Adapting radiation therapy to immunotherapy: Delineation and treatment planning of pre-operative immune-modulating breast iSBRT in 151 patients treated in the randomized phase II Neo-CheckRay trial

IF 5.3 1区医学 Q1 ONCOLOGY Radiotherapy and Oncology Pub Date : 2025-03-06 DOI:10.1016/j.radonc.2025.110836

A.De Caluwé , S. Bellal , K. Cao , K. Peignaux , V. Remouchamps , A. Baten , E. Longton , I. Bessieres , J. Vu-Bezin , Y. Kirova , D.Van Gestel , I. Desmoulins , M. Ignatiadis , E. Romano , L. Buisseret , M. Piccart , C. Vandekerkhove , A. Gulyban , P. Poortmans

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Abstract

Background and purpose

The randomized multicentric phase II Neo-CheckRay trial investigated preoperative immune-modulating stereotactic body radiation therapy (iSBRT) 8 Gy x 3 fractions in combination with chemotherapy with or without the anti PD-L1 durvalumab and the anti-CD73 oleclumab in early-stage, high-risk, luminal B breast cancer. iSBRT was solely delivered to the primary breast cancer leveraging on its immune modulating potential to sustain an anti-tumour response. To avoid immunosuppression induced by radiation therapy (RT), the tumour draining lymph nodes (TDLN) were spared. Here, we present the constraints used in the Neo-CheckRay trial and a dosimetric analysis of all delivered treatment plans with a special focus on the dose to the TDLN.

Materials and Methods

Main constraints were the skin (D0.1 cc < 19.2 Gy), chest wall (D1cc < 15 Gy) and ipsilateral uninvolved breast (V24Gy < 30 %). The dose to the TDLN was reduced by avoiding beams entering or exiting the TDLN. In the present work, the DICOM-RT data of all the patients treated in the Neo-CheckRay trial were collected (n = 151) to describe doses to the target volume, to the organs at risk and the TDLN. The TDLN volumes consisted of the internal mammary nodes (IMN) and the axilla levels I-IV including the interpectoral nodes.

Results

In 151 patients, the median V95% of the gross target volume (GTV) and planning target volume (PTV) were 97.4 % (90 % CI 26.5–100) and 95.5 % (56.1–100). The mean dose (dMean) to all TDLN volumes was < 1 Gy. The highest dMean were to the IMN and axilla level 1: 0.8 Gy (90 % CI 0.1–2.7) and 0.6 Gy (0.0–3.9), respectively. The dMean to the involved lymph nodes, if present, was 0.3 Gy (0.0–5.0).

Conclusion

In the Neo-CheckRay trial, the predefined organs at risk dose constraints were feasible and the TDLN were adequately spared.

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将放射治疗与免疫治疗相适应：在随机II期Neo-CheckRay试验中治疗的151例患者的术前免疫调节乳腺癌iSBRT的描述和治疗计划

背景和目的随机多中心II期Neo-CheckRay试验研究了术前免疫调节立体定向放射治疗（iSBRT） 8 Gy x 3分次与化疗联合使用或不使用抗PD-L1杜伐单抗和抗cd73单抗治疗早期高危B型乳腺癌。iSBRT仅用于原发性乳腺癌，利用其免疫调节潜力维持抗肿瘤反应。为了避免放射治疗（RT）引起的免疫抑制，肿瘤引流淋巴结（TDLN）被保留。在这里，我们提出了Neo-CheckRay试验中使用的限制条件，并对所有交付的治疗方案进行了剂量学分析，特别关注对TDLN的剂量。材料与方法皮肤(D0.1 cc <；19.2 Gy)，胸壁(D1cc <；15 Gy)和同侧未受累乳房(V24Gy <；30%)。通过避免光束进入或离开TDLN，减少了对TDLN的剂量。在本研究中，收集了所有在Neo-CheckRay试验中接受治疗的患者的DICOM-RT数据（n = 151），以描述靶体积、危险器官和TDLN的剂量。TDLN体积包括乳腺内淋巴结（IMN）和腋窝I-IV级，包括胸间淋巴结。结果151例患者的总靶体积（GTV）和计划靶体积（PTV）的中位V95%分别为97.4% （90% CI 26.5 ~ 100）和95.5%（56.1 ~ 100）。所有TDLN体积的平均剂量（dMean）为<；1 Gy。dMean最高的是腋窝1级，分别为0.8 Gy （90% CI 0.1 ~ 2.7）和0.6 Gy（0.0 ~ 3.9）。受累淋巴结的dMean（如果存在）为0.3 Gy（0.0-5.0）。结论在Neo-CheckRay试验中，预先设定的危险器官剂量限制是可行的，TDLN得到了充分的保留。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.