Clinical and Translational Radiation Oncology最新文献

{"title":"Reirradiation for locally recurrent soft tissue sarcomas: A systematic review","authors":"Konrad Zasadziński ,&nbsp;Aleksandra Bochyńska ,&nbsp;Aneta Borkowska ,&nbsp;Piotr Rutkowski ,&nbsp;Mateusz Spałek","doi":"10.1016/j.ctro.2025.101088","DOIUrl":"10.1016/j.ctro.2025.101088","url":null,"abstract":"<div><div>Locally recurrent soft tissue sarcomas (LRSTS) present a significant clinical challenge.There are major limitations to secondary treatment modalities. Reirradiation in such cases has traditionally been considered contraindicated due to the risk of severe normal tissue toxicity. On the other hand, there is evidence showing that multimodality salvage treatment can improve outcomes in some patients. The objective of this systematic review is to determine the feasibility of reirradiation in LRSTS. This systematic review included clinical studies that presented outcomes of patients who underwent any form of repeated radiation treatment for LRSTS. Authors used PubMed Medline, Embase and Scopus databases. This review follows the PRISMA guidelines. The search and selection identified 20 studies involving reirradiation for LRSTS, encompassing a total of 437 patients. Reirradiation modalities comprised brachytherapy, intraoperative radiotherapy (RT), external-beam RT, carbon ion RT and proton RT, as either definitive or perioperative treatment. Reirradiation doses varied across studies, with cumulative nominal doses exceeding 100 Gy in some cohorts. Local control rates ranged from 15 % to 100 %, with most studies reporting the range of 50–70 %. Overall survival rates were similarly variable. Acute and late toxicities were significant, with grade ≥3 complications reported in up to 50 % of patients. The analysis showed that reirradiation, both definitive or as a part of multimodality treatment, can be used in selected patients with LRSTS. This review is limited by retrospective study designs, and a large heterogeneity in patient populations and treatment regimens. Further quality investigation is needed to clearly determine the indications for reirradiation in LRSTS.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101088"},"PeriodicalIF":2.7,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733144","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}

{"title":"Evaluation of organ-specific relative biological effectiveness of proton therapy using radiation-induced pneumonitis as an endpoint","authors":"Li Liao ,&nbsp;Ting Xu ,&nbsp;Mei Chen ,&nbsp;Tingshi Su ,&nbsp;Narayan Sahoo ,&nbsp;Xiaorong Zhu ,&nbsp;Steven J. Frank ,&nbsp;Quynh-Nhu Nguyen ,&nbsp;Zhongxing Liao ,&nbsp;Xiaodong Zhang","doi":"10.1016/j.ctro.2025.101089","DOIUrl":"10.1016/j.ctro.2025.101089","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Proton therapy has become widely used for non-small cell lung cancer (NSCLC) due to its ability to spare normal tissue. However, the commonly assumed relative biological effectiveness (RBE) of 1.1 may underestimate the therapy’s true biological effects on lung, potentially leading to a higher than expected incidence of radiation-induced pneumonitis (RP). In this retrospective study, we evaluated the variability of organ-specific RBE of proton therapy using RP grade 2 or higher (RP2+) as an endpoint.</div></div><div><h3>Materials and methods</h3><div>Data from 270 NSCLC patients across two clinical trials were analyzed, with 134 given photon therapy and 136 given proton therapy. The physical dose was obtained for all patients, and the dose-averaged linear energy transfer (LET_d) was computed for proton therapy recipients. The Lyman-Kutcher-Burman (LKB) model was used to predict RP2+ incidence. RBE was determined using 1) the ratio of the photon dose to the proton dose achieved the same RP2+ incidence and 2) an LET-based RBE estimation derived from the LET-enhanced LKB model.</div></div><div><h3>Results</h3><div>The estimated RBE for RP2+ in proton therapy recipients was variable and consistently exceeded 1.1. The RBE estimated from the photon-to-proton dose ratio model between 1.10 and 1.35, with an average of 1.28. While the LET-enhanced LKB model yielded an RBE range of 1.13 to 1.33, with an average of 1.23.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the RBE of proton therapy for RP2+ is variable and higher than the conventional 1.1 assumption, emphasizing the need to account for variable RBE in treatment planning.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101089"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681362","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}

{"title":"Clinical evidence and reporting standards in reirradiation: Insights from 28 studies at ESTRO 2025, endorsed by the ESTRO reirradiation focus group","authors":"Arnaud Beddok ,&nbsp;Ane L. Appelt ,&nbsp;Stefanie Corradini ,&nbsp;Aileen Duffton ,&nbsp;Gian Marco Petrianni ,&nbsp;Bartłomiej Tomasik ,&nbsp;Eliana Vásquez Osorio ,&nbsp;Jonas Willmann ,&nbsp;Nicolaus Andratschke","doi":"10.1016/j.ctro.2025.101090","DOIUrl":"10.1016/j.ctro.2025.101090","url":null,"abstract":"<div><h3>Background</h3><div>Reirradiation (reRT) has become an increasingly relevant treatment option across multiple tumor sites, supported by technological advances that improve precision and safety. At the ESTRO 2025 Annual Meeting, 28 clinical studies on reRT were presented. This work provides a structured synthesis of their clinical outcomes and assesses adherence to the ESTRO–EORTC reporting recommendations.</div></div><div><h3>Materials and methods</h3><div>All abstracts presented at ESTRO 2025 (n = 2,962) were screened to identify reRT studies (n = 51). Only studies reporting at least one clinical outcome were retained (n = 28). ReRT was classified as type 1 (with geometric overlap of irradiated volumes) or type 2 (without overlap but with potential OAR dose concerns). Each study was evaluated using the 10 mandatory ESTRO–EORTC reporting criteria, covering demographics, performance status, organ function, recurrence classification, target volume, technique and dose, interval since RT1, cumulative OAR doses, method for dose summation, and CTCAE toxicity. Reporting scores ranged from 0 to 10.</div></div><div><h3>Results</h3><div>The 28 studies encompassed brain, head and neck, thoracic, pelvic, prostate, metastatic, and pediatric settings. Clinical outcomes were encouraging in selected series, with local control &gt; 85 % in the phase I DESTROY-1 dose-escalation trial, median overall survival &gt; 40 months in lung and prostate cohorts, and grade ≥ 3 toxicity generally below 10 %. Reporting quality was heterogeneous: the median score was 5/10 (IQR 4–7). Demographics, prescribed dose, and technique were consistently reported, whereas organ function, cumulative OAR doses, and methods for dose summation were often omitted. Classification as type 1 or type 2 reRT was explicitly provided in only a minority of abstracts. Items such as baseline organ function were often missing, particularly in CNS studies where standardized tests are rarely applicable.</div></div><div><h3>Conclusion</h3><div>The ESTRO 2025 abstract set illustrates both the clinical potential and methodological variability of modern reRT. While outcomes are promising across several sites, adherence to standardized reporting remains limited, underscoring the need for consistent implementation of ESTRO–EORTC recommendations to enable comparability and harmonization.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101090"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749565","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}

{"title":"Cone beam computed tomography-guided online adaptive radiation therapy: Clinical implementation in breast and axillary target volumes","authors":"Angelique R.W. van Vlaenderen ,&nbsp;Judith G. Middelburg-van Rijn ,&nbsp;Koen J. Nelissen ,&nbsp;Karin N. Goudschaal ,&nbsp;Lars ter Beek ,&nbsp;Jessica van der Himst ,&nbsp;Cassey E. Glebbeek ,&nbsp;Lisette M. van Maurik ,&nbsp;Amber L. Bakker ,&nbsp;Nina Bijker ,&nbsp;Joost J.C. Verhoeff ,&nbsp;Ben J. Slotman ,&nbsp;Anna Dinkla ,&nbsp;Wilko F.A.R. Verbakel ,&nbsp;Desirée H.J.G. van den Bongard ,&nbsp;on behalf of the BREAST-ART group","doi":"10.1016/j.ctro.2025.101086","DOIUrl":"10.1016/j.ctro.2025.101086","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Daily differences in breast contour and arm positioning can result in frequent re-positioning and offline re-planning in postoperative breast radiotherapy (RT). Online adaptive radiotherapy (oART) enables daily adaptation of the radiotherapy treatment plan. This study aimed to implement oART in breast and axillary target volumes to eliminate the need for repositioning and replanning.</div></div><div><h3>Materials and methods</h3><div>Patients referred for postoperative partial breast irradiation (PBI) and whole breast irradiation (WBI)/post-mastectomy radiotherapy (PMRT) with or without axillary levels I-II (5x5.2 Gy) or I-IV (15x2.67 Gy) were included. On-couch treatment times were evaluated as well as dosimetry, target volume, acute toxicity, and in-house satisfaction questionnaires.</div></div><div><h3>Results</h3><div>Seventy-nine patients (n = 66 PBI/WBI/PMRT, n = 13 WBI + axillary levels I-II/I-IV) were treated with postoperative RT (465 fractions). On-couch median time ranged from 14.5 (range: 10.1–29.2) minutes for right-sided WBI to 25.8 (range: 22.6–36.8) minutes for left-sided WBI + axillary levels I-II. All adapted treatment plans met the D98% ≥ 95 % coverage criteria for the target PTV. Relative breast CTV volumes for the adapted plan decreased in fraction 1 and increased in fractions 2–5 compared to the CTV volume on the planning CT. Toxicity was mainly grades 0 and 1 and patient satisfaction was good.</div></div><div><h3>Conclusion</h3><div>Implementation of oART was feasible in all breast target volumes with acceptable treatment duration, only mild acute toxicity, favorable patient-reported comfort, and dosimetry that met clinical standards. Future work will focus on the implementation of oART in RT boost indications, and selection of breast cancer patients who will benefit most from oART.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101086"},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614619","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}

{"title":"Pre-PROTO-PRIME: stereotactic body proton therapy to the prostate and pelvic nodes for high-risk and node-positive prostate cancer — feasibility, acute toxicity and dosimetric insights","authors":"Srinivas Chilukuri ,&nbsp;Sham C Sundar ,&nbsp;Vasanthapriya Subramani ,&nbsp;Manikandan Arjunan ,&nbsp;Vysakh Raveendran ,&nbsp;Ramakrishna Kamath ,&nbsp;Lilawati Meena ,&nbsp;Aishwarya Guruvaiah ,&nbsp;Reena Phurailatpam ,&nbsp;Rajesh Selvaraj ,&nbsp;Lalit Narendra Chaudhari ,&nbsp;Vineeth Kumaar ,&nbsp;Nidhi Jain ,&nbsp;Mahima Tiwari ,&nbsp;Priyanka Halsana ,&nbsp;Dayananda Sharma ,&nbsp;Priyamvada Maitre ,&nbsp;Vedang Murthy","doi":"10.1016/j.ctro.2025.101084","DOIUrl":"10.1016/j.ctro.2025.101084","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to assess the clinical feasibility, acute toxicity, and dosimetric advantages of stereotactic body proton therapy (SBPT) to the prostate and pelvic lymph nodes in high-risk and node-positive prostate cancer.</div></div><div><h3>Methods</h3><div>This multicentric analysis included 26 patients treated from February 2024 to February 2025 with SBPT to the prostate and pelvis delivered in five fractions. The doses prescribed were 36.25 CGE to the prostate, 35 CGE to the gross nodes and 25 CGE to the pelvic nodal CTV. Acute genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated up to three months post-treatment using CTCAE v5.0 criteria. Dosimetric parameters of SBPT plans were compared with matched photon-based SBRT plans, generated using identical datasets. Statistical analyses were performed using SPSS (IBM v30) and Python (v3.10).</div></div><div><h3>Results</h3><div>No grade 3 toxicities were observed. Grade 2 GU toxicity occurred in 27 % of patients, predominantly characterized by dysuria and urinary frequency. Grade 2 GI toxicity was observed in 3.8 % of patients. SBPT demonstrated comparable target coverage to SBRT, both for the prostate (median D97%: 98.4 % vs 98.8 %) and the nodal CTV (median D97%: 97.9 % vs 98.9 %), while significantly improving sparing of organs-at-risk (OAR), notably the bowel bag (median V14: 123 cc vs 422 cc; p &lt; 0.001), rectum (median V20: 11 % vs 26 %; p &lt; 0.0001), and bladder (median V20: 16 % vs 21 %; p = 0.004).</div></div><div><h3>Conclusion</h3><div>SBPT to the prostate and pelvic lymph nodes is clinically feasible, with low acute toxicity and superior OAR sparing compared to photon-based SBRT. The dosimetric data from this study were used to propose volumetric dose constraints for SBPT planning of the prostate and pelvis. These preliminary results substantiate the rationale for the prospective PROTO-PRIME trial, which will investigate the clinical benefits of SBPT relative to SBRT in this patient population.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101084"},"PeriodicalIF":2.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681365","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}

{"title":"Postoperative chemoradiotherapy for esophageal squamous cell Carcinoma: Results from ESO-Shanghai 17 and joint analyses for phase II clinical trials","authors":"Jingyi Shen ,&nbsp;Dashan Ai ,&nbsp;Yun Chen ,&nbsp;Qi Liu ,&nbsp;Jiaying Deng ,&nbsp;Shengnan Hao ,&nbsp;Xiaofei Zhang ,&nbsp;Junhua Zhang ,&nbsp;Yutong Zhang ,&nbsp;Li Chu ,&nbsp;Yihua Sun ,&nbsp;Yawei Zhang ,&nbsp;Jiaqing Xiang ,&nbsp;Longsheng Miao ,&nbsp;Haiquan Chen ,&nbsp;Hongcheng Zhu ,&nbsp;Kuaile Zhao","doi":"10.1016/j.ctro.2025.101073","DOIUrl":"10.1016/j.ctro.2025.101073","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore efficacy and safety of postoperative chemoradiotherapy in esophageal squamous cell carcinoma.</div></div><div><h3>Materials and methods</h3><div>Two single-arm, phase II trials (ESO-Shanghai 9 and 17) were conducted with the same inclusion criteria: 1) age 18–75, 2) ECOG 0–1, 3) within 3 months after surgery, 4) pathologically confirmed esophageal squamous cell carcinoma(pT3-4orN+,M0), with R0 margins, 5) no preoperative therapy. Both were postoperative concurrent chemoradiotherapy with weekly paclitaxel and carboplatin, and extended-field or small T-shaped field radiotherapy at dose of 45 Gy/25Fx or 50.4 Gy/28Fx in ESO-Shanghai 9 or 17. The primary endpoint was 2-year local control rate, secondary endpoints including overall survival, treatment-related<!--> <!-->toxicities, and failure patterns.</div></div><div><h3>Results</h3><div>ESO-Shanghai 17 enrolled 70 patients from 2020 to 2023. 2-year local control rate was 83.8 %, and 1, 2, 3-year overall survival rates were 95.7 %, 84.0 %, 67.1 %. Local recurrence occurred in 24.3 % and distant metastasis in 21.4 %. There were no significant differences in local recurrence and metastasis. Both studies exhibited similar local recurrence-free survival and overall survival, disease free survival, and distant metastasis-free survival (<em>P</em> = 0.178, 0.224, 0.358, 0.440). No patients experienced grade Ⅳ or higher adverse events (except for leukopenia and neutropenia) in ESO-Shanghai 17. While ESO-Shanghai 9 reported two cases of grade V pneumonia, and grade Ⅲ or higher leukopenia and neutropenia incidences were higher than ESO-Shanghai 17.</div></div><div><h3>Conclusion</h3><div>Postoperative chemoradiotherapy (50.4 Gy/28Fx with small T-shaped field) yielded local control and survival comparable to ESO-Shanghai 9, with no radiation pneumonitis-related deaths in esophageal squamous cell carcinoma.</div><div>(<em>Clinicaltrial:</em> ESO-Shanghai 9, NCT02916511; ESO-Shanghai 17, NCT04764227)</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101073"},"PeriodicalIF":2.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798237","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}

{"title":"Radiotherapy and survival in elderly grade 4 glioma patients: The prognostic value of onco-functional outcome","authors":"Helen X. Hou ,&nbsp;Sophia M. Leiss ,&nbsp;Daniel Schmottermeyer ,&nbsp;Christian Diehl ,&nbsp;Benedikt Wiestler ,&nbsp;Jan Peeken ,&nbsp;Kai Borm ,&nbsp;Chiara Negwer ,&nbsp;Arthur Wagner ,&nbsp;Igor Yakushev ,&nbsp;Claire Delbridge ,&nbsp;Meike Mitsdoerffer ,&nbsp;Friederike Schmidt-Graf ,&nbsp;Bernhardt Meyer ,&nbsp;Stephanie Combs ,&nbsp;Denise Bernhardt","doi":"10.1016/j.ctro.2025.101085","DOIUrl":"10.1016/j.ctro.2025.101085","url":null,"abstract":"<div><h3>Purpose</h3><div><strong>/Objectives:</strong> Older adults with WHO grade 4 glioma face distinct therapeutic challenges due to age-related comorbidities, treatment intolerance and tumor aggressiveness. This retrospective study evaluates the prognostic value of the Onco-Functional Outcome (OFO) classification, which integrates extent of resection and postoperative functional status, in the context of radiotherapy (RT) for patients with grade 4 glioma.</div></div><div><h3>Materials</h3><div><strong>/Methods:</strong> 139 patients aged ≥ 60 years treated between 2001 and 2021 were included. Patients were grouped into four OFO categories based on Karnofsky Performance Status, National Institutes of Health Stroke Scale, and resection extent. Survival outcomes were assessed using Kaplan-Meier and compared by log-rank test. Univariate and multivariable analyses were performed using Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Median OS decreased across OFO groups (OFO1-4: 22.6, 20.5, 12.6, and 11.2 months respectively, log-rank, p = 0.0026). PFS followed a similar pattern (12.2, 9.3, 6.7, and 5.7 months respectively; p = 0.0030). Among 119 patients with known MGMT status, methylation (n = 49) was associated with significantly prolonged OS (36.3 vs. 12.6 months, p &lt; 0.00001) and PFS (14.1 vs 5.9 months, p &lt; 0.00001). Survival advantage of NF–RT showed a a strong trend in both univariate (OS HR = 0.47, 95 % CI 0.28–0.82; p = 0.007) and multivariate models (OS HR = 0.57, 95 % CI 0.33–1.00, 0.051). In multivariable analysis, the OFO classification retained independent prognostic value, with OFO Group 4 associated with a significantly increased risk of both death (OS: HR = 2.91, p = 0.003) and disease progression (PFS: HR = 3.08, p = 0.0005) compared to OFO Group 1.</div></div><div><h3>Conclusions</h3><div>OFO classification effectively stratifies survival in elderly grade 4 glioma patients. Its integration with MGMT methylation status and RT regimen refines risk assessment, supporting personalized treatment strategies in this vulnerable patient group.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101085"},"PeriodicalIF":2.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614551","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}

{"title":"Evaluation of loco-regional recurrences using deformable image registration after isotoxic high dose stereotactic body radiotherapy in localised pancreatic cancer","authors":"Martin Manderlier ,&nbsp;Sara Poeta ,&nbsp;Jean-Luc Engelholm ,&nbsp;Akos Gulyban ,&nbsp;Jean-Luc Van Laethem ,&nbsp;Christelle Bouchart","doi":"10.1016/j.ctro.2025.101081","DOIUrl":"10.1016/j.ctro.2025.101081","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Pancreatic ductal adenocarcinoma is a highly aggressive malignancy with poor survival outcomes. Neoadjuvant treatments, including radiotherapy, have been developed to improve resectability and survival rates. This study evaluates loco-regional recurrence (LRR) patterns after isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT) for localized pancreatic cancer using deformable image registration (DIR).</div></div><div><h3>Materials and Methods</h3><div>Patients with borderline/locally advanced pancreatic adenocarcinoma treated between January 2018 and January 2021 were included. Treatment involved modified FOLFIRINOX chemotherapy, iHD-SBRT, and surgery, if feasible. LRRs identified via CT/MRI during follow-up were mapped back onto initial radiotherapy planning using validated DIR workflows. Recurrences were classified as in-field (IF), marginal (M), or out-of-field (OF).</div></div><div><h3>Results</h3><div>Among 41 patients, LRRs were identified in 17 (10 via CT, 7 via MRI). The majority of LRRs were classified as OF (53 %, n = 9), with 23.5 % (n = 4) each in IF and M categories. Marginal recurrences were located near major abdominal vessels, such as the superior mesenteric artery and coeliac artery. DIR quality metrics, including DICE and MDA, validated the accuracy of the mapping process.</div></div><div><h3>Conclusion</h3><div>Image based evaluation of loco-regional recurrence is an important part of the assessment of patients treated with iHD-SBRT for localised pancreatic cancer. DIR-based analysis emphasized the importance of expanding the tumor-vessel interface (TVI) structure in radiotherapy planning to include the full circumference of adjacent vessels with a 5 mm margin. DIR-based analysis highlighted that several marginal recurrences occurred in proximity to perivascular regions, suggesting a potential benefit of expanding perivascular target coverage in future treatment planning.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101081"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681366","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}

{"title":"125I seed brachytherapy synergized with PD-1 inhibitor imparts potent antitumor immune responses in hepatocellular carcinoma","authors":"Peng Zeng ,&nbsp;Yong Wang ,&nbsp;Duo Shen ,&nbsp;Tiancheng Zhao ,&nbsp;Rong Chen ,&nbsp;Jinhe Guo ,&nbsp;Haidong Zhu ,&nbsp;Gao-Jun Teng","doi":"10.1016/j.ctro.2025.101083","DOIUrl":"10.1016/j.ctro.2025.101083","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Hepatocellular carcinoma (HCC) exhibits a complex immunosuppressive network, leading to resistance to immune checkpoint inhibitors (ICIs). To counter this, we introduced a novel method, brachytherapy of ¹²⁵I seed implantation prior to PD-1 inhibitor therapy, aiming to reprogram these inhibitory lymphocyte subsets, which synergized with PD-1 inhibitor to generate robust antitumor immune responses in HCC.</div></div><div><h3>Methods and materials</h3><div>Mouse orthotopic and subcutaneous HCC models were constructed with H22 cells. ¹²⁵I seeds were implanted into the tumors for irradiation, subsequently. Apoptosis of tumor cells and tissues were measured by flow cytometry (FC) and TdT-mediated dUTP nick end labeling (TUNEL). Immunogenic cell death (ICD) molecules and immune checkpoints were detected with flow cytometer (FCM), confocal fluorescence microscopy, ELISA, chemiluminescence assay and immunofluorescence (IF). Changes of lymphocyte subsets were tested by FC and polychromatic immunofluorescence (PIF). Cytokine release was detected by enzyme-linked immunosorbent assay (ELISA).</div></div><div><h3>Results</h3><div>¹²⁵I seed irradiation reversed myeloid cell aggregation, preventing their differentiation into suppressive dendritic cells (DCs), tumor-associated macrophages (TAMs), and myeloid-derived suppressor cells (MDSCs). This reprogramming led to the activation of a T cell-mediated immune response and enhanced susceptibility to anti-PD-1 therapy. The combination of ¹²⁵I seed brachytherapy with anti-PD-1 therapy elicited a robust anti-tumor immune response, stimulated an abscopal effect suppressing unirradiated distant tumors, and generated memory immunity that resisted tumor rechallenge.</div></div><div><h3>Conclusions</h3><div>Our brachy-primed immunotherapy approach offers a promising and effective treatment strategy, which may improve the immunotherapeutic efficacy in HCC.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101083"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576153","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}

{"title":"Daily adaptive MR-guided stereotactic ablative re-irradiation (re-SABR) in oligometastatic liver disease: A single-institution retrospective analysis","authors":"Elena Moreno-Olmedo ,&nbsp;Dan Murray ,&nbsp;Ben George ,&nbsp;Paul Bassett ,&nbsp;Andy Gaya ,&nbsp;Veni Ezhil ,&nbsp;Somnath Mukherjee ,&nbsp;Rebecca Muirhead ,&nbsp;Ramanivas Sundareyan ,&nbsp;Peter Dickinson ,&nbsp;James Good ,&nbsp;Kasia Owczarczyk","doi":"10.1016/j.ctro.2025.101082","DOIUrl":"10.1016/j.ctro.2025.101082","url":null,"abstract":"<div><h3>Objective</h3><div>Stereotactic ablative body radiotherapy (SABR) is an established treatment option in oligometastatic liver disease. Limited data exist on liver SABR re-irradiation (re-SABR). MR-guided SABR with daily plan adaptation and deformable image registration (DIR) allows organ-at-risk (OAR) sparing and dose accumulation in a re-irradiation setting. We report the safety and efficacy of MR-guided re-SABR in oligometastatic liver disease, alongside a DIR-based workflow for cumulative OAR dose calculation.</div></div><div><h3>Methods</h3><div>MR-guided re-SABR to oligometastatic liver disease was retrospectively analysed. Key inclusion criteria included: prior liver SABR, MR-guided re-SABR to ≤ 4 liver metastases, Child Pugh Score (CPS) ≤ B7, and a minimum prescribed dose of 30 Gy in 5 fractions. Lesions were classified according to the ESTRO-EORTC re-irradiation consensus. Acute and delayed toxicity, local control (LC), local progression-free survival (LPFS), and overall survival (OS) were reported, overall and by primary tumour type. Cumulative OAR doses were estimated using a DIR-based as compared to a non-DIR-based workflow.</div></div><div><h3>Results</h3><div>Between October 2020 and April 2024, twelve patients underwent MR-guided re-SABR to 18 liver metastases. While the majority (12/18) were colorectal in origin, other primaries included pancreas, breast, oesophagogastric, and ovary. 50% of lesions were type-1 re-irradiation (including 3 repeated target irradiations).</div><div>Median prescription BED₁₀ was 100 Gy (range 72–151 Gy) for initial SABR and 100 Gy (range 48–132 Gy) for re-SABR. 50 Gy in 5 fractions (BED10 100 Gy) was delivered in 8 out of 12 re-SABR cases. With a median follow-up of 10 months (range 3–33) from re-SABR, no acute ≥ G2 toxicity was seen. 12-month PFS was 92 % (95 % CI 54–99).</div><div>Median, 1-year, and 2-year OS were 36 months (range 12–37), 100 % (95 % CI 54–99) and 91 % (95 % CI 51–99) for SABR and 22 months, 68 % (95 %CI 28–89) and 34 % (95 % CI 5–67) for re-SABR. DIR-based workflow estimates predicted significantly higher MLD and D700cc (p &lt; 0.01) and smaller uninvolved liver volumes (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>With the limitation of relatively low patient numbers and mixed tumour histology, MR-guided re-SABR to oligometastatic liver disease appeared well tolerated, achieving high LC rates. DIR-based workflow predicted higher cumulative OAR doses, potentially further improving the safety of liver re-SABR.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101082"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681364","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}