Part of a Trimodal Therapy for Non-small Cell Superior Sulcus Tumors: The INKA Study","authors":"Fabian Weykamp MD ,&nbsp;Lukas Schaub MD ,&nbsp;Martin Eichhorn MD ,&nbsp;Hauke Winter MD ,&nbsp;Peter Schirmacher MD, PhD ,&nbsp;Michael Thomas MD ,&nbsp;Uwe Haberkorn MD ,&nbsp;Malte Ellerbrock ,&nbsp;Sebastian Adeberg MD ,&nbsp;Jürgen Debus MD, PhD ,&nbsp;Klaus Herfarth MD","doi":"10.1016/j.adro.2024.101573","DOIUrl":"10.1016/j.adro.2024.101573","url":null,"abstract":"<div><h3>Purpose</h3><p>Superior sulcus tumors are frequently treated with neoadjuvant chemoradiation therapy (nCRT) followed by surgery via a trimodal approach. The INKA study evaluated the replacement of photon irradiation by carbon ion radiation therapy (C12-RT) in this regimen.</p></div><div><h3>Methods and Materials</h3><p>The prospective INKA study included patients with locally advanced non-small cell superior sulcus tumors (&lt;cN3 cM0). Patients received 2 cycles of cisplatin and vinorelbine as per local standard. During the second cycle, 39 Gy(Relative biological effectiveness (RBE)) of hypofractionated C12-RT in 13 fractions were applied. Surgery following fludeoxyglucose F18 positron emission tomography–computed tomography restaging was performed 2 weeks later. The primary endpoint was feasibility and safety measured by the incidence of Common Terminology Criteria for Adverse Events (version 4.0) grade 3/4 toxicity and/or discontinuation because of any reason. Secondary endpoints included the morphologic (Response Evaluation Criteria in Solid Tumors 1.0), metabolic (Positron Emission Tomography Response Criteria in Solid Tumors 1.0), and histopathologic response after nCRT as well as quality of life measurement (QLQ-C30/LC13).</p></div><div><h3>Results</h3><p>Between 2015 and 2020, 14 patients were included and received nCRT. No grade 3/4 toxicity occurred, with no discontinuation because of toxicity. Before surgery, 8 patients (57%) showed a partial response on computed tomography scan. Thirteen patients showed a metabolic response (metabolic complete remission (mCR), 1; metabolic partial remission (mPR), 12). Three patients (21%) were deemed inoperable after nCRT. In patients with resection, a pathologic Complete remission (CR) was seen in 2 patients (19%) and near-complete remission (&lt;10% vital tumor cells) in 6 patients (55%). Pain score was more than half of that at baseline (mean, 69.2 ± 26.2 vs 30.6 ± 29.1; <em>P</em> = .005) after completion of nCRT and before surgery.</p></div><div><h3>Conclusions</h3><p>The INKA trial is the first study to evaluate nCRT with C12-RT and showed excellent response, low toxicity, and rapid pain relief.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101573"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001362/pdfft?md5=7bae0f519a92a891d3aa779614bacc3b&pid=1-s2.0-S2452109424001362-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701235","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":"Prospective Randomized Trial Comparing 2 Devices for Deep Inspiration Breath Hold Management in Breast Radiation Therapy: Results of the BRAVEHeart Trial","authors":"Hilary L. Byrne PhD ,&nbsp;Elisabeth Steiner PhD ,&nbsp;Jeremy Booth PhD ,&nbsp;Gillian Lamoury BMed ,&nbsp;Marita Morgia MBBS ,&nbsp;Susan Carroll MBBS ,&nbsp;Kylie Richardson ,&nbsp;Leigh Ambrose MARTP ,&nbsp;Kuldeep Makhija ,&nbsp;Cameron Stanton MSc ,&nbsp;Benjamin Zwan PhD ,&nbsp;Michael Carr MSc ,&nbsp;Maegan Stewart PhD ,&nbsp;Regina Bromley MSc ,&nbsp;John Atyeo PhD ,&nbsp;Shona Silvester MMedSc ,&nbsp;Natalie Plant MHSc ,&nbsp;Paul Keall PhD","doi":"10.1016/j.adro.2024.101572","DOIUrl":"10.1016/j.adro.2024.101572","url":null,"abstract":"<div><h3>Purpose</h3><p>The Breast Radiotherapy Audio Visual Enhancement for sparing the Heart (BRAVEHeart) trial prospectively randomized patients with left-sided breast cancer to 1 of 2 deep inspiration breath hold biofeedback devices: a novel chest surface tracking system and an abdominal block tracking system. The primary hypothesis was that the accuracy of chest tracking would be higher than that of abdominal tracking as the chest is a more direct surrogate of the breast target.</p></div><div><h3>Methods and Materials</h3><p>Patients with left-sided breast cancer were treated in deep inspiration breath hold with intensity modulated radiation therapy delivery. Patients were randomized to either the novel chest surface system or abdominal block system for active management of breath hold with visual feedback. On both trial arms, the unallocated system was monitored passively. A total of 239,296 cine electronic portal imaging device images were analyzed retrospectively to extract the chest wall position. Treatment accuracy was quantified as the deviation of the internal chest wall during treatment relative to the planned position from the digitally reconstructed radiograph. The correlation between motion of the external surrogate and internal chest wall was calculated per-breath hold. Ease of use was assessed with questionnaires for both radiation therapists and patients and appointment length recorded.</p></div><div><h3>Results</h3><p>Data from 26 participants were available for analysis. No difference was found in delivered treatment accuracy between arms. Across all patients and fractions, the median correlation between internal chest wall movement and external surrogate was 0.69 for the chest surface and 0.17 for the abdominal block. Patients found it easy to follow visual feedback from both systems. No difference was found in appointment length between arms.</p></div><div><h3>Conclusions</h3><p>No statistical evidence was found for superior treatment accuracy, satisfaction, or appointment length for the novel chest surface tracking device compared with the abdominal block system. During deep inspiration breath hold, the median per-breath hold correlation of internal chest wall movement to the motion of the chest surface was higher than the median correlation of the abdominal block to the chest surface.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101572"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001350/pdfft?md5=19ca82eaa5d654d9d1e8467002b6d58d&pid=1-s2.0-S2452109424001350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697156","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}