Clinical and Translational Radiation Oncology最新文献_第10页

Evaluation of 68Ga-FAPI PET/CT and 18F-FDG PET/CT for the diagnosis of recurrent colorectal cancers 对 68Ga-FAPI PET/CT 和 18F-FDG PET/CT 诊断复发性结直肠癌的评估

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-28 DOI: 10.1016/j.ctro.2024.100848

Yue Xi , Yuyun Sun , Bingxin Gu , Linjie Bian , Shaoli Song

Objective

The present study aimed to compare the diagnostic value of gallium-68-labeled fibroblast activation protein inhibitor positron emission tomography/computed tomography (⁶⁸Ga-FAPI PET/CT) and fluorine-18-labeled fluorodeoxyglucose PET/CT (¹⁸F-FDG PET/CT) for detecting recurrent colorectal cancers (CRCs).

Materials and Methods

Fifty-six patients (age: 18–80 years, 31 men and 25 women) with suspected recurrent CRC were enrolled and underwent ¹⁸F-FDG PET/CT and ⁶⁸Ga-FAPI PET/CT sequentially within 1 week. The maximum standard uptake value (SUVmax), tumor-to-background ratio (TBR), and diagnostic accuracy were estimated and compared between the two modalities by using Student’s t-test. The Wilcoxon signed-rank test was used to compare peritoneal carcinoma index (PCI) scores between the two imaging modalities.

Results

⁶⁸Ga-FAPI PET/CT showed higher sensitivity for detecting recurrence (93 % vs. 79 %); lymph node metastasis (89 % vs. 78 %), particularly peritoneal lymph node metastasis (92 % vs. 63 %); and metastatic implantation on the intestinal wall (100 % vs. 25 %) compared to ¹⁸F-FDG PET/CT. However, ⁶⁸Ga-FAPI PET/CT showed lower sensitivity for detecting bone metastasis (67 % vs. 100 %). The mean SUVmax values of peritoneal metastases and metastatic implantation on the intestinal wall were 4.28 ± 2.70 and 7.58 ± 1.66 for ¹⁸F-FDG PET/CT and 5.66 ± 1.97 and 6.70 ± 0.25 for ⁶⁸Ga-FAPI PET/CT, respectively. Furthermore, ⁶⁸Ga-FAPI PET/CT showed significantly higher TBR for peritoneal metastatic lesions (4.22 ± 1.47 vs. 1.41 ± 0.89, p < 0.0001) and metastatic implantation on the intestinal wall (5.63 ± 1.24 vs. 2.20 ± 0.5, p = 0.02) compared to ¹⁸F-FDG PET/CT. For the same patient, ⁶⁸Ga-FAPI PET/CT yielded a more accurate PCI score and a greater area under the curve value for the receiver operating characteristic curve (p < 0.01) than ¹⁸F-FDG PET/CT.

Conclusion

⁶⁸Ga-FAPI PET/CT was superior to ¹⁸F-FDG PET/CT for detecting recurrence and peritoneal metastases. Hence, we propose the combination of these two modalities for better clinical diagnosis and management of patients with CRC.

目的本研究旨在比较镓-68标记的成纤维细胞活化蛋白抑制剂正电子发射断层扫描/计算机断层扫描（68Ga-FAPI PET/CT）和氟-18标记的氟脱氧葡萄糖 PET/CT（18F-FDG PET/CT）对检测复发性结直肠癌（CRC）的诊断价值。材料与方法56例疑似复发性 CRC 患者（年龄：18-80 岁，男性 31 例，女性 25 例）在 1 周内依次接受了 18F-FDG PET/CT 和 68Ga-FAPI PET/CT。采用学生 t 检验法估算并比较了两种模式的最大标准摄取值（SUVmax）、肿瘤与背景比（TBR）和诊断准确性。结果与 18F-FDG PET/CT 相比，68Ga-FAPI PET/CT 在检测复发（93% 对 79%）、淋巴结转移（89% 对 78%），尤其是腹膜淋巴结转移（92% 对 63%）和肠壁转移种植（100% 对 25%）方面显示出更高的灵敏度。然而，68Ga-FAPI PET/CT 检测骨转移的灵敏度较低（67% 对 100%）。腹膜转移和肠壁转移种植的平均SUVmax值在18F-FDG PET/CT中分别为（4.28 ± 2.70）和（7.58 ± 1.66），在68Ga-FAPI PET/CT中分别为（5.66 ± 1.97）和（6.70 ± 0.25）。此外，与18F-FDG PET/CT相比，68Ga-FAPI PET/CT显示腹膜转移病灶（4.22 ± 1.47 vs. 1.41 ± 0.89，p < 0.0001）和肠壁转移种植（5.63 ± 1.24 vs. 2.20 ± 0.5，p = 0.02）的TBR明显更高。结论68Ga-FAPI PET/CT 在检测复发和腹膜转移方面优于 18F-FDG PET/CT。因此，我们建议将这两种方法结合起来，以便更好地对 CRC 患者进行临床诊断和治疗。

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引用次数: 0

PTCOG international survey of practice patterns and trends in utilization of proton therapy for breast cancer PTCOG 对利用质子疗法治疗乳腺癌的实践模式和趋势的国际调查

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-27 DOI: 10.1016/j.ctro.2024.100847

J. Isabelle Choi , Camille Hardy-Abeloos , Alicia Lozano , Alexandra Hanlon , Carlos Vargas , John H. Maduro , Julie Bradley , Birgitte Offersen , Bruce Haffty , Mark Pankuch , Richard Amos , Nalee Kim , Shannon M. MacDonald , Youlia Kirova , Robert W. Mutter

Purpose/objectives

The indications, techniques, and extent to which proton beam therapy (PBT) is employed for breast cancer are unknown. We seek to determine PBT utilization for breast cancer.

Materials/methods

The Particle Therapy Co-Operative Group (PTCOG) Breast Subcommittee developed an IRB-approved 29-question survey and sent it to breast cancer radiation oncologists at all active PBT centers worldwide in June 2023. Descriptive statistics were used to summarize responses, and comparisons by continent were performed using Fisher’s exact tests.

Results

Of 79 surveys distributed, 28 recipients submitted responses (35 % response rate) representing fifteen U.S., 8 European, and 5 Asian centers (continent response rate 50 %, 38 %, and 18 %, respectively). Overall, 93 % reported treating breast cancer patients with PBT; 13 (50 %) have treated ≥100 breast cancer patients at their center since opening. Most (89 %) have pencil beam scanning technology. Nearly half (46 %) use moderate hypofractionation (15–20 fractions) for regional nodal irradiation and 42 % conventional fractionation (25–30 fractions). More European centers prefer hypofractionation (88 %) vs. Asian (50 %) and U.S. (21 %) centers (p = 0.003). Common patient selection methods were practitioner determination/patient preference (n = 16) and comparative plan evaluation (n = 15). U.S. centers reported the most experience with breast PBT, with 71 % having treated ≥100 breast cancer patients vs. 38 % in Europe and none in Asia (p = 0.001). Of respondent centers, 39 % enrolled ≥75 % of breast PBT patients on a research study.

Conclusion

Utilization, patient selection methods, and dose-fractionation approaches for breast cancer PBT vary worldwide. These survey data serve as a benchmark from which successor surveys can provide insight on practice pattern evolution.

目的/目标质子束疗法（PBT）用于乳腺癌的适应症、技术和程度尚不清楚。材料/方法粒子治疗合作组织（PTCOG）乳腺小组委员会制定了一份经 IRB 批准的 29 个问题的调查问卷，并于 2023 年 6 月将其发送给全球所有活跃的 PBT 中心的乳腺癌放射肿瘤学家。结果在发放的 79 份调查问卷中，有 28 位接受者提交了回复（回复率为 35%），分别代表 15 个美国中心、8 个欧洲中心和 5 个亚洲中心（各大洲回复率分别为 50%、38% 和 18%）。总体而言，93%的中心报告使用铅笔束治疗乳腺癌患者；13 个中心（50%）自开业以来已治疗了≥100 名乳腺癌患者。大多数中心（89%）采用铅笔束扫描技术。近一半（46%）的中心采用中度低分次法（15-20 次）进行区域结节照射，42%的中心采用常规分次法（25-30 次）。与亚洲（50%）和美国（21%）的中心相比，更多的欧洲中心（88%）更倾向于采用低剂量照射（p = 0.003）。常见的患者选择方法是医生决定/患者偏好（16 人）和比较计划评估（15 人）。美国中心报告的乳腺 PBT 经验最多，71% 的中心治疗过≥100 名乳腺癌患者，欧洲为 38%，亚洲为零（p = 0.001）。在受访中心中，39%的乳腺癌 PBT 患者参加了≥75%的研究。这些调查数据可作为一个基准，通过后续调查可以深入了解实践模式的演变。

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引用次数: 0

Moderately hypofractionated prostate-only versus whole-pelvis radiotherapy for high-risk prostate cancer: A retrospective real-world single-center cohort study 高风险前列腺癌的适度低分次前列腺单纯放疗与全骨盆放疗对比：回顾性真实世界单中心队列研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-21 DOI: 10.1016/j.ctro.2024.100846

Jenny Kahlmeter Brandell , Antonis Valachis , Henrik Ugge , Daniel Smith , Bengt Johansson

Background

The benefit of prophylactic whole pelvis radiation therapy (WPRT) in prostate cancer has been debated for decades, with evidence based mainly on conventional fractionation targeting pelvic nodes.

Aim

This retrospective cohort study aimed to explore the impact of adding moderately hypofractionated pelvic radiotherapy to prostate-only irradiation (PORT) on prognosis, toxicity, and quality of life in real-world settings.

Materials and methods

Patients with high-risk and conventionally staged prostate cancer (cT1-3N0M0) treated with moderately hypofractionated WPRT or PORT, using external beam radiotherapy alone or combined with high-dose-rate brachytherapy, at Örebro University Hospital between 2008 and 2021 were identified. Biochemical failure-free survival (BFFS), metastasis-free survival (MFS), prostate cancer-specific survival (PCSS), and overall survival (OS) were compared using Kaplan-Meier method and Cox proportional hazards. Toxicity and quality of life measures were also analysed.

Results

Among 516 patients (227 PORT, 289 WPRT), 5-year BFFS rates were 77 % (PORT) and 74 % (WPRT), adjusted HR=1.50 (95 % CI=0.88–2.55). No significant differences were found in MFS, PCSS, or OS in main analyses. WPRT was associated with a higher risk of acute grade ≥ 2 and 3 genitourinary toxicities whereas no differences in late toxicities or quality of life between PORT and WPRT were observed.

Conclusion

We found no significant differences in oncological outcomes or quality of life when comparing moderately hypofractionated PORT to WPRT. Some differences in toxicity patterns were observed. Despite caveats related to study design, our findings support the need for further research on WPRT’s impact on treatment-related and patient-reported outcomes.

这项回顾性队列研究旨在探讨在单纯前列腺照射（PORT）的基础上增加适度低分次盆腔放疗对预后、毒性和生活质量的影响。材料与方法2008年至2021年期间，厄勒布鲁大学医院对高风险、常规分期的前列腺癌患者（cT1-3N0M0）进行了鉴定，这些患者接受了适度低分次的WPRT或PORT治疗，并单独使用或联合使用了高剂量率近距离放射治疗。采用卡普兰-梅耶法（Kaplan-Meier method）和考克斯比例危险法（Cox proportional hazards）比较了无生化失败生存期（BFFS）、无转移生存期（MFS）、前列腺癌特异性生存期（PCSS）和总生存期（OS）。结果516例患者（227例PORT，289例WPRT）中，5年BFFS率分别为77%（PORT）和74%（WPRT），调整后HR=1.50（95% CI=0.88-2.55）。在主要分析中，MFS、PCSS 或 OS 均无明显差异。WPRT与急性≥2级和3级泌尿生殖系统毒性较高的风险相关，而PORT和WPRT在晚期毒性或生活质量方面没有发现差异。我们观察到毒性模式存在一些差异。尽管存在研究设计方面的注意事项，但我们的研究结果支持进一步研究 WPRT 对治疗相关结果和患者报告结果的影响的必要性。

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引用次数: 0

In response to Chuong et al. 作为对 Chuong 等人的回应

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-20 DOI: 10.1016/j.ctro.2024.100839

Guus Grimbergen, Martijn P.W. Intven, Gert J. Meijer

引用次数: 0

Cosmetic outcome in patients with early stage breast cancer after accelerated partial breast irradiation using intraoperative or external beam radiotherapy 早期乳腺癌患者接受术中或体外放射治疗加速乳房部分照射后的美容效果

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-18 DOI: 10.1016/j.ctro.2024.100844

Jetske L.B. Gunster , Daphne H.M. Jacobs , Mirjam E. Mast , Antoinette Verbeek-de Kanter , Ursula J. Fisscher , Anna L. Petoukhova , Gabrielle Speijer , Marieke Straver , Jos Merkus , Corrie A.M. Marijnen , Astrid N. Scholten

Purpose

The aim of this study is to evaluate the cosmetic outcome among early stage breast cancer patients who underwent accelerated partial breast irradiation with either intraoperative electron radiotherapy (IOERT) or photon external beam radiotherapy (EB-APBI).

Materials and methods

This prospective multicenter cohort study enrolled women aged 60 years and older who underwent breast-conserving therapy. Following breast-conserving surgery, patients were treated with either IOERT or EB-APBI. Cosmetic outcome was evaluated over a 5 year follow-up period using both subjective scoring by patients and physicians, as well as objective scoring using BCCT.core software. Differences between treatments over time were described with mixed model analyses.

Results

A total of 241 patients treated with IOERT and 164 patients treated with EB-APBI were eligible for cosmetic analysis. In both groups, the majority of patients reported a satisfactory cosmetic outcome, with no significant differences between treatments over time (p = 0.538). This was also observed by physicians, with satisfactory outcomes ranging from 94 % (170/181) to 91 % (69/76) over time in the IOERT group and from 93 % (124/133) to 95 % (54/57) in the EB-APBI group (p = 0.579). BCCT.core analysis returned satisfactory cosmetic outcomes in 75 % (54/72) of the IOERT patients at 3 years and in 77 % (20/26) at 5 years. These numbers were 86 % (72/84) and 90 % (36/40) for the EB-APBI patients, with no significant differences between treatment over time (p = 0.834).

Conclusion

Regarding the cosmetic results, IOERT and EB-APBI yield comparable and satisfactory outcomes over 5 years follow-up in the treatment of early stage breast cancer.

本研究旨在评估早期乳腺癌患者接受术中电子放疗（IOERT）或光子外照射放疗（EB-APBI）加速部分乳腺照射后的美容效果。保乳手术后，患者接受 IOERT 或 EB-APBI 治疗。通过患者和医生的主观评分以及 BCCT.core 软件的客观评分，对随访 5 年的美容效果进行了评估。结果共有 241 名接受 IOERT 治疗的患者和 164 名接受 EB-APBI 治疗的患者符合美容分析的条件。在这两组患者中，大多数患者的美容效果令人满意，不同治疗方法在不同时期的美容效果无显著差异（p = 0.538）。医生也观察到了这一点，随着时间的推移，IOERT 组的满意度从 94% (170/181) 降至 91% (69/76)，EB-APBI 组的满意度从 93% (124/133) 降至 95% (54/57)（p = 0.579）。BCT.core分析显示，75%的IOERT患者（54/72）在3年后获得了满意的美容效果，77%的患者（20/26）在5年后获得了满意的美容效果。结论就美容效果而言，IOERT 和 EB-APBI 在治疗早期乳腺癌的 5 年随访中取得了相似且令人满意的结果。

{"title":"Cosmetic outcome in patients with early stage breast cancer after accelerated partial breast irradiation using intraoperative or external beam radiotherapy","authors":"Jetske L.B. Gunster , Daphne H.M. Jacobs , Mirjam E. Mast , Antoinette Verbeek-de Kanter , Ursula J. Fisscher , Anna L. Petoukhova , Gabrielle Speijer , Marieke Straver , Jos Merkus , Corrie A.M. Marijnen , Astrid N. Scholten","doi":"10.1016/j.ctro.2024.100844","DOIUrl":"10.1016/j.ctro.2024.100844","url":null,"abstract":"<div><h3>Purpose</h3><p>The aim of this study is to evaluate the cosmetic outcome among early stage breast cancer patients who underwent accelerated partial breast irradiation with either intraoperative electron radiotherapy (IOERT) or photon external beam radiotherapy (EB-APBI).</p></div><div><h3>Materials and methods</h3><p>This prospective multicenter cohort study enrolled women aged 60 years and older who underwent breast-conserving therapy. Following breast-conserving surgery, patients were treated with either IOERT or EB-APBI. Cosmetic outcome was evaluated over a 5 year follow-up period using both subjective scoring by patients and physicians, as well as objective scoring using BCCT.core software. Differences between treatments over time were described with mixed model analyses.</p></div><div><h3>Results</h3><p>A total of 241 patients treated with IOERT and 164 patients treated with EB-APBI were eligible for cosmetic analysis. In both groups, the majority of patients reported a satisfactory cosmetic outcome, with no significant differences between treatments over time (p = 0.538). This was also observed by physicians, with satisfactory outcomes ranging from 94 % (170/181) to 91 % (69/76) over time in the IOERT group and from 93 % (124/133) to 95 % (54/57) in the EB-APBI group (p = 0.579). BCCT.core analysis returned satisfactory cosmetic outcomes in 75 % (54/72) of the IOERT patients at 3 years and in 77 % (20/26) at 5 years. These numbers were 86 % (72/84) and 90 % (36/40) for the EB-APBI patients, with no significant differences between treatment over time (p = 0.834).</p></div><div><h3>Conclusion</h3><p>Regarding the cosmetic results, IOERT and EB-APBI yield comparable and satisfactory outcomes over 5 years follow-up in the treatment of early stage breast cancer.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100844"},"PeriodicalIF":2.7,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001216/pdfft?md5=0599a5a0bebf25a2faae7aa3971524d8&pid=1-s2.0-S2405630824001216-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169497","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

Acute toxicity patterns and their management after moderate and ultra- hypofractionated radiotherapy for prostate cancer: A prospective cohort study 前列腺癌中度和超低分次放射治疗后的急性毒性模式及其处理：前瞻性队列研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-17 DOI: 10.1016/j.ctro.2024.100842

F. Sinzabakira , L. Incrocci , K. de Vries , M.E.M.C. Christianen , M. Franckena , F.E. Froklage , H. Westerveld , W.D. Heemsbergen

Objective

Hypofractionation has become the new clinical standard for prostate cancer. We investigated the management of acute toxicity in patients treated with moderate hypofractionation (MHF) or Ultrahypofractionation (UHF).

Methods

In a prospective cohort setting, patients (N=316) received either MHF (20 fractions of 3/3.1 Gy, 5 fractions per week, N=156) or UHF (7 fractions of 6.1 Gy, 3 fractions per week, N=160) to the prostate +/- (base of the) seminal vesicles between 2019 and 2023. UHF was not indicated in case of significant lower urinary tract symptoms (LUTS) or T3b disease. Patient-reported outcomes (PRO) were online distributed at baseline, end of treatment (aiming at last fraction +/- 3 days), 3 months. Acute toxicity rates, management, and associations with baseline factors were analysed using Chi-square test and logistic regression. CTCAE scores (version 5) were calculated.

Results

Treatment for acute urinary complaints was prescribed in 46 % (MHF) and 29 % (UHF). Taking into consideration baseline LUTS, MHF and UHF showed similar rates of PROs and management. Medication for acute gastrointestinal (GI) symptoms was prescribed for 21.1 % (MHF) and 14.1 % (UHF) with more loperamide for diarrhea in MHF (9.0 %) vs UHF (1.9 %, p = 0.005). Grade ≥ 2 (MHF / UHF) was scored in 40 % / 28 % for GI (p = 0.03) and 50 % / 31 % for GU (p < 0.01). PROs for GI reported after last fraction of UHF were significantly worse compared to before last fraction.

Conclusion

UHF was safe with respect to acute toxicity risks in the selected population. MHF is associated with risks of significant diarrhea which needs further investigation. Furthermore, optimal registration of acute toxicity for UHF requires measurements up to 1–2 weeks after the last fraction.

目的低剂量治疗已成为治疗前列腺癌的新临床标准。方法在一项前瞻性队列研究中，患者（N=316）在2019年至2023年期间接受了前列腺+/-（精囊底部）MHF（20次，每次3/3.1 Gy，每周5次，N=156）或UHF（7次，每次6.1 Gy，每周3次，N=160）治疗。如果出现明显的下尿路症状（LUTS）或T3b疾病，则不适用超高频治疗。患者报告结果（PRO）在基线、治疗结束（以最后一次分次+/- 3天为目标）和3个月时在线发布。采用卡方检验和逻辑回归分析急性毒性发生率、处理情况以及与基线因素的关系。结果46%（MHF）和29%（UHF）的患者因急性尿路感染而接受治疗。考虑到基线 LUTS，MHF 和 UHF 的 PROs 和管理率相似。21.1%（MHF）和14.1%（UHF）的患者因急性胃肠道（GI）症状而用药，其中MHF（9.0%）和UHF（1.9%，p = 0.005）患者因腹泻而服用的洛哌丁胺更多。消化道≥2级（MHF/UHF）的比例分别为40%/28%（p = 0.03）和50%/31%（p <0.01）。结论在选定人群中，超高频治疗在急性毒性风险方面是安全的。MHF与严重腹泻的风险有关，需要进一步研究。此外，超高频治疗急性毒性的最佳登记需要在最后一部分治疗后 1-2 周内进行测量。

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引用次数: 0

Elective pelvic nodal irradiation in the setting of ultrahypofractionated versus moderately hypofractionated and conventionally fractionated radiotherapy for prostate cancer: Outcomes from 3 prospective clinical trials 前列腺癌超低分次放疗与中度低分次和常规分次放疗的选择性盆腔结节照射：3项前瞻性临床试验的结果

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-16 DOI: 10.1016/j.ctro.2024.100843

Rachel M. Glicksman , Andrew Loblaw , Gerard Morton , Danny Vesprini , Ewa Szumacher , Hans T. Chung , William Chu , Stanley K. Liu , Chia-Lin Tseng , Melanie Davidson , Andrea Deabreu , Alexandre Mamedov , Liying Zhang , Patrick Cheung

Background and purpose

Data is needed regarding the use of ultrahypofractionated radiotherapy (UHRT) in the context of prostate cancer elective nodal irradiation (ENI), and how this compares to conventionally fractionated radiotherapy (CFRT) ENI with CFRT or moderately hypofractionated radiotherapy (MHRT) to the prostate.

Materials and methods

Between 2011–2019, 3 prospective clinical trials of unfavourable intermediate or high-risk prostate cancer receiving CFRT (78 Gy in 39 fractions to prostate; 46 Gy in 23 fractions to pelvis), MHRT (68 Gy in 25 fractions to prostate; 48 Gy to pelvis), or UHRT (35–40 Gy in 5 fractions to prostate +/- boost to 50 Gy to intraprostatic lesion; 25 Gy to pelvis) were conducted. Primary endpoints included biochemical failure (Phoenix definition), and acute and late toxicities (CTCAE v3.0/4.0).

Results

Two-hundred-forty patients were enrolled: 90 (37.5 %) had CFRT, 90 (37.5 %) MHRT, and 60 (25 %) UHRT. Median follow-up time was 71.6 months (IQR 53.6–94.8). Cumulative incidence of biochemical failure (95 % CI) at 5-years was 11.7 % (3.5–19.8 %) for CFRT, 6.5 % (0.8–12.2 %) MHRT, and 1.8 % (0–5.2 %) UHRT, which was not significantly different between treatments (p = 0.38). Acute grade ≥ 2 genitourinary toxicity was significantly worse for UHRT versus CFRT and MHRT, but not for acute grade ≥ 3 genitourinary, or acute gastrointestinal toxicities. UHRT was not associated with worse late toxicities.

Conclusion

ENI with UHRT resulted in similar oncologic outcomes to CFRT ENI with prostate CFRT/MHRT, with worse acute grade ≥ 2 GU toxicity but no differences in late toxicity. Randomized phase 3 trials of ENI using UHRT techniques are much anticipated.

背景和目的前列腺癌选择性结节照射（ENI）中超低分次放疗（UHRT）的使用情况，以及与常规分次放疗（CFRT）、前列腺CFRT或中度低分次放疗（MHRT）ENI的比较，需要相关数据。材料与方法在2011-2019年间，对接受CFRT（前列腺78 Gy，39次分割；骨盆46 Gy，23次分割）、MHRT（前列腺68 Gy，25次分割；骨盆48 Gy）或UHRT（前列腺35-40 Gy，5次分割+/-前列腺内病灶50 Gy增强；骨盆25 Gy）治疗的不利的中危或高危前列腺癌患者进行了3项前瞻性临床试验。主要终点包括生化治疗失败（凤凰定义）、急性和晚期毒性反应（CTCAE v3.0/4.0）：90名患者（37.5%）接受了CFRT治疗，90名患者（37.5%）接受了MHRT治疗，60名患者（25%）接受了UHRT治疗。中位随访时间为 71.6 个月（IQR 53.6-94.8）。5年后生化治疗失败的累积发生率（95 % CI）为：CFRT 11.7 %（3.5-19.8 %），MHRT 6.5 %（0.8-12.2 %），UHRT 1.8 %（0-5.2 %），不同治疗方法间无显著差异（P = 0.38）。UHRT与CFRT和MHRT相比，急性≥2级泌尿生殖系统毒性明显更严重，但急性≥3级泌尿生殖系统毒性或急性胃肠道毒性并不明显。结论前列腺癌ENI与前列腺癌CFRT/MHRT相比，前列腺癌ENI与前列腺癌UHRT的肿瘤学结果相似，急性≥2级泌尿生殖系统毒性较差，但晚期毒性无差异。采用 UHRT 技术进行 ENI 的 3 期随机试验令人期待。

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引用次数: 0

Selection for proton radiotherapy of grade 1–3 glioma patients 选择 1-3 级胶质瘤患者接受质子放疗

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-13 DOI: 10.1016/j.ctro.2024.100836

C.S. Byskov , A. Muhic , R.H. Dahlrot , C.A. Haslund , T.L. Guldberg , M. Høyer , P.W. Nyström , L. Dysager , S. Hansen , L. Haldbo-Classen , A.K. Trip , Y. Lassen-Ramshad , B. Weber , S. Lukacova , C.R. Hansen , J.F. Kallehauge

Background

For adult patients with grade 1–3 gliomas, identifying patients with an indication for proton therapy (PT) can be challenging due to sparse evidence supporting its benefits. In this study, we aimed to ensure national consensus and develop a decision support tool to aid clinicians in identifying patients with grade 1–3 gliomas eligible for PT.

Methods

Sixty-one historic patients referred for postoperative radiotherapy for glioma grade 1–3 were included in this study and had new photon therapy and PT plans calculated. These plans along with clinical parameters were presented to neurooncologists with experience in treating brain tumours. The patients were presented at three workshops (WSs), where each neurooncologist individually had to choose between photon and proton therapy. Important parameters were selected using cross validation. Multivariable logistic regression was used to predict the neurooncologists’ treatment modality choice.

Results

At the three WSs 23, 24 and 19 randomly selected patients were presented. Seventy-five percent of the neurooncologists agreed for 14 patients (61%), 16 patients (67%) and 15 patients (79%) at WS1, WS2 and WS3. Age at radiotherapy and difference in mean dose (ΔDmean) to the residual brain were significant predictors of the choice of treatment modality, p < 0.001. Model coefficients were: β_age = 0.07 per year (95% confidence interval [CI] = 0.05–0.09), and β_Δdose = -0.27 per Gy (95% CI=-0.36--0.18).

Conclusion

Higher degree of agreement was reached. Age and ΔDmean to the residual brain significantly predicted the choice of radiation modality. We have developed a decision support model which may aid in the selection of patients with glioma grade 1–3 to PT.

背景对于患有 1-3 级胶质瘤的成人患者来说，由于支持质子治疗（PT）获益的证据稀少，确定患者是否符合质子治疗的适应症可能具有挑战性。在本研究中，我们旨在确保达成全国共识并开发一种决策支持工具，以帮助临床医生确定符合质子治疗条件的 1-3 级胶质瘤患者。方法本研究纳入了 61 名转诊接受术后放疗的 1-3 级胶质瘤患者，并计算了新的光子治疗和质子治疗计划。这些计划和临床参数已提交给具有脑肿瘤治疗经验的神经肿瘤专家。患者在三个研讨会（WSs）上接受治疗，每个神经肿瘤学家都必须在光子治疗和质子治疗之间做出选择。重要参数通过交叉验证选出。结果在三次研讨会上，分别随机抽取了 23、24 和 19 名患者。在 WS1、WS2 和 WS3 中，75% 的神经肿瘤学家同意 14 名患者（61%）、16 名患者（67%）和 15 名患者（79%）的治疗方案。放疗时的年龄和残脑平均剂量（ΔDmean）的差异对治疗方式的选择有显著的预测作用（p < 0.001）。模型系数为β年龄=0.07/年（95% 置信区间 [CI] =0.05-0.09），βΔ剂量=-0.27/Gy（95% CI=-0.36--0.18）。年龄和残脑ΔD均值可显著预测放射方式的选择。我们建立了一个决策支持模型，可帮助选择 1-3 级胶质瘤患者进行 PT 治疗。

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引用次数: 0

Impact of discrimination on training and career of radiation oncologists in France 歧视对法国放射肿瘤学家培训和职业生涯的影响

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-13 DOI: 10.1016/j.ctro.2024.100840

Sabrina Aziez , Cécile Evin , David Azria , Erik Montpetit , Youssef Gannam , Yasmine El Houat , Amandine Ruffier , Véronique Vendrely , Anne Laprie , Florence Huguet

Purpose

In France, radiation oncologists are predominantly men with only 44 % of women. Many studies have highlighted gender disparities in medicine. The main objective of our study was to assess the impact of discriminations on radiation oncologists’ career.

Materials and methods

An anonymous online questionnaire, adapted from the one used by the ESMO W4O group, was sent to all radiation oncologists in France between March and June 2022. It included questions related to professional experience, gender, socio-ethnicity, sexual orientation, and personal life.

Results

Among the 999 radiation oncologists and 168 residents in France, 225 questionnaires were collected (19.2 %). Among the respondents, 60 % were women and 25 % were residents. The mean age was 39.2 years (range: 25–78). The career satisfaction rate was 92 %, with no gender difference. Gender was considered to have a negative impact on the career development by 65 % of women. Social origin was an obstacle to career development for 37 % of all the respondents, and ethnic origin for 25 %. Sixty two percent of women reported having experienced inappropriate behavior or sexual harassment in their workplace, 38 % felt that having a child had “extremely“ or ”very“ much impacted their career versus 8.5 % of men (p < 0.001). The most popular proposals for improvement were the creation of a network of women radiation oncologists with specific educational programs and the addition of quotas in institutions and key positions.

Conclusions

This study is the first one assessing the various type of discrimination experienced by radiation oncologists in France. We make a few proposals for improvement of training and working conditions, regardless of the origin and gender.

目的在法国，放射肿瘤学家以男性为主，女性仅占 44%。许多研究都强调了医学领域的性别差异。材料与方法2022年3月至6月期间，我们向法国所有放射肿瘤学家发送了一份匿名在线问卷，该问卷改编自ESMO W4O小组使用的问卷。结果在法国的999名放射肿瘤学家和168名住院医师中，共收集到225份问卷（19.2%）。受访者中 60% 为女性，25% 为居民。平均年龄为 39.2 岁（范围：25-78 岁）。职业满意度为 92%，无性别差异。65%的女性认为性别对职业发展有负面影响。37%的受访者认为社会出身是职业发展的障碍，25%的受访者认为种族出身是职业发展的障碍。62% 的女性表示在工作场所遭遇过不当行为或性骚扰，38% 的女性认为生孩子对其职业生涯产生了 "极其 "或 "非常 "大的影响，而男性的这一比例仅为 8.5%（p <0.001）。最受欢迎的改进建议是建立一个放射肿瘤女医生网络，并提供专门的教育计划，以及在机构和关键岗位中增加配额。我们提出了一些改善培训和工作条件的建议，无论其出身和性别如何。

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引用次数: 0

Clinical management of oligometastatic cancer: Applying multidisciplinary tumor board recommendations in practice 寡转移性癌症的临床管理：在实践中应用多学科肿瘤委员会的建议

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-08-10 DOI: 10.1016/j.ctro.2024.100838

Sebastian M. Christ , Minsu Breitenstein , Philip Heesen , Brandon Turner , Urs J. Muehlematter , Kaspar Pohl , Jonas Willmann , Alexander Maurer , Sukhdeep K. Nagpal , Maiwand Ahmadsei , Eugenia Badra Vlaskou , Esmée L. Looman , Astrid E. Heusel , Michael Mayinger , Panagiotis Balermpas , Andreas Wicki , Nicolaus Andratschke , Tracy Balboni , Mai Anh Huynh , Martin Huellner , Matthias Guckenberger

Aims

Multidisciplinary tumor boards (MDTs) are an integral part of ensuring high-quality, evidence-based and personalized cancer care. In this study, we aimed to evaluate the adherence to and implementation of MDT recommendations in patients with oligometastatic disease (OMD).

Methods

We screened all oncologic positron emission tomography (PET) scans conducted at a single comprehensive cancer center in 2020. Patients were included if they had evidence of imaging-based OMD from a solid organ malignancy on the index scans, had their OMD case discussed at an MDT, and were treated and followed up at the same center. A switch away from the MDT-recommended treatment modalities was classified as a major deviation; non-MDT-mandated adjustments to a recommended treatment modality were coded as minor deviation. Clinical data was obtained via chart review; statistical calculations were computed using the R software.

Results

After review of PET and/or concurrent brain scans, 787 cases of OMD were identified. Thereof, 347 (44.1 %) cases were discussed at MDT, of which 331 (42.1 %) were therapeutically managed and subsequently followed. The three most commonly recommended therapies were systemic therapy (35.6 %), multimodality treatment including definitive local therapy (17.8 %), and radiotherapy (13.9 %). A major deviation was recorded in 16.3 % of cases (most commonly: none of the MDT-recommended treatment modalities were performed: 19 (35.2 %); not all MDT-planned treatment modalities were performed: 12 (22.2 %); and additional treatment modality was performed: 11 (20.3 %). A minor deviation was found in 1.5 % of cases. On multivariable regression, number of distant metastases (n > 1) was associated with a major deviation (OR: 1.85; 95 % CI, 1.0–3.52). Major deviations were associated with a significantly worse OS (p = 0.0034).

Conclusions

Adherence to and implementation of MDT recommendations in OMD patients was generally high (83.7%). Major deviations might be further reduced by more careful and elaborate discussions of OMD patient characteristics s and patient preferences.

目的多学科肿瘤委员会（MDT）是确保高质量、循证和个性化癌症治疗不可或缺的一部分。在这项研究中，我们旨在评估少转移性疾病（OMD）患者对 MDT 建议的遵守和执行情况。方法我们筛查了 2020 年在一家综合癌症中心进行的所有肿瘤正电子发射断层扫描（PET）扫描。如果患者在索引扫描中发现实体器官恶性肿瘤的影像学证据表明存在寡转移性疾病，且其寡转移性疾病病例在MDT中进行了讨论，并在同一中心接受了治疗和随访，则将其纳入研究范围。偏离MDT推荐的治疗方式被归类为重大偏离；非MDT要求对推荐治疗方式进行的调整被归类为轻微偏离。临床数据通过病历审查获得；统计计算使用 R 软件。其中 347 例（44.1%）在 MDT 上进行了讨论，331 例（42.1%）接受了治疗管理和后续跟踪。最常推荐的三种疗法是全身疗法（35.6%）、多模式疗法（包括确定性局部疗法）（17.8%）和放射疗法（13.9%）。有 16.3% 的病例出现了重大偏差（最常见的情况是：没有采用 MDT 推荐的任何一种治疗方式：19例（35.2%）；未实施 MDT 计划的所有治疗方式：12例（22.2%）；进行了额外治疗：11 (20.3 %).1.5%的病例存在轻微偏差。在多变量回归中，远处转移数量（1）与重大偏离相关（OR：1.85；95 % CI，1.0-3.52）。结论 OMD 患者对 MDT 建议的依从性和执行率普遍较高（83.7%）。通过对 OMD 患者特征和患者偏好进行更仔细、更详细的讨论，可进一步减少重大偏差。

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引用次数: 0