Pharyngeal mucositis and esophagitis incidence following re-irradiation stereotactic body radiotherapy (SBRT) for spinal metastases remains unclear. We retrospectively examined their incidence and risk factors after re-irradiation SBRT to clarify organ tolerance.
Methods and materials
Patients who underwent spine SBRT following prior conventional radiotherapy were included if the SBRT delivered more than 10 Gy to the pharynx or esophagus. SBRT dose was limited to 24 Gy in two fractions. Dose constraints were pharyngeal D1 cc < 20, esophageal D2.5 cc < 19, and D0.035 cc < 24 Gy. The primary endpoint was pharyngeal mucositis and esophagitis occurrence. Patient demographics, clinical factors, and dose-volume parameters were analyzed as predictors of symptomatic toxicities.
Results
Ninety-three patients were included (60 males; median age, 66 years). The median follow-up was 15 (range: 3–111) months. One patient with grade 3 toxicity (1 %) was observed, with no grade 4–5 toxicities. Grade 1 (symptomatic) pharyngeal mucositis occurred in 58 % (14/24) of patients, and grade 2 esophagitis occurred in 27 % (23/85). Clinical factors and symptomatic toxicities were not significantly associated. The estimated Dmax values corresponding to a 20 % risk of symptomatic toxicity were 16.6 Gy for the pharynx and 22.8 Gy for the esophagus.
Conclusions
Grade ≥ 3 pharyngeal mucositis and esophagitis were rare; the current dose constraints are safe for re-irradiated spine SBRT. Reducing the pharyngeal and esophageal maximum doses may be helpful among patients for whom avoiding symptomatic mucositis is particularly important.
背景：脊柱转移瘤再照射立体定向放射治疗（SBRT）后咽粘膜炎和食管炎的发生率尚不清楚。我们回顾性检查SBRT再照射后的发生率和危险因素，以阐明器官耐受。方法和材料：在先前的常规放疗后，如果SBRT向咽部或食道输送超过10 Gy，则纳入了接受脊柱SBRT的患者。SBRT剂量限制在24 Gy，分为两部分。剂量限制为咽部D1 cc <； 20，食道D2.5 cc < 19, D0.035 cc < 24 Gy。主要终点是咽部粘膜炎和食管炎的发生。分析患者人口统计学、临床因素和剂量-体积参数作为症状毒性的预测因素。结果纳入93例患者，其中男性60例，中位年龄66岁。中位随访为15个月（范围：3-111个月）。观察到1例3级毒性（1%），无4-5级毒性。58%（14/24）的患者出现1级（症状性）咽黏膜炎，27%（23/85）的患者出现2级食管炎。临床因素与症状毒性无显著相关性。对应20%症状毒性风险的估计Dmax值为咽部16.6 Gy和食道22.8 Gy。结论≥3级咽黏膜炎、食管炎少见；目前的剂量限制对于再照射的脊柱SBRT是安全的。减少咽部和食道最大剂量可能对避免症状性粘膜炎特别重要的患者有帮助。
{"title":"Pharyngeal mucositis and esophagitis after re-irradiation spine stereotactic body radiotherapy with 24 Gy in two fractions","authors":"Kei Ito , Kentaro Taguchi , Yujiro Nakajima , Keiko Nemoto Murofushi","doi":"10.1016/j.ctro.2025.101100","DOIUrl":"10.1016/j.ctro.2025.101100","url":null,"abstract":"<div><h3>Background</h3><div>Pharyngeal mucositis and esophagitis incidence following re-irradiation stereotactic body radiotherapy (SBRT) for spinal metastases remains unclear. We retrospectively examined their incidence and risk factors after re-irradiation SBRT to clarify organ tolerance.</div></div><div><h3>Methods and materials</h3><div>Patients who underwent spine SBRT following prior conventional radiotherapy were included if the SBRT delivered more than 10 Gy to the pharynx or esophagus. SBRT dose was limited to 24 Gy in two fractions. Dose constraints were pharyngeal D<sub>1 cc</sub> < 20, esophageal D<sub>2.5 cc</sub> < 19, and D<sub>0.035 cc</sub> < 24 Gy. The primary endpoint was pharyngeal mucositis and esophagitis occurrence. Patient demographics, clinical factors, and dose-volume parameters were analyzed as predictors of symptomatic toxicities.</div></div><div><h3>Results</h3><div>Ninety-three patients were included (60 males; median age, 66 years). The median follow-up was 15 (range: 3–111) months. One patient with grade 3 toxicity (1 %) was observed, with no grade 4–5 toxicities. Grade 1 (symptomatic) pharyngeal mucositis occurred in 58 % (14/24) of patients, and grade 2 esophagitis occurred in 27 % (23/85). Clinical factors and symptomatic toxicities were not significantly associated. The estimated D<sub>max</sub> values corresponding to a 20 % risk of symptomatic toxicity were 16.6 Gy for the pharynx and 22.8 Gy for the esophagus.</div></div><div><h3>Conclusions</h3><div>Grade ≥ 3 pharyngeal mucositis and esophagitis were rare; the current dose constraints are safe for re-irradiated spine SBRT. Reducing the pharyngeal and esophageal maximum doses may be helpful among patients for whom avoiding symptomatic mucositis is particularly important.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101100"},"PeriodicalIF":2.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837694","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}
Pub Date : 2025-12-20DOI: 10.1016/j.ctro.2025.101097
Lena Kretzschmar , Maksym Fritsak , Philip Heesen , Astrid Heusel , Sylvie Bonvalot , Matthias Guckenberger , Aisha Miah , Falk Röder , Maria Anna Smolle , Sebastian M. Christ , Siyer Roohani
Background
Pulmonary metastases (PM) develop in ∼ 30 % of sarcoma patients after curative therapy and confer poor prognosis. Surgery and stereotactic body radiotherapy (SBRT) are viable local ablative options, but direct comparative data is limited. This systematic review evaluates oncologic outcomes and toxicities of surgery versus SBRT for sarcoma-derived PM.
Materials and methods
We systematically reviewed Medline and references for studies of sarcoma-PM treated with surgery or SBRT according to PRISMA, including publications up to 13th May 2025. Outcomes included local control (LC), progression-/disease-free survival (PFS/DFS), overall survival (OS), and toxicities, with OS data harmonized for pooled analysis.
Results
Fifty-eight mostly retrospective studies comprising 4,787 patients were included. LC, PFS, and DFS were heterogeneously reported but generally similar. Three-year weighted median LC was 89.6 % (surgery, 2 studies) vs. 87.8 % (SBRT, 15 studies). Reporting on PFS/DFS was limited: Four-year-PFS 21 % (SBRT) vs. 28 % (surgery, 1 study each); 5-year-DFS 12 % (SBRT, 1 study) vs. 19 % (surgery, 9 studies). SBRT toxicities were generally ≤ CTCAE grade 3, while surgery occasionally caused grade 4–5 events. 5-year-OS showed no significant difference: 31.6 % for SBRT [95 %-CI 23.9–41.5 %], 37.8 % for surgery [95 %-CI 30–41.9 %].
Conclusion
Evidence indicates SBRT and surgery provide comparable outcomes for sarcoma- PM, with SBRT offering a more favorable toxicity profile. Though heterogeneous indications and incomplete reporting limit comparability, SBRT should not be viewed solely as fallback for surgically ineligible patients. Treatment should be individualized within a multidisciplinary expert team, integrating patient- and modality-specific factors. Well-designed prospective trials are needed to define relative safety and efficacy.
{"title":"Stereotactic Body Radiotherapy vs. Metastasectomy for Soft Tissue and Bone Sarcoma Lung Metastases – A Systematic Review analyzing Safety and Efficacy","authors":"Lena Kretzschmar , Maksym Fritsak , Philip Heesen , Astrid Heusel , Sylvie Bonvalot , Matthias Guckenberger , Aisha Miah , Falk Röder , Maria Anna Smolle , Sebastian M. Christ , Siyer Roohani","doi":"10.1016/j.ctro.2025.101097","DOIUrl":"10.1016/j.ctro.2025.101097","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary metastases (PM) develop in ∼ 30 % of sarcoma patients after curative therapy and confer poor prognosis. Surgery and stereotactic body radiotherapy (SBRT) are viable local ablative options, but direct comparative data is limited. This systematic review evaluates oncologic outcomes and toxicities of surgery versus SBRT for sarcoma-derived PM.</div></div><div><h3>Materials and methods</h3><div>We systematically reviewed Medline and references for studies of sarcoma-PM treated with surgery or SBRT according to PRISMA, including publications up to 13th May 2025. Outcomes included local control (LC), progression-/disease-free survival (PFS/DFS), overall survival (OS), and toxicities, with OS data harmonized for pooled analysis.</div></div><div><h3>Results</h3><div>Fifty-eight mostly retrospective studies comprising 4,787 patients were included. LC, PFS, and DFS were heterogeneously reported but generally similar. Three-year weighted median LC was 89.6 % (surgery, 2 studies) vs. 87.8 % (SBRT, 15 studies). Reporting on PFS/DFS was limited: Four-year-PFS 21 % (SBRT) vs. 28 % (surgery, 1 study each); 5-year-DFS 12 % (SBRT, 1 study) vs. 19 % (surgery, 9 studies). SBRT toxicities were generally ≤ CTCAE grade 3, while surgery occasionally caused grade 4–5 events. 5-year-OS showed no significant difference: 31.6 % for SBRT [95 %-CI 23.9–41.5 %], 37.8 % for surgery [95 %-CI 30–41.9 %].</div></div><div><h3>Conclusion</h3><div>Evidence indicates SBRT and surgery provide comparable outcomes for sarcoma- PM, with SBRT offering a more favorable toxicity profile. Though heterogeneous indications and incomplete reporting limit comparability, SBRT should not be viewed solely as fallback for surgically ineligible patients. Treatment should be individualized within a multidisciplinary expert team, integrating patient- and modality-specific factors. Well-designed prospective trials are needed to define relative safety and efficacy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101097"},"PeriodicalIF":2.7,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145880920","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}
Pub Date : 2025-12-17DOI: 10.1016/j.ctro.2025.101099
Chujie Li , Xiaojun Li , Rianne Biemans , Rui Zhang , Ming Zhang , Ludwig J. Dubois
Objective
Radiotherapy is a primary treatment for many cancers, but its efficacy is often limited by collateral damage to healthy tissues. Radioadaptation, a phenomenon where low-dose radiotherapy (LDRT) enhances a cell’s ability to withstand subsequent high-dose radiation, occurs in normal cells but is generally absent in cancer cells. Quercetin, a natural flavonoid with antioxidant and anticancer properties, has been proposed as a potential radiomodulator. This study aimed to investigate whether quercetin could differentially regulate the radioadaptive response in human normal breast epithelial versus breast cancer cells.
Methods
Cell viability, clonogenic survival, oxidative stress, and DNA damage responses were assessed in MCF10A and MCF7 cells following treatment with LDRT (0.1 Gy), quercetin, and high-dose radiation. NQO1 and NRF2 expression levels were measured using RT-qPCR, Western blotting, and immunofluorescence. DNA damage was evaluated by γ-H2AX foci and p-ATM levels.
Results
In MCF10A cells, LDRT pre-treatment enhanced resistance to subsequent radiation, which was further potentiated by quercetin, as shown by increased cell viability (p = 0.007), increased surviving fraction (enhancement ratio = 0.85, at 10 % surviving fraction), enhanced adaptation at 4 h on NQO1 mRNA (p < 0.01) and protein expression (p < 0.01), with a modest effect at 24 h on NQO1 mRNA (p = 0.890) and protein (p = 0.453) and reduced ROS level at 24 h (p = 0.021). Quercetin promoted NRF2 delocalization (p = 0.005). In contrast, MCF7 cells showed no radioadaptive response, and quercetin even increased radiosensitivity (enhancement ratio of surviving fraction = 1.12, at 10 surviving fraction) by maintaining ROS levels and DNA damage.
Conclusion
Quercetin selectively enhances radioadaptation in normal cells by activating antioxidant pathways and reducing DNA damage, while preserving or amplifying radiosensitivity in cancer cells. These findings support quercetin may serve as a potential radiomodulating agent with favorable safety for increasing the therapeutic window of radiotherapy.
{"title":"Differential regulation of radioadaptation by quercetin between human normal and cancer cells","authors":"Chujie Li , Xiaojun Li , Rianne Biemans , Rui Zhang , Ming Zhang , Ludwig J. Dubois","doi":"10.1016/j.ctro.2025.101099","DOIUrl":"10.1016/j.ctro.2025.101099","url":null,"abstract":"<div><h3>Objective</h3><div>Radiotherapy is a primary treatment for many cancers, but its efficacy is often limited by collateral damage to healthy tissues. Radioadaptation, a phenomenon where low-dose radiotherapy (LDRT) enhances a cell’s ability to withstand subsequent high-dose radiation, occurs in normal cells but is generally absent in cancer cells. Quercetin, a natural flavonoid with antioxidant and anticancer properties, has been proposed as a potential radiomodulator. This study aimed to investigate whether quercetin could differentially regulate the radioadaptive response in human normal breast epithelial versus breast cancer cells.</div></div><div><h3>Methods</h3><div>Cell viability, clonogenic survival, oxidative stress, and DNA damage responses were assessed in MCF10A and MCF7 cells following treatment with LDRT (0.1 Gy), quercetin, and high-dose radiation. NQO1 and NRF2 expression levels were measured using RT-qPCR, Western blotting, and immunofluorescence. DNA damage was evaluated by γ-H2AX foci and p-ATM levels.</div></div><div><h3>Results</h3><div>In MCF10A cells, LDRT pre-treatment enhanced resistance to subsequent radiation, which was further potentiated by quercetin, as shown by increased cell viability (p = 0.007), increased surviving fraction (enhancement ratio = 0.85, at 10 % surviving fraction), enhanced adaptation at 4 h on NQO1 mRNA (p < 0.01) and protein expression (p < 0.01), with a modest effect at 24 h on NQO1 mRNA (p = 0.890) and protein (p = 0.453) and reduced ROS level at 24 h (p = 0.021). Quercetin promoted NRF2 delocalization (p = 0.005). In contrast, MCF7 cells showed no radioadaptive response, and quercetin even increased radiosensitivity (enhancement ratio of surviving fraction = 1.12, at 10 surviving fraction) by maintaining ROS levels and DNA damage.</div></div><div><h3>Conclusion</h3><div>Quercetin selectively enhances radioadaptation in normal cells by activating antioxidant pathways and reducing DNA damage, while preserving or amplifying radiosensitivity in cancer cells. These findings support quercetin may serve as a potential radiomodulating agent with favorable safety for increasing the therapeutic window of radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101099"},"PeriodicalIF":2.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798238","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}
Pub Date : 2025-12-17DOI: 10.1016/j.ctro.2025.101098
Renske van Noortwijk, Petra S. Kroon, Katelijne M. van Vliet-van den Ende, Erik H. Brondijk, Gonda G. Sikkes, Alexis N.T.J. Kotte, Ina M. Jürgenliemk-Schulz, Femke van der Leij, Astrid L.H.M.W. van Lier
Background and purpose
Standard treatment for locally advanced cervical cancer (LACC) is chemoradiotherapy followed by a brachytherapy (BT) boost. However, BT is not always feasible and magnetic resonance (MR)-guided adaptive radiotherapy on the MR-Linac (MRL) might be an alternative. To investigate the dosimetric feasibility of MRL, BT and MRL treatment plans were compared intra-patient in terms of dosimetric differences, next to anatomical and conformity variations.
Materials and methods
Two groups of ten patients with LACC treated with BT boost were selected: group 1 included patients for which at least one clinically established (EMBRACE II) treatment planning constraint was not achieved during BT, in group 2 all planning constraints were achieved.
BT treatment plans were compared with MRL treatment plans (based on MRI scans without applicator in place) intra-patient, in terms of dose-volume histogram (DVH) parameters, target-to-OAR (organ at risk) surface distances and conformity ratios.
Results
Group 1 resulted in similar prescribed target dose levels for MRL compared to BT, for group 2 all prescribed target dose levels were significantly higher for BT. Rectum D2cm3 was higher for all MRL treatment plans. Volumes of higher dose levels were larger for BT, volumes of lower dose levels were larger for MRL and the CTVHR to OAR (rectum, sigmoid, bowel) surface distance was greater for BT.
Conclusion
This retrospective study demonstrates that with an MRL boost plan, in some situations it is possible to achieve established planning constraints. However, as rectum doses are higher and dose distributions are fundamentally different, BT remains the modality of choice. Clinical trials are necessary to investigate the influence of the MRL dose distribution on oncological outcomes.
{"title":"Dosimetric comparison between brachytherapy and MR-Linac as a boost modality for locally advanced cervical cancer","authors":"Renske van Noortwijk, Petra S. Kroon, Katelijne M. van Vliet-van den Ende, Erik H. Brondijk, Gonda G. Sikkes, Alexis N.T.J. Kotte, Ina M. Jürgenliemk-Schulz, Femke van der Leij, Astrid L.H.M.W. van Lier","doi":"10.1016/j.ctro.2025.101098","DOIUrl":"10.1016/j.ctro.2025.101098","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Standard treatment for locally advanced cervical cancer (LACC) is chemoradiotherapy followed by a brachytherapy (BT) boost. However, BT is not always feasible and magnetic resonance (MR)-guided adaptive radiotherapy on the MR-Linac (MRL) might be an alternative. To investigate the dosimetric feasibility of MRL, BT and MRL treatment plans were compared intra-patient in terms of dosimetric differences, next to anatomical and conformity variations.</div></div><div><h3>Materials and methods</h3><div>Two groups of ten patients with LACC treated with BT boost were selected: group 1 included patients for which at least one clinically established (EMBRACE II) treatment planning constraint was not achieved during BT, in group 2 all planning constraints were achieved.</div><div>BT treatment plans were compared with MRL treatment plans (based on MRI scans without applicator in place) intra-patient, in terms of dose-volume histogram (DVH) parameters, target-to-OAR (organ at risk) surface distances and conformity ratios.</div></div><div><h3>Results</h3><div>Group 1 resulted in similar prescribed target dose levels for MRL compared to BT, for group 2 all prescribed target dose levels were significantly higher for BT. Rectum D2cm<sup>3</sup> was higher for all MRL treatment plans. Volumes of higher dose levels were larger for BT, volumes of lower dose levels were larger for MRL and the CTV<sub>HR</sub> to OAR (rectum, sigmoid, bowel) surface distance was greater for BT.</div></div><div><h3>Conclusion</h3><div>This retrospective study demonstrates that with an MRL boost plan, in some situations it is possible to achieve established planning constraints. However, as rectum doses are higher and dose distributions are fundamentally different, BT remains the modality of choice. Clinical trials are necessary to investigate the influence of the MRL dose distribution on oncological outcomes.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101098"},"PeriodicalIF":2.7,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798322","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}
Pub Date : 2025-12-14DOI: 10.1016/j.ctro.2025.101096
Ciro Franzese , Stephanie Tanadini-Lang , Dirk Verellen , Lisa Wiersema , Juliane Hörner-Rieber , Alejandra Méndez Romero , David Pasquier , Anna Bruynzeel , Judit Boda-Heggemann , Tom Depuydt , Patrik Sibolt , Najma Douir , Łukasz Kuncman , Casper Beijst , Harley Stephens , Carolina de la Pinta , Francesco Cuccia , Maaike Milder , Luca Nicosia , Hiroshi Onishi , Marta Scorsetti
Background
Stereotactic Body Radiation Therapy (SBRT) has become an established treatment for several primary and metastatic malignancies; however, considerable heterogeneity remains in its definition, clinical indications, and technical delivery.
Methods
In May 2025, the SBRT Focus Group of the European Society for Radiotherapy and Oncology (ESTRO), in collaboration with International Stereotactic Radiosurgery Society (ISRS), the Radiosurgery Society (RSS), and the Japanese Society for Radiation Oncology (JASTRO), conducted a global survey. A 44-item questionnaire explored SBRT indications, technical aspects, dose/fractionation, and barriers to implementation. Descriptive statistics summarized the responses.
Results
Overall, 289 professionals from 59 countries participated. Routine use of SBRT was reported by 96.6 % of respondents, with lung, bone, liver and prostate as the most frequent indications. Pancreatic tumor (48.4 %), renal cell carcinoma (46.4 %), and ventricular tachycardia (12.4 %) represented emerging indications. C-arm linacs (89.2 %) and in-room Cone beam CT (CBCT) (92.0 %) were the dominant technologies. Motion management relied mainly on 4D-CT internal target volume (ITV) (88.9 %) and deep inspiration breath-hold (DIBH) (57.8 %). Fractionation was consistent for lung and prostate but heterogeneous for liver, and pancreas. Only 3.5 % reported routine use of online adaptive SBRT, while 61.5 % reported artificial intelligence (AI) use, mainly for organs-at-risk delineation. Key barriers included limited clinical trial funding (35.2 %), high equipment costs (34.2 %), insufficient reimbursement (27.7 %), and workforce shortages (33.9 %).
Conclusions
This ESTRO international survey provides the first global overview of SBRT practices. It demonstrates broad adoption but also substantial variability, highlighting the need for consensus guidelines, greater trial access, and expanded education to harmonize SBRT delivery and ensure equitable care worldwide.
{"title":"Clinical practice, barriers to implementation, and priorities for equitable access of Stereotactic Body Radiation Therapy: An analysis of the global status by the ESTRO SBRT Focus Group","authors":"Ciro Franzese , Stephanie Tanadini-Lang , Dirk Verellen , Lisa Wiersema , Juliane Hörner-Rieber , Alejandra Méndez Romero , David Pasquier , Anna Bruynzeel , Judit Boda-Heggemann , Tom Depuydt , Patrik Sibolt , Najma Douir , Łukasz Kuncman , Casper Beijst , Harley Stephens , Carolina de la Pinta , Francesco Cuccia , Maaike Milder , Luca Nicosia , Hiroshi Onishi , Marta Scorsetti","doi":"10.1016/j.ctro.2025.101096","DOIUrl":"10.1016/j.ctro.2025.101096","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic Body Radiation Therapy (SBRT) has become an established treatment for several primary and metastatic malignancies; however, considerable heterogeneity remains in its definition, clinical indications, and technical delivery.</div></div><div><h3>Methods</h3><div>In May 2025, the SBRT Focus Group of the European Society for Radiotherapy and Oncology (ESTRO), in collaboration with International Stereotactic Radiosurgery Society (ISRS), the Radiosurgery Society (RSS), and the Japanese Society for Radiation Oncology (JASTRO), conducted a global survey. A 44-item questionnaire explored SBRT indications, technical aspects, dose/fractionation, and barriers to implementation. Descriptive statistics summarized the responses.</div></div><div><h3>Results</h3><div>Overall, 289 professionals from 59 countries participated. Routine use of SBRT was reported by 96.6 % of respondents, with lung, bone, liver and prostate as the most frequent indications. Pancreatic tumor (48.4 %), renal cell carcinoma (46.4 %), and ventricular tachycardia (12.4 %) represented emerging indications. C-arm linacs (89.2 %) and in-room Cone beam CT (CBCT) (92.0 %) were the dominant technologies. Motion management relied mainly on 4D-CT internal target volume (ITV) (88.9 %) and deep inspiration breath-hold (DIBH) (57.8 %). Fractionation was consistent for lung and prostate but heterogeneous for liver, and pancreas. Only 3.5 % reported routine use of online adaptive SBRT, while 61.5 % reported artificial intelligence (AI) use, mainly for organs-at-risk delineation. Key barriers included limited clinical trial funding (35.2 %), high equipment costs (34.2 %), insufficient reimbursement (27.7 %), and workforce shortages (33.9 %).</div></div><div><h3>Conclusions</h3><div>This ESTRO international survey provides the first global overview of SBRT practices. It demonstrates broad adoption but also substantial variability, highlighting the need for consensus guidelines, greater trial access, and expanded education to harmonize SBRT delivery and ensure equitable care worldwide.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101096"},"PeriodicalIF":2.7,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798241","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}
Pub Date : 2025-12-12DOI: 10.1016/j.ctro.2025.101095
Max Samuel, Laure Marignol
Aims
To evaluate the association of ferroptosis-related gene expression with overall survival (OS) across multiple cancer types and explore their relationship to biological sex and radiation therapy (RT) outcomes.
Methods
Ferroptosis regulators were identified through a literature review and cross-referenced with the FerrDb database, yielding 55 candidate genes. Five cancers commonly treated with RT were selected. Kaplan-Meier analyses were performed to assess OS associations for each gene, with hazard ratios (HR) and p-values recorded. Segregated analysis according to biological sex were conducted on candidate genes. The analysis was repeated in a cohort of RT treated lung cancer patients.
Results
Across five cancers commonly treated with radiation therapy (RT), 18–35 of 55 ferroptosis-related genes were significantly associated with overall survival (OS). GLS2 and BECN1 were significantly associated with improved OS in all five cancers. SLC7A11 was significant in four cancers and generally associated with poorer OS. Sex differences in the association between these three genes and OS were detected. In RT-treated lung cancer patients (n = 65), HSPB1, GLS2 and GPX4 were associated with improved OS, SLC7A11 with worse OS.
Conclusions
This study provides first evidence of sex-differences in ferroptosis-related gene expression with potential clinical relevance. This pan-cancer resource links ferroptosis-related genes to survival outcomes and highlights SLC7A11, BECN1, and GLS2 as high-priority candidates for future mechanistic and clinical studies. Integrating sex as a biological variable into study design and interpretation will enhance clinical relevance.
{"title":"Pan-Cancer profiling of ferroptosis-related genes reveals prognostic biomarkers and sex-specific associations","authors":"Max Samuel, Laure Marignol","doi":"10.1016/j.ctro.2025.101095","DOIUrl":"10.1016/j.ctro.2025.101095","url":null,"abstract":"<div><h3>Aims</h3><div>To evaluate the association of ferroptosis-related gene expression with overall survival (OS) across multiple cancer types and explore their relationship to biological sex and radiation therapy (RT) outcomes.</div></div><div><h3>Methods</h3><div>Ferroptosis regulators were identified through a literature review and cross-referenced with the FerrDb database, yielding 55 candidate genes. Five cancers commonly treated with RT were selected. Kaplan-Meier analyses were performed to assess OS associations for each gene, with hazard ratios (HR) and p-values recorded. Segregated analysis according to biological sex were conducted on candidate genes. The analysis was repeated in a cohort of RT treated lung cancer patients.</div></div><div><h3>Results</h3><div>Across five cancers commonly treated with radiation therapy (RT), 18–35 of 55 ferroptosis-related genes were significantly associated with overall survival (OS). <em>GLS2</em> and <em>BECN1</em> were significantly associated with improved OS in all five cancers. <em>SLC7A11</em> was significant in four cancers and generally associated with poorer OS. Sex differences in the association between these three genes and OS were detected. In RT-treated lung cancer patients (n = 65), <em>HSPB1</em>, <em>GLS2</em> and <em>GPX4</em> were associated with improved OS, <em>SLC7A11</em> with worse OS.</div></div><div><h3>Conclusions</h3><div>This study provides first evidence of sex-differences in ferroptosis-related gene expression with potential clinical relevance. This pan-cancer resource links ferroptosis-related genes to survival outcomes and highlights <em>SLC7A11</em>, <em>BECN1</em>, and <em>GLS2</em> as high-priority candidates for future mechanistic and clinical studies. Integrating sex as a biological variable into study design and interpretation will enhance clinical relevance.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101095"},"PeriodicalIF":2.7,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798240","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}
Prostate cancer (PCa) is the most common urologic malignancy in men, with most cases diagnosed at a localized stage. The benefit of whole-pelvic radiotherapy (WPRT) to eradicate subclinical nodal disease remains debated, particularly in intermediate-risk PCa. This study assessed the impact of WPRT in this population.
Methods
We conducted a multicenter retrospective study within the AP-HP GRRAP program across five radiotherapy departments. Biopsy-proven intermediate-risk PCa (d’Amico classification) treated with conformational external beam radiotherapy between 2010 and 2019 were included. The primary endpoint was recurrence-free survival (RFS), defined as time from diagnosis to biochemical, local, metastatic recurrence, or death. Secondary endpoints were overall survival (OS) and acute (<6 months) or late (≥6 months) genitourinary (GU), gastrointestinal (GI), and sexual toxicities (CTCAE v4.03/v5.0). Survival outcomes were assessed using univariate and multivariate Cox models.
Results
Three hundred patients (60 per center) were included; 94 % received IMRT and 6 % 3D-RT. After a median follow-up of 77 months, univariate analysis showed no significant association between WPRT and RFS (HR; 0.61; 95 % CI, 0.26–1.42; p = 0.25). Multivariable analysis adjusted for clinical and treatment factors yielded similar results (HR, 0.70; 95 % CI, 0.27 to 1.81; p = 0.46). OS results were also comparable. Rates of grade 2 acute or late toxicities were similar, but grade ≥ 3 late GI toxicity was higher with WPRT (14.3 % vs. 5.4 %; p = 0.045; OR 2.90).
Conclusion
In intermediate-risk PCa, WPRT did not improve RFS or OS compared with prostate-only RT but was associated with an increased risk of severe GI toxicity.
上下文。前列腺癌（PCa）是男性最常见的泌尿系统恶性肿瘤，大多数病例在局部阶段诊断。全盆腔放疗（WPRT）根除亚临床淋巴结疾病的益处仍存在争议，特别是在中危PCa中。本研究评估了WPRT对该人群的影响。方法我们在5个放疗科室的AP-HP GRRAP项目中进行了一项多中心回顾性研究。纳入2010年至2019年期间接受构象外束放疗的活检证实的中危PCa （d 'Amico分类）。主要终点是无复发生存期（RFS），定义为从诊断到生化、局部、转移性复发或死亡的时间。次要终点是总生存期（OS）和急性（6个月）或晚期（≥6个月）泌尿生殖系统（GU）、胃肠道（GI）和性毒性（CTCAE v4.03/v5.0）。使用单因素和多因素Cox模型评估生存结果。结果纳入300例患者（每个中心60例）；94%接受IMRT， 6%接受3D-RT。中位随访77个月后，单因素分析显示WPRT和RFS之间无显著相关性（HR 0.61; 95% CI 0.26-1.42; p = 0.25）。多变量分析调整了临床和治疗因素，结果相似（HR, 0.70; 95% CI, 0.27 ~ 1.81; p = 0.46）。OS结果也具有可比性。2级急性或晚期毒性发生率相似，但WPRT≥3级晚期胃肠道毒性较高（14.3% vs. 5.4%; p = 0.045; or 2.90）。结论：在中危PCa中，WPRT与单纯前列腺RT相比并没有改善RFS或OS，但与严重胃肠道毒性的风险增加有关。
{"title":"Benefit of prophylactic pelvic irradiation in intermediate-risk prostate cancer: A multicenter retrospective study (iPPAPI)","authors":"Charles Raynaud , Rafik Nebbache , Yazid Belkacemi , Cyrus Chargari , Catherine Durdux , Christophe Hennequin , Florence Huguet , Laurent Quero , Jean-Emmanuel Bibault","doi":"10.1016/j.ctro.2025.101093","DOIUrl":"10.1016/j.ctro.2025.101093","url":null,"abstract":"<div><div>Context.</div><div>Prostate cancer (PCa) is the most common urologic malignancy in men, with most cases diagnosed at a localized stage. The benefit of whole-pelvic radiotherapy (WPRT) to eradicate subclinical nodal disease remains debated, particularly in intermediate-risk PCa. This study assessed the impact of WPRT in this population.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective study within the AP-HP GRRAP program across five radiotherapy departments. Biopsy-proven intermediate-risk PCa (d’Amico classification) treated with conformational external beam radiotherapy between 2010 and 2019 were included. The primary endpoint was recurrence-free survival (RFS), defined as time from diagnosis to biochemical, local, metastatic recurrence, or death. Secondary endpoints were overall survival (OS) and acute (<6 months) or late (≥6 months) genitourinary (GU), gastrointestinal (GI), and sexual toxicities (CTCAE v4.03/v5.0). Survival outcomes were assessed using univariate and multivariate Cox models.</div></div><div><h3>Results</h3><div>Three hundred patients (60 per center) were included; 94 % received IMRT and 6 % 3D-RT. After a median follow-up of 77 months, univariate analysis showed no significant association between WPRT and RFS (HR; 0.61; 95 % CI, 0.26–1.42; p = 0.25). Multivariable analysis adjusted for clinical and treatment factors yielded similar results (HR, 0.70; 95 % CI, 0.27 to 1.81; <em>p</em> = 0.46). OS results were also comparable. Rates of grade 2 acute or late toxicities were similar, but grade ≥ 3 late GI toxicity was higher with WPRT (14.3 % vs. 5.4 %; p = 0.045; OR 2.90).</div></div><div><h3>Conclusion</h3><div>In intermediate-risk PCa, WPRT did not improve RFS or OS compared with prostate-only RT but was associated with an increased risk of severe GI toxicity.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101093"},"PeriodicalIF":2.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697912","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}
Pub Date : 2025-12-05DOI: 10.1016/j.ctro.2025.101091
Jennifer Le Guévelou , Miguel Castro , Blanche Texier , Anaïs Barateau , Romane-Alizé Martin , Caroline Lafond , Igor Bessières , Jean-Claude Nunes , Renaud De Crevoisier , Oscar Acosta
Introduction
While urinary organs at risk (OARs) such as the intraprostatic urethra and the bladder trigone are increasingly recognized as associated with severe genitourinary toxicity, their delineation in clinical practice is time consuming and probably associated with a large interobserver variability. The aim of this study was to propose a magnetic resonance (MR) deep learning segmentation of urinary OARs for prostate cancer (PCa) radiotherapy (RT), based on a validated atlas.
Material and methods
In this multicentric study, a convolutional neural network (CNN) for image segmentation (nnU-Net) was trained and validated on three image datasets. Two datasets came from MR-linac devices (Unity®, Elekta and MRIdian®, Viewray), and one dataset came from the PROSTATEx database (MAGNETOM® Trio and Skyra, Siemens). Evaluation of the deep learning segmentation was performed using dice score coefficients (DSC), surface distance (SD) and Hausdorff distance.
Results
A total of 265 MRI were analyzed. The mean DSC for all urinary structures was 0.88. The automatic segmentation model proved to be effective in the segmentation of the target volume and large OARs such as the bladder (mean DSC ranging of 0.95). Regarding urinary OARs, the mean DSC ranged between 0.50 and 0.68. The Hausdorff distance ranged between 4.0 mm to 10.3 mm for urinary OARs, highlighting local mismatches caused by large anatomical variations between patients. However, the SD ranged between 1.0 mm and 1.3 mm for urinary OARs, highlighting an overall good surface correlation for all organs.
Conclusion
This multicentric study is the first to propose a nnU-Net deep learning model for the delineation of urinary OARs, that can be applied to various image dataset. Further work is needed to assess the dosimetric impact of such variations, in various clinical scenarios.
{"title":"Geometric evaluation of a deep learning method for segmentation of urinary OARs on magnetic resonance imaging for prostate cancer radiotherapy","authors":"Jennifer Le Guévelou , Miguel Castro , Blanche Texier , Anaïs Barateau , Romane-Alizé Martin , Caroline Lafond , Igor Bessières , Jean-Claude Nunes , Renaud De Crevoisier , Oscar Acosta","doi":"10.1016/j.ctro.2025.101091","DOIUrl":"10.1016/j.ctro.2025.101091","url":null,"abstract":"<div><h3>Introduction</h3><div>While urinary organs at risk (OARs) such as the intraprostatic urethra and the bladder trigone are increasingly recognized as associated with severe genitourinary toxicity, their delineation in clinical practice is time consuming and probably associated with a large interobserver variability. The aim of this study was to propose a magnetic resonance (MR) deep learning segmentation of urinary OARs for prostate cancer (PCa) radiotherapy (RT), based on a validated atlas.</div></div><div><h3>Material and methods</h3><div>In this multicentric study, a convolutional neural network (CNN) for image segmentation (nnU-Net) was trained and validated on three image datasets. Two datasets came from MR-linac devices (Unity®, Elekta and MRIdian®, Viewray), and one dataset came from the PROSTATEx database (MAGNETOM® Trio and Skyra, Siemens). Evaluation of the deep learning segmentation was performed using dice score coefficients (DSC), surface distance (SD) and Hausdorff distance.</div></div><div><h3>Results</h3><div>A total of 265 MRI were analyzed. The mean DSC for all urinary structures was 0.88. The automatic segmentation model proved to be effective in the segmentation of the target volume and large OARs such as the bladder (mean DSC ranging of 0.95). Regarding urinary OARs, the mean DSC ranged between 0.50 and 0.68. The Hausdorff distance ranged between 4.0 mm to 10.3 mm for urinary OARs, highlighting local mismatches caused by large anatomical variations between patients. However, the SD ranged between 1.0 mm and 1.3 mm for urinary OARs, highlighting an overall good surface correlation for all organs.</div></div><div><h3>Conclusion</h3><div>This multicentric study is the first to propose a nnU-Net deep learning model for the delineation of urinary OARs, that can be applied to various image dataset. Further work is needed to assess the dosimetric impact of such variations, in various clinical scenarios.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101091"},"PeriodicalIF":2.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681363","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}
Pub Date : 2025-12-05DOI: 10.1016/j.ctro.2025.101092
Goda Kalinauskaite , Luise A. Künzel , Kerstin Rubarth , Thao Nguyen , Jakob Dannehl , Celina Höhne , Marcus Beck , Julia Bauer , Daniel Zips , Carolin Senger
Purpose
To compare patient-reported outcome measures (PROMs) in patients treated either with cone-beam CT (CBCT)-based online adaptive radiotherapy (oART) or with CBCT-guided conventional image guided radiotherapy (IGRT).
Materials and methods
In this prospective study with convenience allocation, patients with localized prostate cancer received 62 Gy/20 fractions using either daily CBCT-based oART or CBCT-guided conventional IGRT. PROMs (EPIC, QLQ-PR25, IPSS, NCI-PRO-CTCAE) were collected at baseline and at end of therapy. Changes in scores and clinically meaningful deterioration, based on established minimal clinically important differences (MCID), were analyzed.
Results
Seventy-four patients were included (oART: 58.1 %; IGRT: 41.9 %). Groups were demographically similar, although the oART group included more patients with high-risk tumors (40.5 % vs. 9.7 %, p = 0.03). Patients after oART tended to experience smaller, although not statistically significant, declines in health-related quality of life (HRQoL) domains compared to IGRT: EPIC urinary summary (−12.15 vs −20.57, p = 0.07), urinary function (−9.53 vs −17.47, p = 0.05), urinary incontinence (−5.47 vs −13.93, p = 0.07) and PR25 urinary symptom (20.0 vs. 27.5, p = 0.06). EPIC bowel function decline was also less pronounced (−12.64 vs. −19.78, p = 0.10). NCI-PRO-CTCAE scores favored oART for reduced urinary urgency (0.95 vs. 1.57, p = 0.02) and fecal incontinence (0.03 vs. 0.71, p = 0.02). Fewer oART patients reached MCID thresholds for urinary (8–21 %) and bowel (20–23 %) deterioration, but these differences were not statistically significant.
Conclusion
Our results suggest a small but consistent trend in PROM scores favoring oART over conventional IGRT. In addition, the results may inform the design of controlled randomized trials in the future.
目的比较采用基于锥形束CT （CBCT）的在线自适应放疗（oART）或CBCT引导下的传统图像引导放疗（IGRT）治疗的患者报告的预后指标（PROMs）。材料和方法在这项前瞻性研究中，局部前列腺癌患者采用每日基于cbct的oART或cbct引导的常规IGRT，接受62 Gy/20的剂量。在基线和治疗结束时收集PROMs （EPIC, QLQ-PR25， IPSS, NCI-PRO-CTCAE）。基于已建立的最小临床重要差异（MCID），分析评分变化和临床意义恶化。结果共纳入74例患者（oART: 58.1%; IGRT: 41.9%）。各组在人口统计学上相似，尽管oART组包括更多的高危肿瘤患者（40.5%比9.7%,p = 0.03）。与IGRT相比，oART患者在健康相关生活质量（HRQoL）领域的下降幅度较小，但无统计学意义：EPIC尿汇总（- 12.15 vs - 20.57, p = 0.07）、泌尿功能（- 9.53 vs - 17.47, p = 0.05）、尿失禁（- 5.47 vs - 13.93, p = 0.07）和PR25尿症状（20.0 vs. 27.5, p = 0.06）。EPIC组的肠功能下降也不那么明显（- 12.64 vs - 19.78, p = 0.10）。NCI-PRO-CTCAE评分在减少尿急（0.95比1.57,p = 0.02）和大便失禁（0.03比0.71,p = 0.02）方面有利于oART。较少的oART患者达到MCID阈值的尿（8 - 21%）和肠（20 - 23%）恶化，但这些差异没有统计学意义。结论：我们的研究结果表明，在PROM评分中，oART优于传统IGRT的趋势虽小但一致。此外，这些结果可能为将来的随机对照试验的设计提供信息。
{"title":"Prospective controlled study comparing patient-reported outcomes after daily online adaptive radiotherapy or conventional IGRT in patients with prostate cancer","authors":"Goda Kalinauskaite , Luise A. Künzel , Kerstin Rubarth , Thao Nguyen , Jakob Dannehl , Celina Höhne , Marcus Beck , Julia Bauer , Daniel Zips , Carolin Senger","doi":"10.1016/j.ctro.2025.101092","DOIUrl":"10.1016/j.ctro.2025.101092","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare patient-reported outcome measures (PROMs) in patients treated either with cone-beam CT (CBCT)-based online adaptive radiotherapy (oART) or with CBCT-guided conventional image guided radiotherapy (IGRT).</div></div><div><h3>Materials and methods</h3><div>In this prospective study with convenience allocation, patients with localized prostate cancer received 62 Gy/20 fractions using either daily CBCT-based oART or CBCT-guided conventional IGRT. PROMs (EPIC, QLQ-PR25, IPSS, NCI-PRO-CTCAE) were collected at baseline and at end of therapy. Changes in scores and clinically meaningful deterioration, based on established minimal clinically important differences (MCID), were analyzed.</div></div><div><h3>Results</h3><div>Seventy-four patients were included (oART: 58.1 %; IGRT: 41.9 %). Groups were demographically similar, although the oART group included more patients with high-risk tumors (40.5 % vs. 9.7 %, p = 0.03). Patients after oART tended to experience smaller, although not statistically significant, declines in health-related quality of life (HRQoL) domains compared to IGRT: EPIC urinary summary (−12.15 vs −20.57, p = 0.07), urinary function (−9.53 vs −17.47, p = 0.05), urinary incontinence (−5.47 vs −13.93, p = 0.07) and PR25 urinary symptom (20.0 vs. 27.5, p = 0.06). EPIC bowel function decline was also less pronounced (−12.64 vs. −19.78, p = 0.10). NCI-PRO-CTCAE scores favored oART for reduced urinary urgency (0.95 vs. 1.57, p = 0.02) and fecal incontinence (0.03 vs. 0.71, p = 0.02). Fewer oART patients reached MCID thresholds for urinary (8–21 %) and bowel (20–23 %) deterioration, but these differences were not statistically significant.</div></div><div><h3>Conclusion</h3><div>Our results suggest a small but consistent trend in PROM scores favoring oART over conventional IGRT. In addition, the results may inform the design of controlled randomized trials in the future<strong>.</strong></div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101092"},"PeriodicalIF":2.7,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798239","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}
Pub Date : 2025-12-02DOI: 10.1016/j.ctro.2025.101087
Mianyong Ding , Matteo Maspero , Semi Harrabi , Emmanuel Jouglar , Sabina Vennarini , Timothy Spencer , Britta Weber , Henriette Magelssen , Karen Van Beek , Remus Stoica , Simonetta Saldi , Tom Boterberg , Patrick Melchior , Marry M. van den Heuvel-Eibrink , Geert O. Janssens
We appreciate the commentary from Saad et al., which offers an opportunity to clarify key methodological and clinical aspects of our study assessing the impact of deep learning–based CT auto-contouring for organ-at-risk delineation in paediatric flank irradiation for renal tumours. First, the annotation protocol was provided in the original Supplementary Materials, and additional delineation instructions followed established SIOP-RTSG standards. Second, as already mentioned in the manuscript discussion, we acknowledge the inherent bias associated with STAPLE consensus contours, and we addressed this by including an additional single-expert reference in our evaluation. Third, although dose analysis can provide valuable clinical insights, it is not essential at this stage, as geometric evaluation remains the main benchmark for validating auto-contouring performance. Fourth, while uncertainty quantification is a promising research direction, our study was designed to reflect current clinical practice, where uncertainty-aware segmentation has not yet been integrated into routine auto-segmentation systems. Finally, we recognize that our controlled workshop environment does not fully reflect real-world clinical workflows, a limitation already discussed in our original manuscript. We hope these clarifications foster a balanced understanding of our work and support ongoing efforts toward the safe and effective clinical adoption of AI-assisted contouring in paediatric radiotherapy.
{"title":"Reply to comment on impact of deep learning on CT-based organ-at-risk delineation for flank irradiation in paediatric renal tumours: A SIOP-RTSG radiotherapy committee","authors":"Mianyong Ding , Matteo Maspero , Semi Harrabi , Emmanuel Jouglar , Sabina Vennarini , Timothy Spencer , Britta Weber , Henriette Magelssen , Karen Van Beek , Remus Stoica , Simonetta Saldi , Tom Boterberg , Patrick Melchior , Marry M. van den Heuvel-Eibrink , Geert O. Janssens","doi":"10.1016/j.ctro.2025.101087","DOIUrl":"10.1016/j.ctro.2025.101087","url":null,"abstract":"<div><div>We appreciate the commentary from Saad et al., which offers an opportunity to clarify key methodological and clinical aspects of our study assessing the impact of deep learning–based CT auto-contouring for organ-at-risk delineation in paediatric flank irradiation for renal tumours. First, the annotation protocol was provided in the original Supplementary Materials, and additional delineation instructions followed established SIOP-RTSG standards. Second, as already mentioned in the manuscript discussion, we acknowledge the inherent bias associated with STAPLE consensus contours, and we addressed this by including an additional single-expert reference in our evaluation. Third, although dose analysis can provide valuable clinical insights, it is not essential at this stage, as geometric evaluation remains the main benchmark for validating auto-contouring performance. Fourth, while uncertainty quantification is a promising research direction, our study was designed to reflect current clinical practice, where uncertainty-aware segmentation has not yet been integrated into routine auto-segmentation systems. Finally, we recognize that our controlled workshop environment does not fully reflect real-world clinical workflows, a limitation already discussed in our original manuscript. We hope these clarifications foster a balanced understanding of our work and support ongoing efforts toward the safe and effective clinical adoption of AI-assisted contouring in paediatric radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101087"},"PeriodicalIF":2.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749564","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}
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