Advances in Radiation Oncology最新文献

{"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}

{"title":"Knowledge-Based RapidPlan Volumetric Modulated Arc Therapy Model in Nasopharyngeal Carcinoma","authors":"Szu-Huai Lu MS ,&nbsp;Chun-Wei Wang MD, PhD ,&nbsp;Hsiang-Kuang Liang MD, PhD ,&nbsp;Chih-Kai Chang MS ,&nbsp;Hao-Ting Lan MS ,&nbsp;Shih-Fan Lai MD ,&nbsp;Bing-Shen Huang MD, PhD ,&nbsp;Wan- Yu Chen MD, PhD","doi":"10.1016/j.adro.2025.101716","DOIUrl":"10.1016/j.adro.2025.101716","url":null,"abstract":"<div><h3>Purpose</h3><div>RapidPlan^TM (RP) Eclipse^@, a commercial knowledge-based planning software, predicts radiation doses, enhancing treatment planning efficiency and quality. This study developed a nasopharyngeal carcinoma (NPC) volumetric modulated arc therapy RP model and assessed its quality and efficiency against manual plans.</div></div><div><h3>Methods and Materials</h3><div>The existing plans for 160 patients with NPC constituted the RP model training cohort. An additional 33 patients formed a testing cohort to compare RP and manual plans based on dose-volume histograms, isodose curves, physician plan scores, and selection.</div></div><div><h3>Results</h3><div>The RP plan could be completed within 1 hour. RP plans demonstrated superior conformity compared with manual plans in planning target volume 70. RP plans outperformed manual plans in reducing organs-at-risks (OARs) doses. For advanced T3/4 tumors, chiasma and optic nerve doses remained similar to manual plans. RP plans had higher physician-rated scores in dose-volume histograms of targets, OARs, isodose curves, and holistic scores. Clinical plan acceptance rates of RP plans reached 100%. Physicians chose RP plans over manual plans for 31, 30, and 28 patients for doctors A, B, and C, mainly because of superior OAR sparing and higher conformity.</div></div><div><h3>Conclusions</h3><div>The RP plan efficiently generates high-quality NPC volumetric modulated arc therapy plans. Further applications of RP Eclipse in single-institutional clinical flows and multi-institutional collaborations or clinical trials are warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101716"},"PeriodicalIF":2.2,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating an Artificial Object Detected in Radiographic Images in a Child: Unique Considerations Related to Proton Therapy","authors":"Jiyeon Park PhD ,&nbsp;Daniel J. Indelicato MD ,&nbsp;Soon N. Huh PhD ,&nbsp;Bobby R. Waldrip BS, RTT ,&nbsp;Mark Artz PhD, MBA ,&nbsp;Yawei Zhang PhD ,&nbsp;Michael Vieceli MS ,&nbsp;Hardev Grewal PhD ,&nbsp;Perry Johnson PhD","doi":"10.1016/j.adro.2025.101715","DOIUrl":"10.1016/j.adro.2025.101715","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101715"},"PeriodicalIF":2.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase I/II Study of Ultra-Hypofractionated Carbon-ion Radiation therapy for Low- and Intermediate-Risk Localized Prostate Cancer","authors":"Noriyuki Okonogi MD, PhD ,&nbsp;Hiroshi Tsuji MD, PhD ,&nbsp;Kana Kobayashi MD, PhD ,&nbsp;Mio Nakajima MD, PhD ,&nbsp;Shuri Aoki MD, PhD ,&nbsp;Takanobu Utsumi MD, PhD ,&nbsp;Hiroyoshi Suzuki MD, PhD ,&nbsp;Koichiro Akakura MD, PhD ,&nbsp;Tomohiko Ichikawa MD, PhD ,&nbsp;Hitoshi Ishikawa MD, PhD","doi":"10.1016/j.adro.2024.101705","DOIUrl":"10.1016/j.adro.2024.101705","url":null,"abstract":"<div><h3>Purpose</h3><div>We report herein the 3-year results of a phase I/II prospective study of 4-fraction course of carbon-ion radiation therapy (CIRT) in patients with localized prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>The present was a single-institution, phase I/II prospective study including patients with low- or intermediate-risk prostate cancer, as defined by the National Comprehensive Cancer Network criteria. Eligible patients were randomly assigned (1:1) to a 1- or 2-week schedule. Dose-limiting toxicities (DLTs) were defined as any genitourinary (GU) or gastrointestinal (GI) toxicity grade 3 or higher within 90 days of beginning CIRT. Ten patients were enrolled in each group, and the CIRT dose was increased in a stepwise manner if there were fewer than 4 cases of DLT. The initial CIRT dose was 36 Gy, followed by 40 Gy or 44 Gy. Low-risk patients did not receive androgen deprivation therapy (ADT), whereas intermediate-risk patients received 4 to 8 months of neoadjuvant ADT.</div></div><div><h3>Results</h3><div>Between October 2018 and October 2020, 60 patients were enrolled in the present study and completed the treatment regimen. The median post-CIRT follow-up period was 42 months (range, 27-59 months). Of the 60 patients enrolled, 10 were in the low-risk group, and 50 were in the intermediate-risk group. Neither group experienced grade 3 or higher GI or GU adverse events; therefore, no dose-limiting toxicities were observed. The incidence of grade 2 GU toxicity within 90 days post CIRT was significantly higher in the 44 Gy group than in the 36 to 40 Gy group (<em>P</em> &lt; .01, chi-square test with Yates correction). Biochemical failure was observed in 3 cases by 3 years post CIRT. No clinical recurrence or death because of prostate cancer occurred.</div></div><div><h3>Conclusions</h3><div>Forty Gy in 4 fractions of CIRT may be appropriate for balancing the therapeutic effects and toxicity. Our findings support further investigations into the efficacy of this strategy.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101705"},"PeriodicalIF":2.2,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143094116","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":"Integrating Radiosensitivity Index and Radiation Resistance Related Index Improves Prostate Cancer Outcome Prediction","authors":"Qi-Qiao Wu MD ,&nbsp;Zhao-Sheng Yin MD ,&nbsp;Yi Zhang MD ,&nbsp;Yu-Fu Lin MD ,&nbsp;Jun-Rong Jiang BS ,&nbsp;Ruo-Yan Zheng BS ,&nbsp;Tao Jiang MD ,&nbsp;Dong-Xu Lin MD ,&nbsp;Peng Lai MD ,&nbsp;Fan Chao PhD ,&nbsp;Xin-Yue Wang MD ,&nbsp;Bu-Fu Tang PhD ,&nbsp;Shi-Suo Du PhD ,&nbsp;Jing Sun MD ,&nbsp;Ping Yang MD ,&nbsp;Zhao-Chong Zeng PhD","doi":"10.1016/j.adro.2025.101713","DOIUrl":"10.1016/j.adro.2025.101713","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to establish a nomogram combining 31-gene signature (31-GS), radiosensitivity index (RSI), and radiation-resistance-related gene index (RRRI) to predict recurrence in prostate cancer (PCa) patients.</div></div><div><h3>Methods and Materials</h3><div>Transcriptome data of PCa were obtained from gene expression omnibus and the cancer genome atlas to validate the predictive potential of 3 sets of published biomarkers, namely, 31-GS, RSI, and RRRI. To adjust these markers for the characteristics of PCa, we analyzed 4 PCa-associated radiosensitivity predictive indices based on 31-GS, RSI, and RRRI by the Cox analysis and least absolute shrinkage and selection operator regression analysis. Time-dependent receiver operating characteristic curves, decision curve analyses, integrated discrimination improvement, net reclassification improvement and decision tree model construction were used to compare the radiosensitivity predictive ability of these 4 gene signatures. Key modules and associated functions were identified through a weighted gene co-expression network analysis and gene function enrichment analysis. A nomogram was built to improve the recurrence-prediction capability.</div></div><div><h3>Results</h3><div>We validated and compared the predictive potential of 2 published predictive indices. Based on the 31-GS, RSI, and RRRI, we analyzed 4 PCa-associated radiosensitivity predictive indices: 14Genes, RSI, RRRI, and 20Genes. Among them, 14Genes showed the most promising predictive performance and discriminative capacity. Genes in the key module defined by the 14Genes model were significantly enriched in radiation therapy-related cell death pathways. The area under receiver operating characteristic curve and decision tree variable importance for 14Genes was the highest in the cancer genome atlas and Gene Expression Omnibus Series (GSE) cohorts.</div></div><div><h3>Conclusions</h3><div>This study successfully established a radiosensitivity-related nomogram, which had excellent performance in predicting recurrence in patients with PCa. For patients who received radiation therapy, the 20Genes and RRRI models can be used to predict recurrence-free survival, whereas 20Genes is more radiation therapy-specific but needs further external validation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101713"},"PeriodicalIF":2.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394618","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":"Provider Practices and Perceived Barriers and Facilitators in Improving Quality Practices in Radiation Oncology Peer Review","authors":"Leslie Chang MD ,&nbsp;Sara Alcorn MD, PhD ,&nbsp;Khinh Ranh Voong MD, MPH ,&nbsp;Todd R. McNutt PhD ,&nbsp;Ori Shokek MD ,&nbsp;Suzanne Evans MD, MPH ,&nbsp;Jean L. Wright MD","doi":"10.1016/j.adro.2024.101708","DOIUrl":"10.1016/j.adro.2024.101708","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation oncology peer review evaluates case-specific qualitative treatment planning decisions. We sought to understand interdisciplinary perspectives on peer review to identify factors affecting stakeholder engagement and implementation of recommendations.</div></div><div><h3>Materials and Methods</h3><div>Semistructured interviews and Likert surveys (scaled, 0-10) with radiation oncology peer review participants were audio-recorded and transcribed. Two independent coders utilized a grounded theory approach to extract dominant themes.</div></div><div><h3>Results</h3><div>Participants included 6 academic and 3 community radiation oncologists, 2 residents, 2 medical physicists, 2 radiation therapists, 4 dosimetrists, and 1 industry representative. Thematic priorities of peer review included adherence to institutional guidelines, clinical background to inform decision-making, detection of rare errors, and education. Key facilitators included pretreatment peer review, clear planning guidelines, and feedback on peer recommendations. Barriers to recommendation adoption included resource limitations and a lack of prospective data guiding qualitative recommendations. Participants perceived benefits of peer review were assessed with Likert surveys with higher values placed on reducing practice variation (8.0) and education (7.6) and a lower value placed on the detection of medical errors (7.4) and reduction of treatment delivery incidents (6.9). When comparing Likert scores by participant role, nonphysicians rated the overall importance of peer review (mean, 9.8 vs 6.5, <em>P</em> = .03) and education (mean, 9.0 vs 6.7, <em>P</em> = .02) significantly higher than physicians.</div></div><div><h3>Conclusion</h3><div>Participants in radiation oncology acknowledged the importance of peer review, but there was significant variation in the perceived benefits. A higher value was placed on the alignment of clinical practice and nonphysician participant education. Future processes to improve communication and prospective plan review were identified as beneficial to peer review-mediated plan changes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101708"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143093658","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":"Raising the Bar for Assessing Nutritional Risk Among Patients with Cancer","authors":"Miriam A. Knoll MD ,&nbsp;Julie Wilcox MS","doi":"10.1016/j.adro.2024.101645","DOIUrl":"10.1016/j.adro.2024.101645","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101645"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143174833","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":"Outcomes and Toxicities After Treatment for Men Diagnosed With Localized Prostate Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis","authors":"Doris Kitson-Mills MPH, MPhil ,&nbsp;Andrew Donkor PhD ,&nbsp;Yaw Ampem Amoako MBChB, FWACS ,&nbsp;Kofi Adesi Kyei PhD ,&nbsp;Ernest Barwuah Osei Bonsu MBChB, FWACS ,&nbsp;Verna Vanderpuye MBChB, FWACS ,&nbsp;Yaw Amo Wiafe PhD","doi":"10.1016/j.adro.2024.101670","DOIUrl":"10.1016/j.adro.2024.101670","url":null,"abstract":"<div><h3>Purpose</h3><div>Current management for clinically localized prostate cancer in low- and middle-income countries (LMICs) includes surgery, external beam radiation therapy (EBRT), and brachytherapy either alone or in combination, with plus or minus hormone therapy. The toxicity profiles and oncological outcomes of these treatment modalities vary. This systematic review and meta-analysis aimed to determine the prevalence of treatment-related outcomes and toxicities for men diagnosed with localized prostate cancer in LMICs.</div></div><div><h3>Methods and Materials</h3><div>The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane Library, Embase, and Medline were searched for eligible articles. Meta-analysis was performed with Review Manager version 5.4.1 using a random effects model at a 95% confidence interval.</div></div><div><h3>Results</h3><div>A total of 2,820 patients were analyzed from 24 articles that met the inclusion criteria. Following 3-dimensional conformal radiation therapy (3D-CRT), the most common clinician-reported toxicities were acute skin grade 1, acute genitourinary grade 1, acute gastrointestinal grade 1, and late gastrointestinal grade 1, with 46%, 29%, 24%, and 18%, respectively. Acute and late genitourinary grade 3 and gastrointestinal grade 3 toxicities were below 3% with no grade 4 toxicities reported after 3D-CRT. In the brachytherapy group, the prevalence of acute genitourinary grade 1 toxicity was 19%. Perioperative rectal injury was the least prevalent (2%) after retropubic radical prostatectomy. Following 3D-CRT, the 5-year overall survival rate was 87%, and for the combined brachytherapy and EBRT group, it increased to 96%. The prevalence of 5-year biochemical failure following EBRT and brachytherapy was 18% and 30%, respectively. The 4- and 3-year biochemical failure after radical prostatectomy and combined EBRT with brachytherapy were 22% and 2%, respectively.</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis indicate that in LMICs, EBRT, brachytherapy, and radical prostatectomy, either alone or in combination has an excellent potential for localized prostate cancer control with low toxicities and good oncological outcomes. Results of treatment-related toxicities and outcomes can support policymakers, patients, and clinicians on informed decision-making to strengthen prostate cancer care in the region. However, efforts are required to improve early detection, treatment accessibility, regular post-treatment follow-up care, consistent quality assurance practices, and staff continues development to help minimize treatment toxicities and improve outcomes of localized prostate cancer in LMICs.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101670"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930389","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}