Advances in Radiation Oncology最新文献

{"title":"Expenditures and Use of Hypofractionated Radiation Therapy Treating Breast Cancer Among Medicare Advantage Enrollees, 2009 to 2017","authors":"Loren Saulsberry PhD,&nbsp;Chuanhong Liao MS,&nbsp;Dezheng Huo MD, PhD","doi":"10.1016/j.adro.2024.101568","DOIUrl":"10.1016/j.adro.2024.101568","url":null,"abstract":"<div><h3>Purpose</h3><p>Technology advances in cancer care have paralleled rapidly increasing expenditures in radiation therapy. The use and costs of shorter cancer radiation therapy offer potential utility in clinical practice. We evaluate use and expenditures of Medicare Advantage (MA) beneficiaries receiving hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) in the United States and examine the relationship of patient characteristics with HF-WBI use.</p></div><div><h3>Methods and Materials</h3><p>We performed a retrospective analysis of radiation therapy in MA beneficiaries using private employer-sponsored insurance claims for a pooled cross-sectional evaluation from 2009 to 2017. The study population included female MA beneficiaries with early-stage breast cancer treated with lumpectomy and whole breast irradiation.</p></div><div><h3>Results</h3><p>A total of 9957 women received HF-WBI, and 18,920 received CF-WBI. Older age, greater distance from home to treatment facility, and a higher proportion of college graduates in the community of residence were associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HF-WBI versus CF-WBI (adjusted difference, $4113; 95% CI, $4030-$4,197). Mean patient out-of-pocket expenditure for HF-WBI was $426 less than that of CF-WBI. Across US states, geographic variation existed in the ratio of costs for HF-WBI relative to CF-WBI (range, 0.41-0.87).</p></div><div><h3>Conclusions</h3><p>HF-WBI use among MA beneficiaries with breast cancer has dramatically increased over time, surpassing CF-HBI as the dominant form of radiation therapy. HF-WBI clinical adoption has outpaced any continual cost decrease, despite wide variation across US states for this shorter radiation therapy treatment. As MA enrollment continues to expand, identifying the drivers of HF-WBI use and the sources of variation in costs of HF-WBI will help direct the quality of cancer care delivered to Medicare beneficiaries.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101568"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001313/pdfft?md5=a6284526993467d7929d523cbef50b0b&pid=1-s2.0-S2452109424001313-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704013","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":"Underuse of Postoperative Radiation After Nipple-Sparing Mastectomy for Standard Radiation Indications","authors":"Wesley J. Talcott MD, MBA ,&nbsp;Gustavo N. Marta MD, PhD ,&nbsp;Meena S. Moran MD","doi":"10.1016/j.adro.2024.101569","DOIUrl":"10.1016/j.adro.2024.101569","url":null,"abstract":"<div><h3>Purpose</h3><p>Nipple areola complex-sparing surgeries, such as nipple-sparing mastectomy (NSM), are increasingly used for women with early-stage breast cancer. In the postoperative setting, 2 major indications for postoperative radiation (PORT) with/without regional nodal irradiation (RNI) are: positive margins (margin+) and pathologically involved lymph nodes (pN+). The frequency of these adverse pathologic features and the rate of PORT utilization following NSM for these 2 indications are unknown. We determined the frequency of margin+ and pN+ following NSM compared with nipple-sparing lumpectomy/breast-conserving surgery [BCS] and identified trends in appropriate PORT administration for these standard indications in the NSM setting.</p></div><div><h3>Methods and Materials</h3><p>Using the National Cancer Database (NCDB), women diagnosed with cT1 to cT3,N0M0 invasive carcinoma between 2004 and 2017 who underwent NSM were compared with those who underwent BCS (with nipple preservation). The frequencies of margin+ and pN+ by surgical subtype and use of PORT with/without RNI were assessed by cohort to determine if the type of surgery was associated with radiation delivery. Overall survival between the 2 cohorts was also compared. We performed univariable/multivariable logistic and Cox regression with ORs to control for confounders.</p></div><div><h3>Results</h3><p>Of 624,075 women included, 611,907 underwent BCS, and 12,168 underwent NSM. The surgical margin+ rate was significantly higher for NSM at 4.5% (n = 544) than for BCS at 3.7% (n = 22,449) (<em>P</em> &lt; .001) and remained significant on multivariable analysis (MVA; OR, 1.13; CI, 1.03-1.25; <em>P</em> = .012). Use of PORT for margins+ was significantly lower by MVA after NSM (OR, 0.07; CI, 0.06-0.09; <em>P</em> &lt; .001). Similarly, pN+ rate was significantly higher for NSM at 22.5% (n = 2740) versus BCS at 13.5% (n = 82,288) (<em>P</em> &lt; .001), retaining significance on MVA (OR, 1.12; CI, 1.06-1.19; <em>P</em> &lt; .001). For pN+ undergoing NSM, PORT with RNI was delivered significantly less often on MVA (OR, 0.73; CI, 0.67-0.81; <em>P</em> &lt; .001). Neither high-risk subgroup had differences in overall survival on MVA.</p></div><div><h3>Conclusions</h3><p>NSM is associated with a higher rate of margin+ and pN+ compared with BCS. Radiation is underused after NSM for these standard indications. Our results highlight the need to further refine patient selection for NSM and the importance of communicating the higher potential for adverse pathologic features (and thus, the potential need for radiation) to patients undergoing NSM.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101569"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001325/pdfft?md5=01c5de86b1891fdf19575a41b5e164c5&pid=1-s2.0-S2452109424001325-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692887","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":"Quantification of Dosimetry Improvement With or Without Patient Surface Guidance","authors":"Ke Sheng PhD, FAAPM, DABR ,&nbsp;Minsong Cao PhD ,&nbsp;Andrew Godley PhD ,&nbsp;Mu-Han Lin PhD ,&nbsp;Lukas Henze MEng ,&nbsp;Laura Hammond MSc ,&nbsp;Laurence Delombaerde PhD ,&nbsp;Kirsten Hierholz Dipl -Ing ,&nbsp;Jana Kouptsidis MSc","doi":"10.1016/j.adro.2024.101570","DOIUrl":"10.1016/j.adro.2024.101570","url":null,"abstract":"<div><h3>Purpose</h3><p>Noncoplanar beams and arcs are routinely used to improve dosimetry for intracranial cases, but their application for extracranial cases has been hampered by the risk of collision. This has led to conservative beam selection whose impact on plan dosimetry has not been previously studied.</p></div><div><h3>Methods and Materials</h3><p>A full-body 3-dimensional patient surface was acquired using optical cameras for a single lung patient at the time of computed tomography simulation. Eight stereotactic body radiation therapy (SBRT) plans were created for the patient, with varying degrees of noncoplanarity and deliverability. The plans included volumetric modulated arc therapy and intensity modulated radiation therapy (IMRT) plans ranging from simple, coplanar arcs to multiple noncoplanar arcs and IMRT beams. A total of 70 fields were created across the 8 plans, of which 21 fields were undeliverable with a 5-cm buffer. Organs-at-risk (OARs) metrics including R50, Dmax 2 cm from the PTV, lung V20, and chest wall V30 were evaluated. Five expert SBRT dosimetrists from 5 institutions evaluated field deliverability, with or without the guidance of the clearance map.</p></div><div><h3>Results</h3><p>In the dosimetry evaluation, a clear trend in increasing dosimetric compactness and OAR sparing is observed with increasing plan noncoplanarity. R50, Dmax 2 cm, lung V20, and chest wall V30 decreased 41%, 39%, 43%, and 57%, respectively, from plan 1 (2 coplanar partial arcs) to plan 8 (19 noncoplanar IMRT beams). In the observer tests, the expert dosimetrists’ ability to accurately discern beam deliverability because of collision significantly increases with the clearance map. The errors in predicting colliding fields were eliminated using the whole-body surface and clearance map, and the user was able to select fields based on plan quality and patient comfort instead of being overly conservative.</p></div><div><h3>Conclusion</h3><p>The study shows that incorporating a personalized, whole-body clearance map in the treatment planning workflow can facilitate the adoption of noncoplanar beams or arcs that benefit the SBRT plan dosimetry.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101570"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001337/pdfft?md5=72abedba7c03476b91252b0d8940b6fe&pid=1-s2.0-S2452109424001337-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695523","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":"18F-Flotufolastat Positron Emission Tomography in African American Patients With Suspected Prostate Cancer Recurrence: Findings From the Phase 3 SPOTLIGHT Study","authors":"Soroush Rais-Bahrami MD ,&nbsp;Mark Fleming MD ,&nbsp;Benjamin Gartrell MD ,&nbsp;William C. Lavely MD ,&nbsp;Albert Chau MSc ,&nbsp;Phillip Davis MD ,&nbsp;David M. Schuster MD","doi":"10.1016/j.adro.2024.101571","DOIUrl":"10.1016/j.adro.2024.101571","url":null,"abstract":"<div><h3>Purpose</h3><p>Although African American (AA) patients are disproportionately affected by prostate cancer, they are often underrepresented in oncology clinical trials. The SPOTLIGHT study (NCT04186845) assessed the novel diagnostic positron emission tomography radiopharmaceutical, ¹⁸F-flotufolastat (¹⁸F-rhPSMA-7.3), in patients with recurrent prostate cancer. The proportion of AA patients enrolled in SPOTLIGHT (17%) was greater than typically enrolled in oncology trials (8.5%) and was representative of the US population (14%). This post hoc analysis of SPOTLIGHT evaluates the diagnostic performance of ¹⁸F-flotufolastat in AA patients.</p></div><div><h3>Methods and Materials</h3><p>Patients underwent positron emission tomography/computed tomography 50 to 70 minutes after intravenous administration of 296 MBq ¹⁸F-flotufolastat. Three blinded readers evaluated all images, with the majority read (agreement of ≥2 readers) result reported here. Standard of truth (SoT) was established with histopathology or correlative imaging. Data from AA patients were evaluated to determine the ¹⁸F-flotufolastat overall detection rate (DR), positive predictive value (PPV), and verified DR (VDR). VDR (SoT-verified) is equivalent to DR × PPV.</p></div><div><h3>Results</h3><p>In total, 61 of 366 (17%) patients were AAs. Although baseline characteristics were broadly similar, fewer AA patients (56%) had undergone prostatectomy than non-AA patients (82%). The patient-level DR was 93% (57/61) in AA patients, increasing from 67% at prostate-specific antigen &lt;0.5 ng/mL to 100% at prostate-specific antigen ≥10 ng/mL. Patient-level DR was marginally lower in all other patients (87%, 264/305). However, when stratifying by prior treatment, DRs were similar across ethnic groups in postprostatectomy patients, but in patients with intact prostates, AA patients had higher prostate DR than non-AA patients. SoT-verification (predominantly with conventional imaging [79%]) gave a VDR of 64% and PPV of 68% in AA patients, versus 55% and 64%, respectively, in all other patients.</p></div><div><h3>Conclusions</h3><p>¹⁸F-Flotufolastat DRs were marginally higher in AA patients than in all other patients enrolled in SPOTLIGHT. High VDR and PPV were also achieved in AA patients from across all participating centers, indicating the broad applicability of newly US Food and Drug Administration–approved ¹⁸F-flotufolastat to the US population as a whole.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101571"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001349/pdfft?md5=6326106769069cc5cc663bad23d491c8&pid=1-s2.0-S2452109424001349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716344","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":"Stem Cell Therapy Using Bone Marrow-Derived Muse Cells Repairs Radiation-Induced Intestinal Injury Through Their Intestine-Homing via Sphingosine Monophosphate-Sphingosine Monophosphate Receptor 2 Interaction","authors":"Taichi Miura PhD ,&nbsp;Junko Kado MS ,&nbsp;Hirotoshi Takiyama MD, PhD ,&nbsp;Mitsuko Kawano PhD ,&nbsp;Asako Yamagiri BS ,&nbsp;Shoko Nishihara PhD ,&nbsp;Shigeru Yamada MD, PhD ,&nbsp;Fumiaki Nakayama MD, PhD","doi":"10.1016/j.adro.2024.101565","DOIUrl":"10.1016/j.adro.2024.101565","url":null,"abstract":"<div><h3>Purpose</h3><p>There is still no effective treatment for the gastrointestinal side effects of radiation therapy. Multilineage-differentiating stress-enduring (Muse) cells are tissue stem cells that have the ability to spontaneously home in on injured tissues and repair them. Several clinical trials have shown that stem cell therapy using human bone marrow-derived Muse (hBM-Muse) cells is effective in treating various diseases, but it is not known whether they are effective in treating radiation-induced intestinal injury. In this study, we investigated whether hBM-Muse cells are homing to the radiation-damaged intestine and promote its repair.</p></div><div><h3>Methods and Materials</h3><p>hBM-Muse cells were injected into the tail vein of mice 2 hours after high-dose total body irradiation. Then, homing analysis, crypt assay, bromodeoxyuridine assay, Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) assay, immunostaining, and survival time measurements were performed. In addition, we analyzed the expression of sphingosine monophosphate (S1P), a Muse cell-inducing factor, in the mouse small intestine after irradiation. Finally, we investigated whether the administration of JTE-013, an S1P receptor 2-specific antagonist, inhibits hBM-Muse cells homing to the injured intestine.</p></div><div><h3>Results</h3><p>S1P expression increased in mouse intestine after irradiation, with hBM-Muse cells homing in on the injured intestine. Injection of hBM-Muse cells after radiation exposure significantly increased the number of crypts, proliferating cells in the crypts, and small intestinal component cells such as intestinal stem cells inhibited radiation-induced apoptosis and prolonged mouse survival. Treatment with JTE-013 significantly inhibited intestinal homing and therapeutic effects of hBM-Muse cells. These findings indicate that hBM-Muse cells homed in on the injured intestine through the S1P-S1P receptor 2 interaction to exert therapeutic effects on the radiation-induced intestinal injury.</p></div><div><h3>Conclusions</h3><p>This study indicates that hBM-Muse cells are effective in treating radiation-induced intestinal injury, suggesting that hBM-Muse cell-based stem cell therapy has the potential to overcome gastrointestinal side effects that limit the indications for radiation therapy.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101565"},"PeriodicalIF":2.2,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001283/pdfft?md5=35095bcc1084c70d603c12cdbd949fb5&pid=1-s2.0-S2452109424001283-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691572","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":"Using Scorecards to Tune Ethos Directive Templates: An Adaptive Radiation Therapy Individualized Approach-Cervix Dosimetric Planning Study","authors":"Kareem Rayn MD ,&nbsp;Anthony Magliari CMD ,&nbsp;Ryan Clark CMD ,&nbsp;Omar Rana BS ,&nbsp;Kevin Moore PhD, CMD ,&nbsp;Xenia Ray PhD","doi":"10.1016/j.adro.2024.101550","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101550","url":null,"abstract":"<div><h3>Purpose</h3><p>The Adaptive Radiation Therapy Individualized Approach-Cervix clinical trial uses predefined clinical directive templates (CDTs) combined with RapidPlan dose-volume histogram estimations (DVHe) to guide plan optimization in the Ethos treatment planning system. The dosimetric scorecard is a scoring tool that quantifies improvements in plan quality after physicians have precisely expressed their complete clinical intent. To our knowledge, this is the first study to use the dosimetric scorecard tool to tune an Ethos CDT to improve resulting plan quality.</p></div><div><h3>Methods and Materials</h3><p>Iterative replanning was used to modify the draft CDT (CDT-1) in Ethos 1.1 to generate a new CDT (CDT-2) that maximized the clinical consensus scorecard's total score compared with CDT-1. CDT-2 was established, and resulting plans were compared with and without a DVHe. Additional fixed field intensity modulated radiation therapy beam geometries were compared between CDT-1 and CDT-2, both with DVHe. After obtaining favorable results when comparing CDT-1 versus CDT-2 for 2 test cases, 10 additional cases were retrospectively identified and tested.</p></div><div><h3>Results</h3><p>CDT-2 reduced organ at risk doses without compromising planning target volume coverage in the initial test cases. When combined with DVHe, CDT-2 marginally outperformed CDT-1. Plan quality further improved with a 19-field geometry. In the expanded analysis, CDT-2 achieved higher scores than CDT-1 in most cases, with the 19-field approach showing superiority. Optimization and calculation time increased by 1.9 minutes, monitor unit (MU)/field decreased by 44.4, whereas beam-on time increased by 2.8 minutes when increasing fields to 19 from 9. Reoptimization with Ethos 1.1 Maintenance Release 1 resulted in decreased MU and minimal score changes.</p></div><div><h3>Conclusions</h3><p>The scorecard is an effective tool to adjust an Ethos CDT to improve the average calculated plan quality. It also allowed for easy evaluation of the dosimetric impact of other planning parameters (beam arrangements and use of DVHe) to identify the best approach. Using a finely tuned CDT is expected to improve planning efficiency and decrease intrainstitutional plan quality variability, benefiting cone beam computed tomography–guided adaptive radiation therapy.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101550"},"PeriodicalIF":2.2,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001131/pdfft?md5=88836ccfe337f9e349266b0c6fb93ab5&pid=1-s2.0-S2452109424001131-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543702","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 Radiation on Exosomes in Regulating Tumor Immune Microenvironment","authors":"Silai Yu MD ,&nbsp;Shanshan Jiang PhD ,&nbsp;Yue Zhou MD ,&nbsp;Zhengfei Zhu PhD ,&nbsp;Xi Yang PhD","doi":"10.1016/j.adro.2024.101549","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101549","url":null,"abstract":"<div><h3>Purpose</h3><p>Exosomes have been shown to play a role in most, if not all, steps of cancer progression. We still lack a comprehensive understanding of the bidirectional communication of exosomes between tumor cells and immune cells. This article aims to explore how exosomes can influence cancer growth and how they are affected by radiation therapy.</p></div><div><h3>Methods and Materials</h3><p>We searched on PubMed and Web of Science on the impact of radiation on tumor derived exosomes and immune cell derived exosomes in tumor immune microenvironment. We screened all the related articles and summarized their main discoveries and important results.</p></div><div><h3>Results</h3><p>This article reviewed the effects of tumor derived exosomes and immune cell-derived exosomes on TME and tumor progression after radiotherapy, suggesting the dual effects of exosomes which may refer to clinical practice. Moreover, we retrospected the clinical applications based on tumor derived exosomes, including liquid biopsy, radio-resistance and drug delivery, and discussed the challenges and prospects.</p></div><div><h3>Conclusions</h3><p>Exosomes are important in cancer treatment, especially with radiation therapy. Learning more about them could lead to better treatments. However, there are still challenges to overcome. The review points out the need for more research in this area.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101549"},"PeriodicalIF":2.2,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S245210942400112X/pdfft?md5=210f6ef3dd5a089b8cd76e4fb135ca09&pid=1-s2.0-S245210942400112X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543692","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":"Lung and Liver Stereotactic Body Radiation Therapy During Mechanically Assisted Deep Inspiration Breath-Holds: A Prospective Feasibility Trial","authors":"Loïc Vander Veken MD, PhD ,&nbsp;Geneviève Van Ooteghem MD, PhD ,&nbsp;Benoît Ghaye MD, PhD ,&nbsp;Ariane Razavi MSc ,&nbsp;David Dechambre MSc ,&nbsp;Xavier Geets MD, PhD","doi":"10.1016/j.adro.2024.101563","DOIUrl":"10.1016/j.adro.2024.101563","url":null,"abstract":"<div><h3>Purpose</h3><p>Radiation therapy for tumors subject to breathing-related motion during breath-holds (BHs) has the potential to substantially reduce the irradiated volume. Mechanically assisted and noninvasive ventilation (MANIV) could ensure the target repositioning accuracy during each BH while facilitating treatment feasibility through oxygen supplementation and a perfectly replicated mechanical support. However, there is currently no clinical evidence substantiating the use of MANIV-induced BH for moving tumors. The aim of this work was, therefore, to evaluate the technique's performance under real treatment conditions.</p></div><div><h3>Methods and Materials</h3><p>Patients eligible for lung or liver stereotactic body radiation therapy were prospectively included in a single-arm trial. The primary endpoint corresponded to the treatment feasibility with MANIV. Secondary outcomes comprised intrafraction geometric uncertainties extracted from real-time imaging, tolerance to BH, and treatment time.</p></div><div><h3>Results</h3><p>Treatment was successfully delivered in 92.9% (13/14) of patients: 1 patient with a liver tumor was excluded because of a mechanically induced gastric insufflation displacing the liver cranially by more than 1 cm. In the left-right/anteroposterior/craniocaudal directions, the recalculated safety margins based on intrafraction positional data were 4.6 mm/5.1 mm/5.6 mm and 4.7 mm/7.3 mm/5.9 mm for lung and liver lesions, respectively. Compared with the free-breathing internal target volume and midposition approaches, the average reduction in the planning target volume with MANIV reached −47.2% ± 15.3%, <em>P</em> &lt; .001, and −29.4% ± 19.2%, <em>P</em> = .007, for intrathoracic tumors and −23.3% ± 12.4%, <em>P</em> &lt; .001, and −9.3% ± 15.3%, <em>P</em> = .073, for upper abdominal tumors, respectively. For 1 liver lesion, large caudal drifts of occasionally more than 1 cm were measured. The total slot time was 53.1 ± 10.6 minutes with a BH comfort level of 80.1% ± 10.6%.</p></div><div><h3>Conclusions</h3><p>MANIV enables high treatment feasibility within a nonselected population. Accurate intrafraction tumor repositioning is achieved for lung tumors. Because of occasional intra-BH caudal drifts, pretreatment assessment of BH stability for liver lesions is, however, recommended.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101563"},"PeriodicalIF":2.2,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S245210942400126X/pdfft?md5=2aacbb1f64348b5f3e181f95b6c8f0d3&pid=1-s2.0-S245210942400126X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714562","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":"Sensitivity Response Analysis of Optical Surface Monitoring Systems Using the Fitzpatrick Scale: A Phantom Study","authors":"Rakesh Kapoor MD ,&nbsp;Aarti Jamwal PhD ,&nbsp;Gaganpreet Singh PhD ,&nbsp;Arun S. Oinam PhD ,&nbsp;Divya Khosla MD ,&nbsp;Mandeep Garg MD","doi":"10.1016/j.adro.2024.101564","DOIUrl":"10.1016/j.adro.2024.101564","url":null,"abstract":"<div><h3>Purpose</h3><p>Optical surface monitoring systems (OSMSs) have gained substantial attention in modern radiation therapy, specifically in the context of surface guided radiation therapy, which offers real-time patient surface monitoring, ensuring accurate and effective radiation therapy treatments. The aim of this article is to evaluate the OSMS camera sensitivity toward different skin tones, categorized according to the Fitzpatrick scale, a universal classification of human skin tones, using a phantom.</p></div><div><h3>Methods and Materials</h3><p>This study used Catalyst and Sentinel OSMSs (C-RAD). The Alderson RANDO female pelvis phantom, located at the isocenter in computed tomography simulation and treatment rooms, served as an experimental subject. Eighteen skin tone–matching cotton cloths, selected on the basis of Von Luschan chromatic and Fitzpatrick scales, were wrapped around the phantom for sensitivity evaluation. Camera sensitivity was optimized by adjusting threshold/gain (100%-600%) and integration time during individual scans in both rooms. Temporal response analysis spanned 2 months, with 16 measurements for each OSMS taken in varying light conditions.</p></div><div><h3>Results</h3><p>The OSMSs successfully detected the surface of cloth-covered phantoms with varying mean (SD) integration times: 550 (34) to 950 (43) μs for the Sentinel system and 2300 (71) to 12,000 (400) μs for the Catalyst system. The sensitivity parameters differed for each skin tone, with lighter skin requiring shorter integration times and gain/threshold values. Darker skin tones necessitated higher parameters for optimal surface images. The reliability of the systems declined with excessive parameters, leading to noise and compromised accuracy in patient positioning.</p></div><div><h3>Conclusions</h3><p>Optimized sensitivity parameters tailored to individual skin tones are crucial for effective real-time patient surface monitoring in radiation therapy, as variations in skin color can affect the accuracy of measurements. The precision of skin color measurements in OSMSs relies on carefully adjusting camera sensitivity parameters. However, careful consideration is essential, as larger values are required for darker skin tones, compromising reliability. This suggests the need for exploring alternative image guidance methods for patients with darker skin tones.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101564"},"PeriodicalIF":2.2,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001271/pdfft?md5=6678f11f15193342ba0fb3527f14095b&pid=1-s2.0-S2452109424001271-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693399","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":"FM - Frontmatter","authors":"","doi":"10.1016/j.adro.2024.101553","DOIUrl":"10.1016/j.adro.2024.101553","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 7","pages":"Article 101553"},"PeriodicalIF":2.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001167/pdfft?md5=f079f6532c13dbfa211d51e6c9ceb5f7&pid=1-s2.0-S2452109424001167-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141623981","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}