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

Reply to comment on Treatment-related toxicity, utility and patient-reported outcomes of head and neck cancer patients treated with proton therapy: A longitudinal study. 质子治疗头颈癌患者的治疗相关毒性、效用和患者报告的结果：一项纵向研究。

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-14 eCollection Date: 2025-09-01 DOI: 10.1016/j.ctro.2025.101013

Yi Hsuan Chen, Michiel Kroesen, Mischa S Hoogeman, Matthijs M Versteegh, Carin A Uyl-de Groot, Hedwig M Blommestein

引用次数: 0

Clarifying gastrointestinal toxicity attribution in WP-SBRT: Commentary on Dinesan et al. and proposal of a bladder-bowel displacement index. 澄清WP-SBRT的胃肠道毒性归属：对Dinesan等人的评论和膀胱-肠移位指数的建议。

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-14 eCollection Date: 2025-09-01 DOI: 10.1016/j.ctro.2025.100995

Gonca Altınışık İnan, Emine Melis Basman, Serenay Demir

引用次数: 0

Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy 乳房切除术后质子或光子放射治疗的即时2期乳房重建结果

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-13 DOI: 10.1016/j.ctro.2025.101015

Robert W. Gao , William S. Harmsen , Na L. Smith , Trey C. Mullikin , Adam C. Amundson , Feven Abraha , Kimberly G. Gergelis , Arslan Afzal , Christin A. Harless , Aparna Vijayasekaran , Minh-Doan T. Nguyen , Judy C. Boughey , Nicholas B. Remmes , Hok S. Wan Chan Tseung , May Elbanna , Allison E. Garda , Mark R. Waddle , Safia K. Ahmed , Sean S. Park , Kimberly S. Corbin , Dean A. Shumway

Purpose

To evaluate the impact of postmastectomy radiotherapy (PMRT) on immediate breast reconstruction (IBR) outcomes among patients treated with proton or photon radiotherapy.

Material and Methods

Patients who had undergone mastectomy, immediate breast reconstruction, and PMRT at our institution were included in a retrospective analysis of risk factors for surgical site infection (SSI), unplanned reoperation, and reconstruction failure. Univariate Cox models were used to examine associations of variables with reconstruction outcomes.

Results

Two-hundred thirty-one women were included, of whom 224 (97.0 %) underwent two-stage IBR with placement of a tissue expander and 7 (3 %) had direct-to-implant IBR. One-hundred sixty-five patients (71.4 %) received proton and 65 (28.6 %) received photon therapy. Twenty-nine patients (12.6 %) received hypofractionation. Median follow-up was 1.8 years. Two-year cumulative risk of SSI was 17.83 % (95 % CI 12.27–24.41 %); unplanned reoperation was 16.19 % (95 % CI 10.06–22.10 %); and reconstruction failure was 7.60 % (95 % CI 3.55–12.11). On multivariable analysis, prophylactic use of Mepitel Film reduced the risk of SSI [HR: 0.35 (95 % CI: 0.18–0.69), p = 0.002] and unplanned reoperation [HR: 0.39 (95 % CI: 0.20–0.79), p = 0.008]. The small number of events (n = 16) precluded multivariable analysis of reconstruction failure; on univariate analysis, receipt of a chest wall boost [HR: 4.98 (95 % CI: 1.12–22.10), p = 0.035] and/or lymph node boost [HR: 3.66 (95 % CI: 1.25–10.73), p = 0.018] were associated with reconstruction failure.

Conclusions

Although approximately one-fifth of women experienced SSI or unplanned reoperation, the rate of reconstruction failure was low (7.6%) and most women achieved a successful reconstruction outcome with PMRT using photons or protons. The lower rate of SSI and unplanned reoperation with use of Mepitel Film highlights the need for further evaluation.

目的探讨乳房切除术后放射治疗（PMRT）对质子或光子放射治疗患者即刻乳房重建（IBR）结果的影响。材料和方法回顾性分析我院行乳房切除术、即刻乳房重建和PMRT的患者手术部位感染（SSI）、计划外再手术和重建失败的危险因素。单变量Cox模型用于检验变量与重建结果的关联。结果纳入231名妇女，其中224名（97.0%）接受了两期IBR并放置组织扩张器，7名（3%）接受了直接植入IBR。165例（71.4%）接受质子治疗，65例（28.6%）接受光子治疗。29例（12.6%）患者接受了低分割术。中位随访时间为1.8年。两年累积SSI风险为17.83% (95% CI 12.27 - 24.41%)；计划外再手术占16.19% (95% CI 10.06 ~ 22.10%)；重建失败率为7.60% （95% CI 3.55 ~ 12.11）。在多变量分析中，预防性使用Mepitel Film降低了SSI的风险[HR: 0.35 (95% CI: 0.18-0.69), p = 0.002]和计划外再手术的风险[HR: 0.39 (95% CI: 0.20-0.79), p = 0.008]。事件数量少（n = 16）排除了重建失败的多变量分析；在单因素分析中，胸壁增强[风险比：4.98 (95% CI: 1.12-22.10), p = 0.035]和/或淋巴结增强[风险比：3.66 (95% CI: 1.25-10.73), p = 0.018]与重建失败相关。结论：尽管约五分之一的女性经历过SSI或计划外的再手术，但重建失败率很低（7.6%），大多数女性使用光子或质子进行PMRT成功重建。较低的SSI发生率和使用Mepitel膜的意外再手术突出了进一步评估的必要性。

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引用次数: 0

Radiotherapy boost to the primary tumour in locally advanced rectal cancer: Systematic review of practices and meta-analysis 放疗对局部晚期直肠癌原发肿瘤的促进作用：实践的系统回顾和荟萃分析

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-13 DOI: 10.1016/j.ctro.2025.101014

Julien Pierrard , Lorraine Donnay , Alix Collard , Geneviève Van Ooteghem

Introduction

In locally advanced rectal cancer (LARC), increasing the complete response (CR) rate after total neo-adjuvant treatment may increase the patient eligibility for non-operative management (“watch and wait”, W&W). Although a radiotherapy (RT) boost to the primary tumour may enhance CR rates, clear guidelines are currently lacking. This systematic review and meta-analysis investigate the technical parameters used for rectal boost RT and assess their impact on oncological outcomes.

Methods

Following PRISMA guidelines, the terms “rectum,” “radiotherapy,” and “boost” were searched in PubMed and EMBASE (PROSPERO: CRD42023444685). Studies reporting on external beam RT boost to the primary tumour in LARC and meeting quality criteria were included. Descriptive analyses extracted data on RT technique, preparation, boost delineation, dose, chemotherapy, and follow-up. A mixed-effects meta-analysis model evaluated the impact of selected parameters on CR and local recurrence rate (LRR). Studies were analysed separately based on treatment intent: planned surgery or W&W.

Results

Out of 3904 references, 83 were included in the descriptive analysis and 78 in the meta-analysis. Substantial variability in RT parameters was observed across studies. Pathologic CR rates were significantly higher with intensity-modulated/volumetric-modulated arc RT (IMRT/VMAT, p = 0.007), simultaneous boost (p = 0.020), dose escalation (Biological equivalent dose > 74 Gy, p = 0.035), and the combination of induction and consolidation chemotherapy (p = 0.023). No significant associations were found for clinical CR or LRR.

Conclusion

While rectal RT boost is already part of real-world practices, the wide heterogeneity in techniques highlights the urgent need for standardisation. Our meta-analysis suggests that IMRT/VMAT, simultaneous boost, and dose escalation are associated with higher pathological CR rates and should be considered in future rectal boost guidelines. These findings, however, warrant careful interpretation due to the absence of adjustments for clinical, tumoral, or patient-related parameters that may also influence response rate and oncological outcomes.

在局部晚期直肠癌（LARC）中，提高完全新辅助治疗后的完全缓解率（CR）可能会增加患者接受非手术治疗的资格（“观察和等待”，W&；W）。虽然对原发肿瘤进行放疗（RT）可能会提高CR率，但目前缺乏明确的指导方针。本系统综述和荟萃分析调查了用于直肠增强RT的技术参数，并评估了它们对肿瘤预后的影响。方法按照PRISMA指南，在PubMed和EMBASE （PROSPERO: CRD42023444685）中检索“直肠”、“放疗”和“boost”这三个术语。研究报告了LARC中对原发肿瘤的外束放疗增强并符合质量标准。描述性分析提取了放疗技术、制剂、增强描绘、剂量、化疗和随访方面的数据。混合效应荟萃分析模型评估了所选参数对CR和局部复发率（LRR）的影响。研究根据治疗意图分别进行分析：计划手术或W&；W。结果3904篇文献中，描述性分析纳入83篇，meta分析纳入78篇。在不同的研究中观察到RT参数有很大的可变性。调强/调容弧线放疗（IMRT/VMAT, p = 0.007）、同步增强（p = 0.020）、剂量递增(生物等效剂量>；74 Gy, p = 0.035)，诱导合并巩固化疗（p = 0.023）。临床CR或LRR未发现显著相关性。结论虽然直肠RT增强术已经成为现实世界的一部分，但技术的广泛异质性突出了对标准化的迫切需要。我们的荟萃分析表明，IMRT/VMAT、同时增强和剂量递增与更高的病理CR率相关，应在未来的直肠增强指南中予以考虑。然而，由于缺乏对临床、肿瘤或患者相关参数的调整，这些发现需要仔细解释，这些参数也可能影响反应率和肿瘤预后。

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引用次数: 0

Overexpression of JAML in colorectal cancer cells predicts higher radiosensitivity by inactivating ATR pathway 结直肠癌细胞中JAML的过表达可通过灭活ATR通路预测更高的放射敏感性

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-11 DOI: 10.1016/j.ctro.2025.101016

Mingyan Zhang , Wenhui Shi , Yanan Liu , Yufeng Wang , Yinying Dong , Chunsheng Yang , Yawen Zheng , Ning Liu , Yan Zheng , Meili Sun

Background

Junctional adhesion molecule–like protein (JAML) is highly expressed in cancer tissues of patients with colorectal cancer (CRC) and promotes cancer proliferation. However, the relationship between JAML expression and radiosensitivity of CRC remains unclear.

Methods

Stable CRC cell lines with knocked down or overexpressed JAML were used to evaluate the effects of irradiation on cell viability and cell proliferation using Cell Counting Kit-8 (CCK8) and cell clone formation assay, respectively. Cellular immunofluorescence, flow cytometry, and western blotting were used to determine the mechanism. Tumor-bearing nude mouse models were established to verify the relationships between the expression of JAML and the radiosensitivity of CRC.

Results

The results of CCK8 and cell clone formation assay showed that the viability and proliferation of CRC cells with JAML overexpression were significantly inhibited after exposure to irradiation compared with those of CRC cells with low expression of JAML. DNA damage and cell apoptosis were significantly increased in the JAML-overexpression group compared with the JAML-low-expression group after exposure to irradiation. The phosphorylation of the ataxia telangiectasia and Rad3-related protein (ATR)-checkpoint kinase 1 (CHK1)-mediated DNA damage repair pathway was inhibited in the JAML-overexpression group compared with the JAML-low-expression CRC cells after irradiation. Similar results were observed in CRC xenografts in vivo.

Conclusions

CRC cells with JAML overexpression are more sensitive to radiotherapy of X-rays because of the decreased phosphorylation of the ATR-CHK1-mediated DNA damage repair pathway. The expression of JAML in CRC cells could be used as a predictive biomarker of radiosensitivity in patients with CRC.

结直肠癌（CRC）患者的癌组织中高表达的连接粘附分子样蛋白（JAML）可促进肿瘤的增殖。然而，JAML表达与CRC放射敏感性之间的关系尚不清楚。方法采用细胞计数试剂盒-8 （cell Counting Kit-8, CCK8）和细胞克隆形成实验，分别评价辐照对JAML敲低或过表达的CRC稳定细胞系细胞活力和细胞增殖的影响。细胞免疫荧光、流式细胞术、western blotting检测其作用机制。建立荷瘤裸鼠模型，验证JAML表达与CRC放射敏感性之间的关系。结果CCK8和细胞克隆形成实验结果显示，与JAML低表达的CRC细胞相比，JAML过表达的CRC细胞的生存能力和增殖能力受到了明显的抑制。暴露后，与低表达组相比，过表达组的DNA损伤和细胞凋亡明显增加。与低表达jaml的CRC细胞相比，jaml -过表达组在辐射后的失调性毛细血管扩张和rad3相关蛋白(ATR)-检查点激酶1 （CHK1）介导的DNA损伤修复途径的磷酸化被抑制。在体内CRC异种移植中也观察到类似的结果。结论JAML过表达的scrc细胞由于atr - chk1介导的DNA损伤修复通路磷酸化降低，对x射线放疗更敏感。JAML在结直肠癌细胞中的表达可作为结直肠癌患者放射敏感性的预测性生物标志物。

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引用次数: 0

Palliative expeditiously adaptive quad shot radiotherapy for head and neck cancers (PEAQ-RT) 缓解性快速适应性头颈部肿瘤四针放射治疗（PEAQ-RT）

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-08 DOI: 10.1016/j.ctro.2025.101012

Weiren Liu , Joshua P. Schiff , Comron Hassanzadeh , Karen Miller , Casey Hatscher , Robbie Beckert , Alex Price , Mackenzie Daly , Randall Brenneman , Lauren Henke , Anthony Apicelli , Michael Moravan , Wade Thorstad , Eric Laugeman

Purpose/objective

Quad shot radiotherapy (QS-RT) is integral to head and neck cancer palliative care, but multiple CT-simulations for QS-RT cycles can be burdensome for patients. We evaluated the ability of an online adaptive radiotherapy (ART) workflow (PEAQ-RT) to eliminate extra CT simulations in QS-RT and reduce treatment related burdens.

Materials/methods

Ten patients with head and neck malignancies were enrolled in this prospective study receiving QS-RT for up to three cycles, each comprising four fractions of 350 cGy delivered twice daily, with a total dose of 1400 cGy per cycle. QS-RT could be delivered up to three cycles, spaced three to four weeks apart. Patients underwent standard CT simulation, and the simulation plan served as the treatment plan for the first QS-RT cycle. For subsequent QS-RT cycles, patients proceeded directly to adaptive treatment via institutional online ART protocol. Feasibility was defined as completing this expedited adaptive QS-RT workflow in at least 80 % of attempted adapted fractions.

Results

Ten patients aged 56–89 were enrolled. Eight patients received a second cycle of QS-RT and four patients received a third cycle. PEAQ-RT workflow was feasible in 87.5% (7/8) of patients who received at least one adapted cycle and was feasible in 86% (12/14) of attempted adapted fractions. For the second and third cycles, average total workflow time for the adaptive treatments was 28 min (14–38). All constraint violations were resolved with the use of online adaptation. The PEAQ-RT workflow eliminated a median of 2 (range: 0–2) simulation visits with additional QS-RT cycles. This resulted in a median travel distance savings of 50.8 miles (range: 40.6–848 miles) and a median reduction of 3.5 h in travel time per patient.

Conclusion

PEAQ-RT enabled QS-RT while eliminating the need for additional CT simulation appointments for subsequent cycles.

目的/目的四次放射治疗（QS-RT）是头颈癌姑息治疗不可或缺的一部分，但多次ct模拟QS-RT周期可能给患者带来负担。我们评估了在线自适应放疗（ART）工作流程（PEAQ-RT）消除QS-RT中额外的CT模拟和减少治疗相关负担的能力。材料/方法10例头颈部恶性肿瘤患者被纳入这项前瞻性研究，接受长达三个周期的QS-RT，每个周期包括四个部分，350 cGy，每天两次，每周期总剂量为1400 cGy。QS-RT最多可以提供三个周期，间隔三到四周。患者进行标准CT模拟，模拟方案作为第一个QS-RT周期的治疗方案。在随后的QS-RT周期中，患者通过机构在线ART协议直接进行适应性治疗。可行性定义为在至少80%的尝试适应分数中完成此快速自适应QS-RT工作流。结果入选患者10例，年龄56 ~ 89岁。8名患者接受了第二周期的QS-RT， 4名患者接受了第三周期的QS-RT。PEAQ-RT工作流程在接受至少一个适应周期的87.5%（7/8）患者中是可行的，在86%（12/14）尝试适应部分中是可行的。对于第二个和第三个周期，适应性处理的平均总工作时间为28分钟（14-38）。使用在线自适应解决了所有违反约束的问题。PEAQ-RT工作流程通过额外的QS-RT周期消除了2次（范围：0-2）模拟访问的中位数。这使得平均路程节省了50.8英里（40.6-848英里），平均每位患者的路程减少了3.5小时。peaq - rt支持QS-RT，同时消除了后续周期额外CT模拟预约的需要。

{"title":"Palliative expeditiously adaptive quad shot radiotherapy for head and neck cancers (PEAQ-RT)","authors":"Weiren Liu , Joshua P. Schiff , Comron Hassanzadeh , Karen Miller , Casey Hatscher , Robbie Beckert , Alex Price , Mackenzie Daly , Randall Brenneman , Lauren Henke , Anthony Apicelli , Michael Moravan , Wade Thorstad , Eric Laugeman","doi":"10.1016/j.ctro.2025.101012","DOIUrl":"10.1016/j.ctro.2025.101012","url":null,"abstract":"<div><h3>Purpose/objective</h3><div>Quad shot radiotherapy (QS-RT) is integral to head and neck cancer palliative care, but multiple CT-simulations for QS-RT cycles can be burdensome for patients. We evaluated the ability of an online adaptive radiotherapy (ART) workflow (PEAQ-RT) to eliminate extra CT simulations in QS-RT and reduce treatment related burdens.</div></div><div><h3>Materials/methods</h3><div>Ten patients with head and neck malignancies were enrolled in this prospective study receiving QS-RT for up to three cycles, each comprising four fractions of 350 cGy delivered twice daily, with a total dose of 1400 cGy per cycle. QS-RT could be delivered up to three cycles, spaced three to four weeks apart. Patients underwent standard CT simulation, and the simulation plan served as the treatment plan for the first QS-RT cycle. For subsequent QS-RT cycles, patients proceeded directly to adaptive treatment via institutional online ART protocol. Feasibility was defined as completing this expedited adaptive QS-RT workflow in at least 80 % of attempted adapted fractions.</div></div><div><h3>Results</h3><div>Ten patients aged 56–89 were enrolled. Eight patients received a second cycle of QS-RT and four patients received a third cycle. PEAQ-RT workflow was feasible in 87.5% (7/8) of patients who received at least one adapted cycle and was feasible in 86% (12/14) of attempted adapted fractions. For the second and third cycles, average total workflow time for the adaptive treatments was 28 min (14–38). All constraint violations were resolved with the use of online adaptation. The PEAQ-RT workflow eliminated a median of 2 (range: 0–2) simulation visits with additional QS-RT cycles. This resulted in a median travel distance savings of 50.8 miles (range: 40.6–848 miles) and a median reduction of 3.5 h in travel time per patient.</div></div><div><h3>Conclusion</h3><div>PEAQ-RT enabled QS-RT while eliminating the need for additional CT simulation appointments for subsequent cycles.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101012"},"PeriodicalIF":2.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Changes in splenic volumes following stereotactic ablative radiotherapy (SABR) to adrenal tumors 肾上腺肿瘤立体定向消融放疗（SABR）后脾体积的变化

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-07 DOI: 10.1016/j.ctro.2025.101011

Nicolas Giraud , Miguel A. Palacios , John R. van Sornsen de Koste , Antonio M. Marzo , Peter S.N. van Rossum , Famke L. Schneiders , Suresh Senan

Purpose

Splenic irradiation can result in life-threatening infections. Updated dose constraints have been recommended for patients undergoing chemoradiotherapy and conventional radiotherapy but splenic constraints were not specified in trials of stereotactic ablative radiotherapy (SABR). We studied splenic doses in patients undergoing SABR for adrenal metastases and late changes in splenic volume (SV).

Material and Methods

Patients treated with breath-hold MR-guided SABR for adrenal metastases were identified from an Ethics-approved database. Splenic dose constraints were not routinely used. The spleen was delineated retrospectively on both breath-hold CT and MR-scans. Mean spleen dose (MSD) and relative V_5-10-20-30Gy values were derived from the baseline plan. SV was measured on available follow-up CT scans at 6–12–24 months. Regression analyses were performed to assess SV changes in relation to splenic dose and other parameters.

Results

SABR was delivered to 113 adrenal tumors mostly using 5 fractions (64 % of tumors), 3 fractions (19 %) or a single fraction (14 %). Systemic therapy was administered during or within 3 months preceding/after SABR in 51 % of patients. Left-sided tumors comprised 56 % of total, and baseline median MSD and V_10Gy were 9.7 Gy (range 1.5–28.4 Gy) and 46.3 % (range 0–100 %), respectively. Corresponding values for right-sided adrenal plans were 1.5 Gy (0.2–5.9 Gy) and 0 % (0–6.2 %), respectively. In multivariable analysis, a higher MSD was significantly associated with left laterality (p < 0.001), higher prescription dose (p = 0.02), and larger GTV (p < 0.001). An MSD of > 10 Gy was observed in 28 patients (25 %). Among these, a greater than 20 % decrease in SV was found in 46 % of patients with available follow-up at 6 months (n = 59), 40 % at 12 months (n = 47) and 50 % at 24 months (n = 31).

Conclusion

Substantial reductions in spleen volume occur in 40–50 % of patients treated with adrenal SABR with an MSD of >10 Gy. The clinical relevance of splenic atrophy merits further study.

目的：脾照射可导致危及生命的感染。更新的剂量限制已被推荐给接受放化疗和常规放疗的患者，但在立体定向消融放疗（SABR）的试验中没有指定脾限制。我们研究了肾上腺转移患者接受SABR的脾剂量和脾体积（SV）的晚期变化。材料和方法从伦理批准的数据库中确定采用屏息磁共振引导SABR治疗肾上腺转移的患者。脾剂量限制不常用。在屏气CT和mr扫描上回顾性描绘脾脏。平均脾脏剂量（MSD）和相对V5-10-20-30Gy值由基线计划得出。在6-12-24个月的随访CT扫描上测量SV。采用回归分析评估SV变化与脾剂量和其他参数的关系。结果113例肾上腺肿瘤采用5段（64%）、3段（19%）或单段（14%）给药。51%的患者在SABR期间或前后3个月内接受了全身治疗。左侧肿瘤占总数的56%，基线中位MSD和V10Gy分别为9.7 Gy （1.5-28.4 Gy）和46.3%（0 - 100%）。右侧肾上腺平面相应值分别为1.5 Gy （0.2-5.9 Gy）和0%（0 - 6.2%）。在多变量分析中，较高的MSD与左侧侧度显著相关(p <；0.001)、较高的处方剂量（p = 0.02）和较大的GTV (p <；0.001)。MSD为>；28例（25%）患者观察到10 Gy。其中，46%的患者在6个月时（n = 59）， 40%的患者在12个月时（n = 47）， 50%的患者在24个月时（n = 31）， SV下降超过20%。结论：在MSD为10 Gy的肾上腺SABR患者中，有40 - 50%的患者脾脏体积明显缩小。脾萎缩的临床意义值得进一步研究。

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引用次数: 0

Prostate radiotherapy in patients with metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis of randomised controlled trials 转移性激素敏感前列腺癌患者的前列腺放疗：随机对照试验的系统回顾和荟萃分析

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-05 DOI: 10.1016/j.ctro.2025.101009

Navid Roessler , Marcin Miszczyk , Alessandro Dematteis , Fabio Zattoni , Tamás Fazekas , Filippo Carletti , Giuseppe Reitano , Akihiro Matsukawa , Ahmed R. Alfarhan , Angelo Cormio , Abdulrahman S. Alqahtani , Timo F.W. Soeterik , Giulia Marvaso , Giorgio Gandaglia , Péter Nyirády , Paweł Rajwa , Łukasz Nyk , Peter Soo Palencia , Michael S. Leapman , Barbara A. Jereczek-Fossa , Shahrokh F. Shariat

Introduction

The incidence of synchronous metastatic hormone-sensitive prostate cancer (mHSPC) is rising with the increasing use of next-generation imaging. Local radiotherapy (RT) was shown to improve survival in patients with mHSPC; however, new data require a re-assessment of the indication and value of local RT in mHSPC.

Methods

In this prospectively registered systematic review and meta-analysis (CRD42025648251), we searched MEDLINE, Scopus, CENTRAL, and Google Scholar in March 2025 for phase 3 RCTs evaluating the addition of RT to systemic therapy to improve OS in mHSPC patients. Hazard ratios (HRs) were pooled using random-effects meta-analysis. Risk of Bias was assessed with Cochrane’s RoB 2 tool.

Results

Out of the 10,615 individual records, we identified three RCTs: HORRAD (n = 432), STAMPEDE (n = 2,061), and PEACE-1 (n = 1,173). The systemic treatment included androgen deprivation therapy (ADT) in HORRAD, ADT ± Docetaxel in STAMPEDE, and ADT ± Docetaxel ± Abiraterone in PEACE-1 trial. Local RT was not associated with significantly improved OS in all patients (HR = 0.92; 95 % confidence interval [CI] 0.85–1.00; p = 0.06), or in those with low metastatic burden (HR = 0.74; 95 %CI 0.51–1.06; p = 0.1); however, exploratory analyses showed a significant improvement in androgen deprivation resistance-free survival (HR = 0.76; 95 %CI 0.70–0.82; p < 0.001). Local RT was associated with significant reduction in local prostate cancer related events in the HORRAD (18 % vs. 30 %) and PEACE-1 (12 % vs. 22 %) trials, but not in the STAMPEDE trial (49 % vs. 51 %).

Conclusion

Local RT does not improve OS in unselected patients treated with modern systemic therapies for mHSPC. However, it delays ADT resistance and reduces local adverse events, with relatively tolerable toxicity. Future studies should refine selection criteria, ideally using PSMA-PET imaging, dynamic response markers, and/or genomic profiling, to identify mHSPC patients most likely to benefit from local RT.

同步转移性激素敏感前列腺癌（mHSPC）的发病率随着下一代成像技术的使用越来越多而上升。局部放疗（RT）可改善mHSPC患者的生存；然而，新的数据需要重新评估mHSPC的适应症和局部RT的价值。方法在这项前瞻性注册的系统评价和荟萃分析（CRD42025648251）中，我们于2025年3月检索了MEDLINE、Scopus、CENTRAL和谷歌Scholar，以评估在全身治疗中增加RT治疗以改善mHSPC患者的OS的3期rct。采用随机效应荟萃分析合并风险比（hr）。采用Cochrane的RoB 2工具评估偏倚风险。结果在10615个个体记录中，我们确定了3个随机对照试验：HORRAD （n = 432）、STAMPEDE （n = 2061）和PEACE-1 （n = 1173）。全身治疗包括：HORRAD组ADT±多西他赛，STAMPEDE组ADT±多西他赛，PEACE-1组ADT±多西他赛±阿比龙。所有患者的局部放疗与OS的显著改善无关(HR = 0.92；95%置信区间[CI] 0.85-1.00；p = 0.06)，或低转移负荷患者(HR = 0.74；95% ci 0.51-1.06；p = 0.1)；然而，探索性分析显示，雄激素剥夺无抵抗生存显著改善(HR = 0.76；95% ci 0.70-0.82；p & lt;0.001)。在HORRAD试验（18%对30%）和PEACE-1试验（12%对22%）中，局部放疗与局部前列腺癌相关事件的显著减少相关，但在STAMPEDE试验中没有（49%对51%）。结论局部放疗不能改善未选择的mHSPC现代全身治疗患者的OS。然而，它延缓了ADT耐药性，减少了局部不良事件，毒性相对可耐受。未来的研究应该完善选择标准，理想情况下使用PSMA-PET成像，动态反应标记物和/或基因组分析，以确定mHSPC患者最有可能从局部RT中受益。

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引用次数: 0

Symptomatic posttreatment edema after stereotactic radiotherapy (SRS/FSRS) for intracranial meningiomas: patterns and predictive factors 颅内脑膜瘤立体定向放疗（SRS/FSRS）后的症状性水肿：模式和预测因素

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-04 DOI: 10.1016/j.ctro.2025.101010

Dorra Aissaoui , Naoual Oulmoudne , Houda Bahig , Giuseppina Laura Masucci , Robert Moumdjian , David Roberge , Cynthia Menard , Laurent Létourneau-Guillon , Carole Lambert , Jean-Paul Bahary

Background

Symptomatic posttreatment edema (SPTE) is a complication that may develop after radiotherapy for intracranial meningiomas. Our study aims at reviewing rates of SPTE in a large cohort of a single institution and identifying possible predictive factors.

Methods

We retrospectively analyzed data of 293 patients with 304 intracranial meningiomas irradiated at our institution between 2005 and 2018. We evaluated rates of SPTE and investigated numerous factors by univariate and multivariate analysis. Kaplan Meier analysis was used for estimation of actuarial local control and overall survival.

Results

Median age was 60 years. Meningiomas were treated with fractionated stereotactic radiation therapy (70 %), single fraction stereotactic radiosurgery (24 %) or fractionated stereotactic radiosurgery (6 %). Median imaging follow-up was 60 months, actuarial 10 year local control rate for patients with grade 1 meningiomas who received radiotherapy as definitive treatment was 99 %. Local control at 5 years was 94 % for grade 1 meningioma, 57 % and 53 % for grade 2 and 3 respectively. Sixteen patients (5.5 %) developed SPTE, median time to onset was 3 months (range 1–26 months). the higher rates of SPTE observed were in midline (13 %) and convexity (9 %), compared to skull base tumors (2 %). On univariate analysis, age > 60 years (p > 0.03), pretreatment peritumoral edema (p = 0.014), medline location (p = 0.018), tumor size > 30 mm (p = 0.015) and grade 2 histology (p = 0.03) were predictive of SPTE. On multivariate analysis, only tumor location and size remained statistically significant.

Conclusions

Based on our results, patients at high risk of SPTE can be identified based on patient and tumor characteristics. The best treatment technique in high risk patients is yet to be defined.

背景：症状性治疗后水肿（SPTE）是颅内脑膜瘤放疗后可能出现的并发症。我们的研究旨在回顾单一机构的大型队列中SPTE的发生率，并确定可能的预测因素。方法回顾性分析我院2005年至2018年收治的304例颅内脑膜瘤患者293例的资料。我们评估了SPTE的发生率，并通过单因素和多因素分析调查了许多因素。Kaplan Meier分析用于估计精算局部控制和总生存期。结果中位年龄为60岁。脑膜瘤采用分次立体定向放射治疗（70%）、单次立体定向放射治疗（24%）或分次立体定向放射治疗（6%）。影像学随访中位数为60个月，精算10年局部控制率为99%，放疗为最终治疗的1级脑膜瘤患者。5年局部控制率1级脑膜瘤为94%，2级和3级脑膜瘤分别为57%和53%。16例（5.5%）发生SPTE，中位发病时间为3个月（范围1-26个月）。与颅底肿瘤（2%）相比，中线肿瘤（13%）和凸部肿瘤（9%）的SPTE发生率较高。单变量分析，年龄>；60年(p >；0.03)、预处理肿瘤周围水肿（p = 0.014）、中线位置（p = 0.018）、肿瘤大小>；30mm （p = 0.015）和2级组织学（p = 0.03）是SPTE的预测指标。在多变量分析中，只有肿瘤的位置和大小具有统计学意义。结论根据我们的研究结果，可以根据患者和肿瘤特征来识别SPTE的高危患者。高风险患者的最佳治疗技术尚未确定。

{"title":"Symptomatic posttreatment edema after stereotactic radiotherapy (SRS/FSRS) for intracranial meningiomas: patterns and predictive factors","authors":"Dorra Aissaoui , Naoual Oulmoudne , Houda Bahig , Giuseppina Laura Masucci , Robert Moumdjian , David Roberge , Cynthia Menard , Laurent Létourneau-Guillon , Carole Lambert , Jean-Paul Bahary","doi":"10.1016/j.ctro.2025.101010","DOIUrl":"10.1016/j.ctro.2025.101010","url":null,"abstract":"<div><h3>Background</h3><div>Symptomatic posttreatment edema (SPTE) is a complication that may develop after radiotherapy for intracranial meningiomas. Our study aims at reviewing rates of SPTE in a large cohort of a single institution and identifying possible predictive factors.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data of 293 patients with 304 intracranial meningiomas irradiated at our institution between 2005 and 2018. We evaluated rates of SPTE and investigated numerous factors by univariate and multivariate analysis. Kaplan Meier analysis was used for estimation of actuarial local control and overall survival.</div></div><div><h3>Results</h3><div>Median age was 60 years. Meningiomas were treated with fractionated stereotactic radiation therapy (70 %), single fraction stereotactic radiosurgery (24 %) or fractionated stereotactic radiosurgery (6 %). Median imaging follow-up was 60 months, actuarial 10 year local control rate for patients with grade 1 meningiomas who received radiotherapy as definitive treatment was 99 %. Local control at 5 years was 94 % for grade 1 meningioma, 57 % and 53 % for grade 2 and 3 respectively. Sixteen patients (5.5 %) developed SPTE, median time to onset was 3 months (range 1–26 months). the higher rates of SPTE observed were in midline (13 %) and convexity (9 %), compared to skull base tumors (2 %). On univariate analysis, age > 60 years (p > 0.03), pretreatment peritumoral edema (p = 0.014), medline location (p = 0.018), tumor size > 30 mm (p = 0.015) and grade 2 histology (p = 0.03) were predictive of SPTE. On multivariate analysis, only tumor location and size remained statistically significant.</div></div><div><h3>Conclusions</h3><div>Based on our results, patients at high risk of SPTE can be identified based on patient and tumor characteristics. The best treatment technique in high risk patients is yet to be defined.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101010"},"PeriodicalIF":2.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Response to Letter to the Editor. 对给编辑的信的回应。

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-03 eCollection Date: 2025-09-01 DOI: 10.1016/j.ctro.2025.101002

Eric D Ehler, Grace H Hutchinson, Jianling Yuan, Kathryn E Dusenbery

引用次数: 0