Clinical and Translational Radiation Oncology最新文献

Avoiding prostate bed radiation for the PSMA-PET detected nodal recurrence patient post prostatectomy 避免对前列腺切除术后检测到结节复发的 PSMA-PET 患者进行前列腺床放射治疗

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-26 DOI: 10.1016/j.ctro.2024.100896

Benjamin Challis , Andrew Kneebone , Thomas Eade , Lesley Guo , John Atyeo , Chris Brown , George Hruby

Background

Nodal only recurrence post radical prostatectomy (RP) is increasingly recognised in the PSMA scan era. Management is controversial with a curative approach usually incorporating prostate bed and nodal irradiation (PB + NRT) in combination with long-term hormonal therapy. It is unknown whether omitting prostate-bed irradiation (PBRT) is safe in a subgroup of these patients.

Purpose

To document the outcomes for pelvic nodal only salvage radiation therapy (NRT) plus concurrent androgen deprivation therapy (ADT) for patients with PSMA PET documented nodal relapses.

Methods and materials

Eligible patients included PSMA PET documented nodal only relapses post RP who received NRT with or without PBRT at Royal North Shore Hospital (NSCC), Gosford Hospital (CCCC) or Genesis Care (GC) between January 2015 and December 2021. Baseline demographics, surgical pathology, radiation details, ADT use and outcomes were documented.

Results

Forty-six patients were identified, 22 in the PB + NRT cohort and 24 in the NRT cohort. Compared to the PBRT + NRT group, the NRT cohort had lower stage disease (pT2 = 7 (29 %), pT3a = 15 (63 %), pT3b = 1 (4 %) vs pT2 = 0, pT3a = 10 (45 %), pT3b = 12 (55 %)) (p=<0.001) and lower rates of R1 resection (0 % vs 63.6 % (n = 14)) (p < 0.001) respectively. The median follow-up from radiotherapy was 3.9 years.

Four-year biochemical failure- free survival (BFFS) was 64 % in the NRT group vs 67 % in the PB + NRT group. Of the ten (41.6 %) failures in the NRT group, 1 (4 %) was a biochemical failure only, 2 (8 %) recurred in the PB and received further salvage treatment, 4 (17 %) had nodal failure outside the pelvis and 3 (13 %) had distant metastases.

One patient (4 %) in the NRT group recorded late grade ≥2 GU toxicity compared with 7 (32 %) in the PB + NRT. No patients in the NRT group recorded late grade ≥2 GI toxicity compared with 2 (9 %) in the PB + NRT cohort.

Conclusion

This study provides early evidence for the feasibility of PBRT sparing to avoid local toxicity. Most patients in this cohort failed distantly. This data suggests that for selected men PB-avoidance may be considered given informed consent.

背景在 PSMA 扫描时代，根治性前列腺切除术（RP）后仅结节复发的情况越来越多。治疗方法存在争议，通常采用前列腺床和结节照射（PB + NRT）结合长期激素治疗的根治性方法。目的记录仅对盆腔结节进行挽救性放疗（NRT）并同时使用雄激素剥夺疗法（ADT）治疗 PSMA PET 记录的结节复发患者的疗效。方法和材料符合条件的患者包括：2015年1月至2021年12月期间在皇家北岸医院（NSCC）、戈斯福德医院（CCCC）或创世纪护理中心（GC）接受NRT加或不加PBRT治疗的PSMA PET记录的RP后仅结节复发患者。记录了基线人口统计学、手术病理学、放射详情、ADT使用情况和结果。结果确定了46名患者，其中PB + NRT队列22人，NRT队列24人。与 PBRT + NRT 组相比，NRT 组患者的疾病分期较低（pT2 = 7 (29 %), pT3a = 15 (63 %), pT3b = 1 (4 %) vs pT2 = 0, pT3a = 10 (45 %), pT3b = 12 (55 %)）（p=<0.001），R1 切除率较低（0 % vs 63.6 % (n = 14)）（p<0.001）。放疗后的中位随访时间为 3.9 年。NRT 组的四年无生化失败生存率（BFFS）为 64%，PB + NRT 组为 67%。在 NRT 组的 10 例（41.6%）失败病例中，1 例（4%）仅为生化失败，2 例（8%）在 PB 复发并接受了进一步的挽救治疗，4 例（17%）为盆腔外结节失败，3 例（13%）为远处转移。NRT 组中没有患者出现晚期≥2 级消化道毒性，而 PB + NRT 组中有 2 例（9%）。该队列中的大多数患者都在远处失败。这些数据表明，在征得知情同意的情况下，可以考虑对部分男性患者采取避免 PBT 的治疗方法。

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引用次数: 0

Bridging the care gap: patients’ needs and experiences regarding shared decision-making in radiotherapy 缩小护理差距：患者对放射治疗共同决策的需求和经验

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-24 DOI: 10.1016/j.ctro.2024.100897

A.R. van Hienen , C.J.W. Offermann , L.J. Boersma , M.J.G. Jacobs , R.R.R. Fijten

Background and purpose

Shared decision-making (SDM), a collaborative process in which patients and physicians jointly determine further treatment, has been associated with numerous positive effects. However, its implementation into routine clinical practice faces challenges. In radiotherapy (RT) it may have additional challenges, since patients are referred from another oncologist, often “to undergo RT”. The aim of this study is to understand patients’ preferences and experiences regarding SDM at an academic RT clinic, and to identify targets for SDM implementation in RT.

Materials and methods

We adapted an earlier survey sent out by the Dutch Cancer Patient Organizations Federation to fit the RT setting. The survey was distributed via letters and social media to (former) patients who had their intake between 2020 and 2022.

Results

1799 participants completed the survey, of whom 88,3% mentioned to always or often prefer SDM. 23,1% of participants reported experiencing a choice, and 50% of these participants experienced multiple options. The most commons reason for preferring SDM was bodily autonomy (n = 1114) and against SDM was wanting to decide themselves instead (n = 11). Participants with a higher educational attainment were more likely to prefer and experience SDM. Older participants were more likely to experience multiple options.

Conclusion

Our findings reaffirm that most cancer patients prefer SDM, and extend these findings to RT. However, we found a large gap between patients’ desire for SDM, and the SDM experienced in our RT institute. SDM implementation strategies are needed and should focus on overcoming RT-specific and patient-reported barriers and opportunities.

背景和目的共同决策（SDM）是患者和医生共同决定下一步治疗方案的协作过程，具有许多积极的作用。然而，将其应用于常规临床实践却面临着挑战。在放射治疗（RT）中，由于患者是由其他肿瘤医生转诊而来，通常是 "为了接受 RT 治疗"，因此可能会面临更多挑战。本研究旨在了解一家学术性 RT 诊所的患者对 SDM 的偏好和体验，并确定在 RT 中实施 SDM 的目标。我们通过信件和社交媒体向 2020 年至 2022 年期间接受治疗的（前）患者发放了调查问卷。结果 1799 名参与者完成了调查，其中 88.3% 的人表示总是或经常喜欢 SDM。23.1%的参与者表示有过选择，其中50%的参与者有过多种选择。倾向于 SDM 的最常见原因是身体自主权（n = 1114），而反对 SDM 的原因是希望自己做决定（n = 11）。受教育程度较高的参与者更倾向于并经历过 SDM。结论我们的研究结果再次证实，大多数癌症患者倾向于 SDM，并将这些研究结果扩展到 RT。然而，我们发现患者对 SDM 的渴望与我们 RT 机构中的 SDM 之间存在很大差距。需要制定 SDM 实施策略，并应重点克服 RT 特有的和患者报告的障碍和机会。

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引用次数: 0

Tumor sequencing before and after neoadjuvant chemoradiotherapy in locally advanced rectal cancer: Genetic tumor characterization and clinical outcome 局部晚期直肠癌新辅助化疗前后的肿瘤测序：肿瘤基因特征和临床结果

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-22 DOI: 10.1016/j.ctro.2024.100894

Kerstin Clasen , Nadja Ballin , Leon Schütz , Irina Bonzheim , Olga Kelemen , Michael Orth , Cihan Gani , Olaf Rieß , Stephan Ossowski , Maximilian Niyazi , Christopher Schroeder

Background and purpose

Neoadjuvant chemoradiotherapy (NCRT) is a standard treatment option for locally advanced rectal cancer. However, there is still conflicting data about the genetic landscape and potential dynamics during and after NCRT. This study evaluated oncogenic driver mutations before NCRT and investigated corresponding resection samples after treatment.

Materials and methods

In 17 patients the pre-therapeutic biopsy and in ten cases the related resection specimen were investigated by next-generation sequencing using a dedicated cancer panel (708 genes). Oncogenic driver mutations and tumor mutational burden (TMB) were compared pre- and post NCRT to evaluate stability of the genomic landscape. TMB and frequently detected driver mutations were correlated with outcome parameters.

Results

In our corresponding tumor samples before and after NCRT 95.2 % of the oncogenic driver mutations could be found in both specimens whereas one ATM and one RYR1 mutation were not detectable after NCRT. TMB decreased in all patients after neoadjuvant treatment. KRAS ± TP53 mutations and TMB ≥ 5 were associated with impaired outcome.

Conclusion

Most oncogenic driver mutations investigated persisted after neoadjuvant treatment. At the same time, we did not observe ascending TMB after treatment but decline. Thus, NCRT does not seem to induce a relevant number of new driver mutations or mutational burden. Genetic profiling implies the potential to support tumor-informed approaches and outcome estimation in future.

背景和目的新辅助化放疗（NCRT）是局部晚期直肠癌的标准治疗方案。然而，关于 NCRT 期间和之后的基因状况和潜在动态的数据仍然相互矛盾。本研究评估了 NCRT 治疗前的致癌驱动基因突变，并对治疗后的相应切除样本进行了调查。材料和方法使用专用癌症面板（708 个基因）对 17 例患者的治疗前活检和 10 例患者的相关切除标本进行了新一代测序。对NCRT前后的致癌驱动基因突变和肿瘤突变负荷（TMB）进行了比较，以评估基因组格局的稳定性。结果在NCRT前后的相应肿瘤样本中，95.2%的致癌驱动基因突变在两个样本中都能找到，而一个ATM和一个RYR1突变在NCRT后检测不到。新辅助治疗后，所有患者的TMB均有所下降。KRAS±TP53突变和TMB≥5与预后受损有关。同时，我们没有观察到治疗后TMB上升，而是下降。因此，新辅助治疗似乎不会诱发相关数量的新驱动基因突变或突变负荷。基因图谱分析意味着未来有可能支持肿瘤知情方法和预后评估。

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引用次数: 0

Stereotactic ablative radiotherapy for primary kidney cancer – An international patterns of practice survey 原发性肾癌的立体定向消融放疗-国际实践模式调查

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-21 DOI: 10.1016/j.ctro.2024.100891

Katherine Taplin , Raquibul Hannan , Simon S. Lo , Scott C. Morgan , Muhammad Ali , Samantha Sigurdson , Matthias Guckenberger , Anand Swaminath

Purpose

To conduct an international survey of radiation oncologists treating primary renal cell carcinoma (RCC) with SABR to ascertain the general patterns of SABR use, common dose/treatment/follow-up details, and expected outcomes.

Materials and methods

A 51-question survey was created containing the following themes: prevalence and clinical scenarios in which RCC SABR is used, dose-fractionation schedules, treatment delivery details, follow-up/outcome assessments, and implementation barriers. The survey was distributed widely across multiple influential radiation oncology societies and social media, and ran from January to April 2023.

Results

A total of 255 respondents participated, mostly from academic centers within Europe/North America. Of these, 40 % (n = 102) currently offer SABR (50 % having begun within the last 3 years). Common barriers in non-users included lack of referrals by urologists and lack of supportive practice guidelines. Of respondents who do offer SABR, 77 % treat both small (4 cm or less) and large (>4 cm) renal masses. Dose-fractionation strategies varied from 27-52 Gy (3–5 fractions) for multifraction regimens, and 15–34 Gy for single fractions. Apart from treatment for medically inoperable disease, scenarios in which SABR was likely to be offered were for recurrence post surgery/thermal ablation and for oligometastatic kidney lesions. Uncommon scenarios included RCC with renal vein/inferior vena cava thrombosis, and as cytoreductive therapy in metastatic RCC. Expected local control outcomes were generally above 70 %, higher for small versus large renal masses.

Conclusions

SABR is a relatively newer indication for primary RCC, offered by less than 50% of respondents, with both consistent and variable practice patterns observed.

目的对使用SABR治疗原发性肾细胞癌（RCC）的放射肿瘤学家进行国际调查，以确定SABR使用的一般模式、常见剂量/治疗/随访细节和预期结果。材料和方法创建了一项包含51个问题的调查，其中包含以下主题：使用RCC SABR的患病率和临床情况，剂量分级时间表，治疗交付细节，随访/结果评估以及实施障碍。该调查于2023年1月至4月在多个有影响力的放射肿瘤学学会和社交媒体上广泛发布。结果共有255名受访者参与，大部分来自欧洲/北美的学术中心。其中，40% （n = 102）目前提供SABR（50%是在过去3年内开始的）。非使用者的常见障碍包括缺乏泌尿科医生的转诊和缺乏支持性的实践指南。在提供SABR的应答者中，77%治疗小（4厘米或更小）和大（4厘米）肾肿块。剂量-分馏策略从多组分方案的27-52 Gy（3-5组分）到单组分方案的15-34 Gy不等。除了治疗医学上不能手术的疾病外，SABR可能用于手术后复发/热消融和肾少转移病变。不常见的情况包括肾静脉/下腔静脉血栓形成的肾细胞癌，以及转移性肾细胞癌的细胞减少治疗。预期的局部控制结果通常在70%以上，较小的肾肿块比较大的肾肿块更高。结论：ssabr是原发性RCC的一个相对较新的适应症，只有不到50%的受访者提供，并且观察到一致和可变的实践模式。

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引用次数: 0

Fractionated stereotactic radiotherapy of brainstem metastases – Clinical outcome and prognostic factors 脑干转移瘤的分次立体定向放射治疗 - 临床疗效和预后因素

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-21 DOI: 10.1016/j.ctro.2024.100893

Anna Krämer , Laura Hahnemann , Fabian Schunn , Christoph A. Grott , Michael Thomas , Petros Christopoulos , Jonathan W. Lischalk , Juliane Hörner-Rieber , Philipp Hoegen-Saßmannshausen , Tanja Eichkorn , Maximilian Y. Deng , Eva Meixner , Kristin Lang , Angela Paul , Fabian Weykamp , Jürgen Debus , Laila König

Introduction

Brain metastases (BM) are the most common malignancy in the central nervous system (CNS) and observed in approximately 30% of cancer patients. Brainstem metastases (BSM) are challenging because of their location and the associated neurological risks. There are still no general therapeutic recommendations in this setting. Stereotactic radiosurgery (SRS) is one of few possible local therapy options but limited due to the tolerance dose of the brainstem. There is still no standard regarding the optimal dose und fractionation.

Methods

We retrospectively analyzed 65 patients with fractionated stereotactic radiotherapy (fSRT) for 69 BSM. FSRT was delivered at a dose of 30 Gy in six fractions prescribed to the 70 % isodose performed with Cyberknife. Overall survival (OS), local control (LC) and total intracranial brain control (TIBC) were analyzed via Kaplan-Meier method. Cox proportional hazards models were used to identify prognostic factors.

Results

Median follow-up was 27.3 months. One-year TIBC was 35.0 % and one-year LC was 84.1 %. Median OS was 8.9 months. In total, local progression occurred in 7.7 % and in 8.2 % symptomatic radiation-induced contrast enhancements (RICE) were diagnosed. In univariate analysis the Karnofsky performance scale index (KPI) (p = 0,001) was an independent prognostic factor for longer OS. Acute CTCAE grade 3 toxicities occurred in 18.4 %.

Conclusion

FSRT for BSM is as an effective and safe treatment approach with high LC rates and reasonable neurological toxicity despite the poor prognosis in this patient cohort is still very poor. Clinical and imaging follow-up is necessary to identify cerebral progression and adverse toxicity including RICE.

导言脑转移（BM）是中枢神经系统（CNS）中最常见的恶性肿瘤，约有 30% 的癌症患者会出现脑转移。脑干转移瘤（BSM）因其位置和相关的神经风险而具有挑战性。目前还没有针对这种情况的通用治疗建议。立体定向放射手术（SRS）是少数可能的局部治疗方案之一，但由于脑干的耐受剂量而受到限制。方法我们回顾性分析了65例接受分次立体定向放射治疗（fSRT）的69例BSM患者。FSRT的剂量为30 Gy，分6次进行，根据Cyberknife的70%等剂量进行。通过 Kaplan-Meier 法分析了总生存率（OS）、局部控制率（LC）和颅内脑总控制率（TIBC）。结果中位随访时间为27.3个月。一年 TIBC 为 35.0%，一年 LC 为 84.1%。中位 OS 为 8.9 个月。共有7.7%的患者出现局部进展，8.2%的患者被诊断为无症状放射诱导对比度增强（RICE）。在单变量分析中，卡诺夫斯基表现指数（KPI）（p = 0.001）是延长OS的独立预后因素。CTCAE3级急性毒性发生率为18.4%。结论BSM的FSRT是一种有效、安全的治疗方法，具有较高的LC率和合理的神经毒性，尽管该患者群的预后仍然很差。有必要进行临床和影像学随访，以确定脑部进展和包括 RICE 在内的不良毒性。

{"title":"Fractionated stereotactic radiotherapy of brainstem metastases – Clinical outcome and prognostic factors","authors":"Anna Krämer , Laura Hahnemann , Fabian Schunn , Christoph A. Grott , Michael Thomas , Petros Christopoulos , Jonathan W. Lischalk , Juliane Hörner-Rieber , Philipp Hoegen-Saßmannshausen , Tanja Eichkorn , Maximilian Y. Deng , Eva Meixner , Kristin Lang , Angela Paul , Fabian Weykamp , Jürgen Debus , Laila König","doi":"10.1016/j.ctro.2024.100893","DOIUrl":"10.1016/j.ctro.2024.100893","url":null,"abstract":"<div><h3>Introduction</h3><div>Brain metastases (BM) are the most common malignancy in the central nervous system (CNS) and observed in approximately 30% of cancer patients. Brainstem metastases (BSM) are challenging because of their location and the associated neurological risks. There are still no general therapeutic recommendations in this setting. Stereotactic radiosurgery (SRS) is one of few possible local therapy options but limited due to the tolerance dose of the brainstem. There is still no standard regarding the optimal dose und fractionation.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 65 patients with fractionated stereotactic radiotherapy (fSRT) for 69 BSM. FSRT was delivered at a dose of 30 Gy in six fractions prescribed to the 70 % isodose performed with Cyberknife. Overall survival (OS), local control (LC) and total intracranial brain control (TIBC) were analyzed via Kaplan-Meier method. Cox proportional hazards models were used to identify prognostic factors.</div></div><div><h3>Results</h3><div>Median follow-up was 27.3 months. One-year TIBC was 35.0 % and one-year LC was 84.1 %. Median OS was 8.9 months. In total, local progression occurred in 7.7 % and in 8.2 % symptomatic radiation-induced contrast enhancements (RICE) were diagnosed. In univariate analysis the Karnofsky performance scale index (KPI) (p = 0,001) was an independent prognostic factor for longer OS. Acute CTCAE grade 3 toxicities occurred in 18.4 %.</div></div><div><h3>Conclusion</h3><div>FSRT for BSM is as an effective and safe treatment approach with high LC rates and reasonable neurological toxicity despite the poor prognosis in this patient cohort is still very poor. Clinical and imaging follow-up is necessary to identify cerebral progression and adverse toxicity including RICE.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100893"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stereotactic body radiation therapy in primary liver tumor: Local control, outcomes and toxicities 原发性肝肿瘤的立体定向体放射治疗：局部控制、疗效和毒性

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-21 DOI: 10.1016/j.ctro.2024.100892

Ludovic Hernandez , Laure Parent , Victoire Molinier , Bertrand Suc , Françoise Izar , Elisabeth Moyal , Jean-Marie Peron , Philippe Otal , Amélie Lusque , Anouchka Modesto

Objective

Stereotactic body radiation therapy (SBRT) is a therapeutic option in the guidelines for liver primaries after standard strategies like surgery or thermoablation have failed. To assess its efficacy and safety, we reviewed all patients treated by SBRT for a hepatocellular carcinoma (HCC) over a six-year period.

Methods and materials

The study included all patients treated by SBRT for HCC between April 2015 and November 2021 in the University Cancer Institute at Toulouse-Oncopole. All patients were inoperable and not eligible for thermoablation, or after a failure. All tumor sizes were included and cirrhosis up to Child-Pugh B was accepted. Local control (LC), overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Treatment response was assessed using mRECIST criteria. Toxicity was graded using CTCAE (v4.0).

Results

One hundred and nine patients with 118 lesions were treated. Half underwent prior standard treatment. Median dose was 50 Grays in five fractions for most patients. Chronic liver disease represented 90.8 % of cases with a median age of 69 years. Median tumor size was 4.0 cm. Median follow-up was 22.2 months [95 %CI: 15.1–30.4]. LC, OS and PFS at two years were 82.4 % [95 %CI: 71.3; 89.5], 73.2 % [95 %CI: 61.5; 81.8] and 35.8 % [95 %CI: 25.1; 46.7], respectively. Acute toxicities occurred in 20.2 % of patients, including 10.1 % grade 3–4 and 1.8 % grade 5. Late toxicities occurred in 5.5 % of patients including 4.6 % grade 3–4. Grade ≥ 3 toxicity was related to digestive perforation or liver failure.

Conclusion

SBRT provides good LC with an acceptable safety profile. It can be used in several settings such as salvage therapy or in combination with validated treatment. Prospective randomized trials are needed to validate SBRT as a standard alternative.

目的立体定向体放射治疗（SBRT）是手术或热消融等标准策略失败后，肝脏原发癌治疗指南中的一种治疗方案。为评估其疗效和安全性，我们回顾了六年来所有接受 SBRT 治疗的肝细胞癌（HCC）患者。所有患者均无法手术，不符合热消融条件，或治疗失败。所有肿瘤大小均包括在内，肝硬化程度达到Child-Pugh B均可接受。局部控制率（LC）、总生存率（OS）和无进展生存率（PFS）采用卡普兰-梅耶法估算。治疗反应采用 mRECIST 标准进行评估。采用 CTCAE（v4.0）对毒性进行分级。半数患者之前接受过标准治疗。大多数患者的中位剂量为50格雷，分5次进行。慢性肝病患者占 90.8%，中位年龄为 69 岁。肿瘤中位大小为 4.0 厘米。中位随访时间为 22.2 个月[95 %CI：15.1-30.4]。两年的LC、OS和PFS分别为82.4% [95 %CI: 71.3; 89.5]、73.2% [95 %CI: 61.5; 81.8]和35.8% [95 %CI: 25.1; 46.7]。20.2%的患者出现急性毒性反应，其中10.1%为3-4级，1.8%为5级。5.5%的患者出现晚期毒性反应，其中4.6%为3-4级。≥3级毒性与消化道穿孔或肝功能衰竭有关。它可用于多种情况，如挽救治疗或与有效治疗联合使用。需要进行前瞻性随机试验来验证 SBRT 作为标准替代疗法的有效性。

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引用次数: 0

Is postoperative radiotherapy effective in patients with completely resected pathologic stage IIIA(N2) non-small cell lung cancer? High-risk populations should consider it 完全切除的病理分期 IIIA（N2）非小细胞肺癌患者术后放疗有效吗？高危人群应考虑

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-17 DOI: 10.1016/j.ctro.2024.100889

Shu-Xian Zhang , Chen-Chen Zhang , Run-Ping Hou , Xu-Wei Cai , Jun Liu , Wen Yu , Qin Zhang , Jin-Dong Guo , Chang-Lu Wang , Hong-Xuan Li , Zheng-Fei Zhu , Xiao-Long Fu , Wen Feng

Background and purpose

We aimed to assess the benefits of postoperative radiotherapy (PORT) in completely resected patients with pathologic stage IIIA(N2) non-small cell lung cancer (NSCLC) with a high risk of locoregional recurrence (LRR).

Materials and methods

A prospective, randomized trial was conducted starting in July 2016 to explore the optimal timing of PORT in high-LRR-risk patients with completely resected IIIA(N2) NSCLC (NCT02974426). Patients were identified as high-LRR-risk patients via the prognostic index (PI) model and were randomly assigned to PORT-first or PORT-last treatment. To evaluate PORT for high-LRR-risk patients, all patients in this trial constituted the PORT cohort, whereas high-LRR-risk patients without PORT were selected from a retrospective cohort as the non-PORT cohort. Propensity score-matched (PSM) analyses were conducted to compare overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).

Results

Between 2016 and 2022, 132 patients were included in the trial, with a median follow-up of 49.3 months. The 3-year OS rate was 83.2 %, and the 3-year DFS rate was 35.0 %. Among these patients, 122 patients (92 %) received planned PORT. For 132 intention-to-treat patients, PSM analysis with the non-PORT cohort (n = 307) resulted in 130 matched pairs. The results revealed that PORT improved LRFS (3-year LRFS, 77.6 % vs. 57.3 %; p = 0.00014), DFS (3-year DFS, 35.2 % vs. 28.6 %; p = 0.038), and OS (3-year OS, 83.0 % vs. 60.7 %; p = 0.00017), with no difference in DMFS (p = 0.17).

Conclusion

PORT could increase local control, DFS, and OS in high-LRR-risk patients with completely resected IIIA(N2) NSCLC. Future research should utilize multidimensional data to pinpoint more precise subgroups benefiting from PORT, with prospective trials validating these findings.

背景和目的我们旨在评估术后放疗（PORT）对完全切除的病理IIIA（N2）期非小细胞肺癌（NSCLC）患者的益处，这些患者具有较高的局部复发（LRR）风险。材料和方法自2016年7月起开展了一项前瞻性随机试验，以探索完全切除的IIIA（N2）期NSCLC高LRR风险患者PORT的最佳时机（NCT02974426）。患者通过预后指数（PI）模型被确定为高LRR风险患者，并随机分配到PORT-first或PORT-last治疗。为评估高 LRR 风险患者的 PORT 治疗效果，该试验中的所有患者构成 PORT 队列，而未接受 PORT 治疗的高 LRR 风险患者则从回顾性队列中选出，作为非 PORT 队列。进行倾向评分匹配（PSM）分析，比较总生存期（OS）、无病生存期（DFS）、无局部复发生存期（LRFS）和无远处转移生存期（DMFS）。结果2016年至2022年间，共有132名患者纳入试验，中位随访时间为49.3个月。3年OS率为83.2%，3年DFS率为35.0%。其中，122 名患者（92%）接受了计划的 PORT 治疗。对于 132 例意向治疗患者，通过与非 PORT 患者队列（n = 307）进行 PSM 分析，得出 130 对匹配患者。结果显示，PORT 改善了 LRFS（3 年 LRFS，77.6 % vs. 57.3 %；p = 0.00014）、DFS（3 年 DFS，35.2 % vs. 28.6 %；p = 0.038）和 OS（3 年 OS，83.0 % vs. 60.结论PORT可以增加完全切除的IIIA（N2）NSCLC高LRR风险患者的局部控制、DFS和OS。未来的研究应利用多维数据更精确地确定受益于PORT的亚组，并通过前瞻性试验验证这些发现。

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引用次数: 0

Elective pelvic nodal irradiation in elderly men treated with hypofractionated radiotherapy 采用低分量放射治疗的老年男性的选择性盆腔结节照射

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-14 DOI: 10.1016/j.ctro.2024.100888

Rachel M. Glicksman , Andrew Loblaw , Patrick Cheung

引用次数: 0

The prognostic utility of IGF-1 in hepatocellular carcinoma treated with stereotactic body radiotherapy IGF-1 在接受立体定向体放射治疗的肝细胞癌中的预后作用

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-12 DOI: 10.1016/j.ctro.2024.100887

Ahmed Allam Mohamed , Cennet Sahin , Marie-Luise Berres , Oliver Beetz , Martin von Websky , Thomas Vogel , Florian W.R. Vondran , Philipp Bruners , Matthias Imöhl , Katharina Frank , Edith Vogt , Binney Pal Singh , Michael J. Eble

Background

Hepatocellular carcinoma (HCC) poses a significant challenge for patients ineligible for surgical resection or liver transplantation. Local therapies like Stereotactic Body Radiotherapy (SBRT) are crucial for those with liver-limited disease. Insulin-like growth factor-1 (IGF-1) is a potential biomarker for liver function. This study evaluates IGF-1’s prognostic value in predicting survival outcomes in HCC patients undergoing SBRT.

Methods

We analyzed 42 HCC patients treated with SBRT between May 2021 and January 2024, with IGF-1 levels measured within four weeks before SBRT. Patient demographics, tumor metrics, and clinical outcomes were examined. The prognostic significance of IGF-1 was assessed using Cox proportional hazards and ROC curve analysis to determine optimal IGF-1 cutoffs for survival prediction. A nomogram predicting 1-year and 2-year survival was constructed using a multivariate Cox model.

Results

IGF-1 levels were significantly lower in patients with cirrhosis or sarcopenia. Median overall survival (OS) was 24 months, with a significant survival difference favoring patients with IGF-1 levels above 62.4 ng/ml (Hazard Ratio [HR]: 5.9, P = 0.0025). A multivariable Cox model including Child-Turcotte-Pugh (CTP) score, IGF-1, and tumor volume effectively predicted survival. IGF-1 and tumor volume significantly impacted OS (HR: 6.9 and 1.004, p = 0.014 and 0.0022, respectively). Integrating IGF-1 with CTP score improved predictive accuracy (c-index 0.66 to 0.75, p = 0.052).

The nomogram, integrating IGF-1 with the CTP and tumour volume, exhibited robust predictive accuracy with an area under the curve (AUC) of 0.84 for 2-year survival.

Conclusion

IGF-1 is a reliable biomarker for liver function and survival prediction in HCC patients undergoing SBRT. Higher IGF-1 levels indicate better prognosis. The developed nomogram, incorporating IGF-1, enhances clinical decision-making for SBRT management. Further validation in larger cohorts is needed.

背景肝细胞癌（HCC）给不符合手术切除或肝移植条件的患者带来了巨大挑战。立体定向体放射治疗（SBRT）等局部疗法对肝局限性疾病患者至关重要。胰岛素样生长因子-1（IGF-1）是一种潜在的肝功能生物标志物。本研究评估了 IGF-1 在预测接受 SBRT 治疗的 HCC 患者生存结果方面的预后价值。方法我们分析了 2021 年 5 月至 2024 年 1 月间接受 SBRT 治疗的 42 例 HCC 患者，他们在接受 SBRT 治疗前四周内测定了 IGF-1 水平。我们对患者的人口统计学特征、肿瘤指标和临床结果进行了研究。采用Cox比例危险分析和ROC曲线分析评估了IGF-1的预后意义，以确定预测生存期的最佳IGF-1临界值。结果肝硬化或肌肉疏松症患者的IGF-1水平明显较低。中位总生存期（OS）为24个月，IGF-1水平高于62.4纳克/毫升的患者生存期差异明显（危险比[HR]：5.9，P = 0.0025）。包括Child-Turcotte-Pugh（CTP）评分、IGF-1和肿瘤体积在内的多变量Cox模型可有效预测生存率。IGF-1和肿瘤体积对OS有显著影响（HR：分别为6.9和1.004，p = 0.014和0.0022）。将 IGF-1 与 CTP 评分相结合可提高预测准确性（c 指数从 0.66 升至 0.75，p = 0.052）。将 IGF-1 与 CTP 和肿瘤体积相结合的提名图显示了强大的预测准确性，2 年生存率的曲线下面积（AUC）为 0.84。IGF-1水平越高，预后越好。所开发的包含 IGF-1 的提名图能增强 SBRT 管理的临床决策。还需要在更大的队列中进一步验证。

{"title":"The prognostic utility of IGF-1 in hepatocellular carcinoma treated with stereotactic body radiotherapy","authors":"Ahmed Allam Mohamed , Cennet Sahin , Marie-Luise Berres , Oliver Beetz , Martin von Websky , Thomas Vogel , Florian W.R. Vondran , Philipp Bruners , Matthias Imöhl , Katharina Frank , Edith Vogt , Binney Pal Singh , Michael J. Eble","doi":"10.1016/j.ctro.2024.100887","DOIUrl":"10.1016/j.ctro.2024.100887","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) poses a significant challenge for patients ineligible for surgical resection or liver transplantation. Local therapies like Stereotactic Body Radiotherapy (SBRT) are crucial for those with liver-limited disease. Insulin-like growth factor-1 (IGF-1) is a potential biomarker for liver function. This study evaluates IGF-1’s prognostic value in predicting survival outcomes in HCC patients undergoing SBRT.</div></div><div><h3>Methods</h3><div>We analyzed 42 HCC patients treated with SBRT between May 2021 and January 2024, with IGF-1 levels measured within four weeks before SBRT. Patient demographics, tumor metrics, and clinical outcomes were examined. The prognostic significance of IGF-1 was assessed using Cox proportional hazards and ROC curve analysis to determine optimal IGF-1 cutoffs for survival prediction. A nomogram predicting 1-year and 2-year survival was constructed using a multivariate Cox model.</div></div><div><h3>Results</h3><div>IGF-1 levels were significantly lower in patients with cirrhosis or sarcopenia. Median overall survival (OS) was 24 months, with a significant survival difference favoring patients with IGF-1 levels above 62.4 ng/ml (Hazard Ratio [HR]: 5.9, P = 0.0025). A multivariable Cox model including Child-Turcotte-Pugh (CTP) score, IGF-1, and tumor volume effectively predicted survival. IGF-1 and tumor volume significantly impacted OS (HR: 6.9 and 1.004, p = 0.014 and 0.0022, respectively). Integrating IGF-1 with CTP score improved predictive accuracy (c-index 0.66 to 0.75, p = 0.052).</div><div>The nomogram, integrating IGF-1 with the CTP and tumour volume, exhibited robust predictive accuracy with an area under the curve (AUC) of 0.84 for 2-year survival.</div></div><div><h3>Conclusion</h3><div>IGF-1 is a reliable biomarker for liver function and survival prediction in HCC patients undergoing SBRT. Higher IGF-1 levels indicate better prognosis. The developed nomogram, incorporating IGF-1, enhances clinical decision-making for SBRT management. Further validation in larger cohorts is needed.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100887"},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Normal tissue complication probability modeling for late rectal bleeding after conventional or hypofractionated radiotherapy for prostate cancer 前列腺癌常规或低分量放疗后晚期直肠出血的正常组织并发症概率建模

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-11-10 DOI: 10.1016/j.ctro.2024.100886

Christian A.M. Jongen , Ben J.M. Heijmen , Wilco Schillemans , Andras Zolnay , Marnix G. Witte , Floris J. Pos , Ben Vanneste , Ludwig J. Dubois , David van Klaveren , Luca Incrocci , Wilma D. Heemsbergen

Purpose

To develop a single NTCP model for grade ≥ 2 late rectal bleeding (G2 LRB) after conventional or hypofractionated radiotherapy for prostate cancer.

Methods and Materials

The development dataset consisted of prostate cancer patients (n = 656) previously randomized to conventional (39 x 2 Gy) or hypofractionated (19 x 3.4 Gy) external beam radiotherapy with N = 89 G2 LRB cases. Candidate predictors were obtained from literature. We fitted five separate logistic regression models to the data, each with one of the following dose parameters as candidate predictors in biological effective dose (BED), assuming α/β = 3 Gy: Equivalent uniform dose (EUD) with n = 0.1, EUD with n = 0.2, the relative volume receiving ≥ 111.9 Gy in BED (V111.9, the equivalent of physical V70 for a conventional schedule), minimum BED to the hottest 0.1 cm³ (D_0.1cm3) or 2 cm³ (D_2cm3). Previous abdominal surgery was included in every model and fractionation schedule was tested as predictor in each model. A sensitivity analysis was performed by varying the α/β-ratio, n and dose-volume cutoff.

Results

The pre-selected candidate dosimetric predictor and previous abdominal surgery were significantly associated with the outcome in all five models. Fractionation schedule was eliminated by the backward scheme in only the EUD (n = 0.1), D_0.1cm3 and D_2cm3-based models. In internal validation these models showed AUC’s of 0.64, 0.60 & 0.62, respectively. The sensitivity analyses showed that EUD models with n ≥ 0.15 and / or α/β ≥ 4 Gy failed, and EUD models based on α/β = 2 Gy with n = 0.05–0.2 showed good fits as well.

Conclusions

Our trial data set with different fractionation schedules offered the unique possibility to generate unbiased BED-based models. EUD (n = 0.1), D_0.1cm3 and D_2cm3 performed overall best in predicting G2 LRB; with α/β = 2 Gy equally good models were obtained. External validation is required to confirm our results.

目的针对前列腺癌常规或超分割放疗后≥2级晚期直肠出血（G2 LRB）建立一个单一的NTCP模型。方法和材料开发数据集包括先前随机接受常规（39 x 2 Gy）或超分割（19 x 3.4 Gy）外照射放疗的前列腺癌患者（N = 656），其中G2 LRB病例N = 89。候选预测因子来自文献。我们对数据分别拟合了五个逻辑回归模型，假定α/β=3 Gy，每个模型都将下列剂量参数之一作为生物有效剂量（BED）的候选预测因子：等效均匀剂量（EUD），n = 0.1；等效均匀剂量（EUD），n = 0.2；接受 BED ≥ 111.9 Gy 的相对体积（V111.9，相当于常规计划的物理 V70）；最小 BED 至最热 0.1 cm3（D0.1cm3）或 2 cm3（D2cm3）。每个模型都包括曾进行过的腹部手术，每个模型都将分层计划作为预测因子进行测试。通过改变α/β比值、n和剂量-体积临界值进行了敏感性分析。只有在基于 EUD（n = 0.1）、D0.1cm3 和 D2cm3 的模型中，分次计划被后向方案剔除。在内部验证中，这些模型的 AUC 值分别为 0.64、0.60 & 和 0.62。敏感性分析表明，n ≥ 0.15 和/或 α/β ≥ 4 Gy 的 EUD 模型失败，而基于 α/β = 2 Gy 和 n = 0.05-0.2 的 EUD 模型也显示出良好的拟合效果。EUD（n = 0.1）、D0.1cm3 和 D2cm3 在预测 G2 LRB 方面总体表现最佳；在 α/β = 2 Gy 时，获得了同样好的模型。要确认我们的结果，还需要外部验证。

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引用次数: 0