Clinical and Translational Radiation Oncology最新文献

{"title":"Pediatric CNS relapse of neuroblastoma treated with upright proton craniospinal irradiation","authors":"Philip Blumenfeld ,&nbsp;Alexander Pryanichnikov ,&nbsp;Zelig Tochner ,&nbsp;Aaron M Allen ,&nbsp;Iris Fried ,&nbsp;David Gozal ,&nbsp;Sean Marzeeq ,&nbsp;Stéphane Ledot ,&nbsp;Shimshon Winograd ,&nbsp;Ayman Salhab ,&nbsp;Marc Wygoda ,&nbsp;Yair Hillman ,&nbsp;Jon Feldman ,&nbsp;Aron Popovtzer","doi":"10.1016/j.ctro.2025.101080","DOIUrl":"10.1016/j.ctro.2025.101080","url":null,"abstract":"<div><div>Craniospinal irradiation (CSI) is a technically demanding treatment in pediatric oncology, especially for young children, who often require daily anesthesia. Although proton therapy offers dosimetric advantages over photons by eliminating exit dose and reducing exposure to healthy tissues, its global availability is limited due to the cost and complexity of gantry-based systems. Recently, gantry-less proton therapy with upright positioning has recently emerged as a compact, cost-efficient alternative, integrating robotic positioning and vertical CT-based image guidance.</div><div>This study reports the first pediatric case of upright proton CSI delivered under intravenous monitored anesthesia care (MAC) using such a system. A four-year-old male patient with relapsed neuroblastoma in the central nervous system received CSI at a dose of 18.0 Gy(RBE) in 12 fractions, along with a simultaneous integrated boost (SIB) of 21.6 Gy(RBE) to the resection cavity. This was followed by a sequential boost to the resection cavity in five fractions, for a total dose of 30.6 Gy(RBE). The treatment was performed in the seated position with customized immobilization, upright volumetric CT verification, and reproducible daily setup. MAC achieved without intubation, allowing continuous airway access.</div><div>The patient completed the treatment regimen without interruption, did not experience any grade 2 or higher acute toxicities, and demonstrated adequate tolerance of daily anesthesia. This case demonstrates the clinical feasibility of upright proton CSI under MAC and provides proof of concept for the broader adoption of gantry-less proton therapy in complicated cases.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101080"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576156","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":"Impact of excluding internal mammary node coverage on musculoskeletal dosimetry in breast radiotherapy","authors":"Stephen Lowell Ciocon ,&nbsp;Antonio de la Pena Villarreal ,&nbsp;Grace Lee ,&nbsp;Randa Kamel ,&nbsp;Mohammad Rahman ,&nbsp;Leigh Conroy ,&nbsp;Robert Bleakney ,&nbsp;Jennifer Croke ,&nbsp;Anne Koch ,&nbsp;Emma Mauti ,&nbsp;Jennifer Jones ,&nbsp;Eugene Chang ,&nbsp;Melissa Weidman ,&nbsp;Wey Leong ,&nbsp;Zhihui Amy Liu ,&nbsp;Xiang Y. Ye ,&nbsp;Jennifer Yin Yee Kwan ,&nbsp;Fei-Fei Liu","doi":"10.1016/j.ctro.2025.101077","DOIUrl":"10.1016/j.ctro.2025.101077","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Breast cancer radiotherapy (RT) can lead to shoulder complications including weakness, restricted motion, and discomfort, affecting up to 40% of patients. The necessity to include the internal mammary nodes (IMNs) during breast and nodal irradiation for every patient remains under discussion, particularly for early-stage breast cancers. The dosimetric effect on nearby musculoskeletal (MSK) structures when targeting the IMNs remains to be completely understood; hence the focus of this current study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective study included breast cancer patients who underwent lumpectomy and nodal sampling followed by adjuvant hypofractionated whole breast and regional nodal RT (4005 cGy in 15 fractions) who were treated between January 1, 2022, and November 30, 2023 at a single institution. MSK structures such as the bones (ribs, scapula), muscles (pectoralis, rhomboids), and joints (glenohumeral, acromioclavicular) were retrospectively contoured on the CT simulation images. Two RT plans (one with and one without IMN coverage) were created, and dosimetric parameters including mean (Dmean), near maximum (D2), near minimum (D98) and volumes received 15, 20 and 40 Gy (V15, V20, V40) were compared. Standardized mean difference between the plans was calculated for each dosimetric parameter, and Wilxocon’s signed-rank test was used for comparison. Univariable linear regression analysis was used to identify patient and tumor factors that were associated with more significant dosimetric differences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 30 breast cancer patients with a median age of 63 (range 30–82 years) were selected for analysis. The location of tumours included 15 (50 %) in the right breast, and 15 (50 %) in the left breast; with 10 (33 %) centrally, 10 (33 %) medially, and 10 (33 %) were laterally-located within the breast. The pathologic T stage included 6 (20 %) T0/Tis, 11 (37 %) T1, and 13 (43 %) T2. Seven patients (23 %) were N0, 19 (63 %) were N1, and 4 (13 %) were N2a. Nine patients received adjuvant chemotherapy, 11 neoadjuvant chemotherapy, and 10 patients received no chemotherapy.&lt;/div&gt;&lt;div&gt;The exclusion of IMN coverage led to significantly decreased Dmean for muscle groups in the posterior, posterolateral, lateral, anterior and antero-lateral-posterior regions. Specifically, the largest absolute reductions included teres major (Dmean 340 cGy), subscapularis (320 cGy), serratus anterior (241 cGy), latissimus dorsi (232 cGy), chestwall (209 cGy), and the pectoralis minor (37 cGy) muscles. Significant differences were also observed for V40 and V15 of pectoralis minor (V40 of 12 %), pectoralis major (V40 of 10 %), and for both subscapularis and teres major (V15 of 8 %) muscles.&lt;/div&gt;&lt;div&gt;Patient factors that were associated with greater dosimetric differences included younger age, larger breast size, larger tumor cavity, and non-central tumor locations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclu","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101077"},"PeriodicalIF":2.7,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614552","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":"Impact of tumour proximity to organs-at-risk in adaptive MR-guided SBRT for central lung tumours and metastases","authors":"Sina Mansoorian ,&nbsp;Ala Sami Ismail Salameh ,&nbsp;Laura Hamm ,&nbsp;Svenja Hering ,&nbsp;Diego Kauffmann-Guerrero ,&nbsp;Helmut Weingandt ,&nbsp;Vanessa da Silva Mendes ,&nbsp;Jan Hofmaier ,&nbsp;Sebastian Marschner ,&nbsp;Nina-Sophie Schmidt-Hegemann ,&nbsp;Guillaume Landry ,&nbsp;Claus Belka ,&nbsp;Stefanie Corradini ,&nbsp;Chukwuka Eze","doi":"10.1016/j.ctro.2025.101079","DOIUrl":"10.1016/j.ctro.2025.101079","url":null,"abstract":"<div><h3>Background</h3><div>Centrally located lung tumours present challenges for SBRT due to elevated toxicity risk. Online adaptive MR-guided radiotherapy (oMRgRT) offers improved target coverage and Organ at risk (OAR) sparing by accounting for interfractional anatomical changes. This study evaluated the dosimetric impact of oMRgRT, with emphasis on tumour location relative to OARs and the clinical benefit of adaptation.</div></div><div><h3>Methods</h3><div>We retrospectively analysed 36 PTVs across 294 treatment sessions using a 0.35 T MR-Linac. Tumours were categorised by proximity to six critical OARs: proximal bronchial tree (PBT), trachea, heart, great vessels, brachial plexus, and oesophagus. Predicted/reoptimised plans from all fractions were compared to assess improvements in target coverage and OAR sparing. All dosimetric parameters were presented as a percentage of baseline plan metrics. Statistical tests included the Wilcoxon signed-rank test and the Mann-Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>Adaptive planning significantly improved target volume dosimetry. PTV D_98% increased from 92.8 ± 8.7% to 99.9 ± 1% (p &lt; 0.01); V_{prescription dose (PD)} improved from 92.7 ± 5.4% to 97.7 ± 1.1% (p &lt; 0.01). GTV D_98% rose from 98.5 ± 5.5% to 100.4 ± 4.3% (p &lt; 0.01), with V_PD increasing from 97.7 ± 3.9% to 98.1 ± 3.5% (p &lt; 0.01). Improvements in PTV coverage were observed across all subgroups, with the greatest gains in GTV coverage, most notable in tumours adjacent to the PBT and heart. Tumours near the trachea, great vessels, and brachial plexus showed minimal change. The most significant reductions in OAR doses were also seen in the heart and PBT groups, while proximity to the trachea resulted in minimal benefit<strong>.</strong></div></div><div><h3>Conclusion</h3><div>Daily oMRgRT significantly improves target coverage and OAR sparing in centrally located tumours, especially in anatomically complex regions. The adaptive approach enables clinically meaningful trade-offs between tumour coverage and OAR sparing. Further studies are needed to refine adaptation protocols based on tumour sublocation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"57 ","pages":"Article 101079"},"PeriodicalIF":2.7,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798236","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":"The evolution of cardiac changes after breast cancer adjuvant radiotherapy – A six-year follow-up study","authors":"Mikko Moisander ,&nbsp;Suvi Tuohinen ,&nbsp;Heidi Lähdeaho ,&nbsp;Heini Huhtala ,&nbsp;Kjell Nikus ,&nbsp;Vesa Virtanen ,&nbsp;Pirkko-Liisa Kellokumpu-Lehtinen ,&nbsp;Pekka Raatikainen ,&nbsp;Tanja Skyttä","doi":"10.1016/j.ctro.2025.101078","DOIUrl":"10.1016/j.ctro.2025.101078","url":null,"abstract":"<div><h3>Introduction</h3><div>This prospective study investigated the long-term effects of adjuvant radiotherapy (RT) on cardiac function and biomarkers in early breast cancer patients over a six-year follow-up.</div></div><div><h3>Methods</h3><div>Seventy-three women treated with RT alone, without chemotherapy, were included. Cardiac radiation doses were quantified, and echocardiography and serum biomarkers (high-sensitivity cardiac troponin T [hscTnT] and N-terminal pro-brain natriuretic peptide [proBNP]) were assessed before RT and at three- and six-years post-treatment.</div></div><div><h3>Results</h3><div>Cardiac biomarkers increased significantly during follow-up. Median hscTnT rose from 4 to 6 ng/L (p&lt;0.001), correlating with higher radiation doses to the heart in left-sided patients. ProBNP increased from 78 to 118 ng/L (p&lt;0.001). Left ventricular (LV) systolic function declined in left-sided patients: ejection fraction decreased from 65% to 60% (p=0.002), global longitudinal strain from –18% to –17% (p=0.006), and stroke volume from 74 to 67 mL (p=0.015). Diastolic dysfunction also progressed, with impairments in isovolumic relaxation time and left atrial ejection fraction. Aromatase inhibitor (AI) use and higher mean heart dose were associated with greater cardiac impairment.</div></div><div><h3>Conclusion</h3><div>Subclinical deterioration in cardiac function and elevated biomarkers were evident three years after RT and persisted at six years, suggesting permanent cardiac effects. Both radiation dose and AI therapy contributed to these changes. These findings underscore the importance of long-term cardiac monitoring and support the use of sensitive imaging and biomarkers to detect early radiotherapy-induced cardiotoxicity.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101078"},"PeriodicalIF":2.7,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576152","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":"Prostate- and metastases-directed radiotherapy in de novo low-volume metastatic prostate cancer","authors":"Jan-Hendrik Bolten ,&nbsp;Fabian Weykamp ,&nbsp;Christoph Grott ,&nbsp;David Neugebauer ,&nbsp;Lars Wessel ,&nbsp;Felix H. Englert ,&nbsp;Justus Valentini ,&nbsp;Magdalena Goertz ,&nbsp;Stephanie Zschaebitz ,&nbsp;Johannes Huber ,&nbsp;Erik Winter ,&nbsp;Juergen Debus ,&nbsp;Jakob Liermann","doi":"10.1016/j.ctro.2025.101072","DOIUrl":"10.1016/j.ctro.2025.101072","url":null,"abstract":"<div><h3>Background</h3><div>The role of radiotherapy in de novo low-volume metastatic prostate cancer (LVmPC) is constantly evolving and still offers considerable potential for further optimization. Rising interest in this topic demands further investigations in this specific patient cohort. We report on clinical outcomes and toxicity of combined prostate-directed (PDRT) and metastasis-directed radiotherapy (MDRT) with ablative dose concepts in patients with de novo LVmPC.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 21 patients with LVmPC treated with PDRT plus MDRT between 2018 and 2025 in addition to systemic treatment. Staging was performed with PSMA-PET/CT imaging (n = 19/21). Radiotherapy included high-dose external beam PDRT and MDRT to all detectable bone and nodal metastases. Toxicity was assessed using CTCAE v5.0, IPSS, and EPIC-26 questionnaires. Oncologic outcomes included biochemical recurrence-free survival, PSA response, and time to next-line systemic therapy.</div></div><div><h3>Results</h3><div>Additional radiotherapy of all tumor sites in LVmPC was well tolerated; no grade ≥ III gastrointestinal or genitourinary toxicity occurred. The most common adverse events were associated with hormonal therapy. Quality of life remained stable or improved in urinary and bowel domains. Undetectable PSA was achieved in 67 % of patients after radiotherapy in addition to systemic therapy. 14 % of the patients developed biochemical recurrence within 40 months after radiotherapy completion.</div></div><div><h3>Conclusion</h3><div>Combined PDRT and MDRT in addition to standard of care in patients with de novo LVmPC is feasible, well tolerated, and associated with promising biochemical control. Further prospective studies with larger patient cohorts integrating PSMA-PET/CT and other risk stratification factors are warranted to better define which patient subgroups benefit most from additional radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101072"},"PeriodicalIF":2.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576186","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":"Consolidation ICIs Alter cardiac subregion radiosensitivity in NSCLC patients treated with Chemo-Radiotherapy","authors":"Yejin Kim ,&nbsp;Gowoon Yang ,&nbsp;Jaewon Oh ,&nbsp;Seo-Yeon Gwak ,&nbsp;Kyung Hwan Kim ,&nbsp;Joongyo Lee ,&nbsp;Jin Sung Kim ,&nbsp;Chang Geol Lee ,&nbsp;Jaeho Cho ,&nbsp;Bonnie Ky ,&nbsp;Hong In Yoon ,&nbsp;Clemens Grassberger","doi":"10.1016/j.ctro.2025.101069","DOIUrl":"10.1016/j.ctro.2025.101069","url":null,"abstract":"<div><h3>Purpose</h3><div>he addition of immune checkpoint inhibitor (ICI) as consolidation therapy after chemoradiation (CRT) has improved survival rates in non-small cell lung cancer (NSCLC) patients. However, the cardiotoxicity of CRT combined with ICI remains underexplored. This study assesses if ICI exposure alters the critical cardiac subregion linked to radiation-induced heart disease (RIHD) following CRT.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 321 locally advanced NSCLC patients treated with definitive CRT from August 2008 to December 2019, including 67 who received consolidation ICI. Cardiac contours include the entire heart, chambers, major coronary arteries, and conduction nodes. The primary endpoint was RIHD, defined as a major adverse cardiac event and atrial fibrillation. We used Fine-Gray analysis to investigate associations between RIHD and mean doses to cardiac subregions.</div></div><div><h3>Results</h3><div>In total, 53 patients (18.4 %) developed RIHD, with no significant difference between CRT and CRT + ICI groups. Doses to cardiac subregions were similar between the groups. In the CRT group, multivariable analysis shows that dose to the base of the heart, especially the sinoatrial node (SAN), correlated with increased RIHD risk (HR = 1.02 per 1 Gy, 95 %CI [1.01–1.03], p &lt; 0.001). In the CRT + IO group, the left ventricle (LV) dose was a significant predictor (1.06 [1.06–1.1], p = 0.006).</div></div><div><h3>Conclusions</h3><div>Doses to the SAN and the base of the heart correlate with RIHD in CRT patients, while doses to LV in CRT + ICI patients. While the 2–6 % increased risk per Gy seems modest, it is clinically significant as the subregions, being small structures, can potentially be completely spared with a carefully optimized plan.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101069"},"PeriodicalIF":2.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576185","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":"Vascular calcifications in early-breast radiotherapy planning-CT: Opportunistic detection and cardiovascular risk assessment","authors":"Ana Aurora Diaz-Gavela ,&nbsp;Julio Fernández-Mata ,&nbsp;Elia del Cerro-Peñalver ,&nbsp;Sofía Sanchez-Garcia ,&nbsp;Cristina Andreu-Vazquez ,&nbsp;Israel John Thuissard-Vasallo ,&nbsp;David Sanz-Rosa ,&nbsp;Lucía González-Cortijo ,&nbsp;Marina Peña-Huertas ,&nbsp;Victor Duque-Santana ,&nbsp;Luis Leonardo Guerrero ,&nbsp;Yolanda Molina Lopez ,&nbsp;Felipe Couñago","doi":"10.1016/j.ctro.2025.101076","DOIUrl":"10.1016/j.ctro.2025.101076","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence of vascular calcifications on radiotherapy-planning CTs in women with early breast cancer (BC) and their association with subsequent cardiovascular (CV) events.</div></div><div><h3>Material and methods</h3><div>Single-center retrospective study of patients who received adjuvant radiotherapy for early BC after breast conserving surgery (2009–2019). Planning CTs were visually assessed for vascular calcifications and the incidence of CV events during follow-up was determined. Comparative analyses of clinical characteristics were conducted across groups stratified by calcification status. Multivariate logistic regression served to evaluate CV event risk, with adjustment for conventional cardiovascular risk factors (CVRF).</div></div><div><h3>Results</h3><div>The study included 882 patients. The median (IQR) age was 52 (46–62) years. Calcifications were found in 340 patients (38.5 %), 154 (17.5 %) in coronary arteries. Patients with calcifications were significantly older (62 vs. 48 years) and more likely to present CVRF, including hypertension (32.6 % vs. 10.0 %), dyslipidemia (34.7 % vs. 15.3 %), and diabetes (11.5 % vs. 3.1 %). Median follow-up was 8 years (6–10), with 35 patients (4.0 %) experiencing a CV event. Vascular calcification was associated with a significantly higher incidence of CV events (7.1 % vs. 2.0 %; OR = 3.7; 95 % CI: 1.8–7.6). The presence of coronary calcifications, adjusted for age and conventional CVRF, was associated with a 2.86-fold (95 % CI: 1.05–7.78) higher risk of a CV event.</div></div><div><h3>Conclusion</h3><div>This study shows that vascular calcifications detected incidentally on radiotherapy planning CTs for early BC are common and associated with an increased risk of CV events that is independent of conventional CVRF. These findings suggest that planning CTs in these patients should be routinely reviewed to check for vascular calcifications.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101076"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516561","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":"Cardiac substructure radiotherapy dose and changes in physical activity and quality of life after chemoradiotherapy for NSCLC: a secondary analysis of the CLARITY prospective study","authors":"Nikhil Yegya-Raman ,&nbsp;Kyunga Ko ,&nbsp;Ivy S. Han ,&nbsp;Joshua D. Mitchell ,&nbsp;Wei Zou ,&nbsp;Nitin Ohri ,&nbsp;Salma K. Jabbour ,&nbsp;Raymond H. Mak ,&nbsp;Clifford Robinson ,&nbsp;William P. Levin ,&nbsp;Leanne Barrett ,&nbsp;Congying Xia ,&nbsp;Eva Berlin ,&nbsp;Paco Bravo ,&nbsp;Marcelo Di Carli ,&nbsp;Roger Cohen ,&nbsp;Sandra Hutton ,&nbsp;Jonathan Keltz ,&nbsp;Jessica Wang ,&nbsp;Omotayo Fasan ,&nbsp;Bonnie Ky","doi":"10.1016/j.ctro.2025.101070","DOIUrl":"10.1016/j.ctro.2025.101070","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective was to assess associations between cardiac substructure dose and changes in patient-reported outcomes (PROs) post-chemoradiotherapy for non-small cell lung cancer (NSCLC).</div></div><div><h3>Methods and Materials</h3><div>The study population was derived from CLARITY (NCT04305613), a multi-institutional longitudinal prospective cohort study. Patients treated with conventionally fractionated radiotherapy (1.8–2 Gy per fraction) with concurrent chemotherapy completed physical activity (Godin) and quality of life (FACIT-Fatigue and Dyspnea) questionnaires at baseline, completion of radiotherapy, 6 and 12 months post-radiotherapy. Thirty cardiac dosimetric parameters were <em>a priori</em> selected from centrally contoured radiotherapy plans: mean dose, maximum dose, volume receiving ≥ 5 Gy (V5Gy), V15Gy, and V30Gy to the whole heart, left ventricle, right ventricle, left atrium, right atrium, and left anterior descending coronary artery, and applied to a LASSO regression model to further define variable importance. Associations between cardiac radiation dose metrics and changes in PROs were assessed using repeated-measures linear regression via generalized estimating equations with correction for multiple testing.</div></div><div><h3>Results</h3><div>In a subcohort of 122 patients, the median age was 67 years, 57% were male, and 41% had prevalent cardiovascular disease. Median whole heart mean dose was 9 Gy, whole heart maximum dose was 64 Gy, and LAD V15Gy was 1%. Godin physical activity (p = 0.0499), FACIT-Fatigue (p &lt; 0.001), and FACIT-Dyspnea scores (p = 0.0037) worsened from baseline to end of radiotherapy, then recovered to baseline levels thereafter. In multivariable analysis and after adjusting for multiple comparisons, no cardiac dose metric was significantly associated with a worsening in patient-reported physical activity, fatigue or dyspnea (p &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>PROs worsened from baseline to the end of thoracic chemoradiotherapy, then recovered to baseline levels. Cardiac radiation dose metrics were not associated with these changes.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101070"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576154","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 for Primary Urethral Carcinoma (PUC): An Illustrative and Narrative Review","authors":"Shreya Dhingra ,&nbsp;Arunima Nagar ,&nbsp;Amandeep Arora ,&nbsp;Maneesh Singh ,&nbsp;Priyamvada Maitre ,&nbsp;Ankit Misra ,&nbsp;Mahendra Pal ,&nbsp;Amit Joshi ,&nbsp;Santosh Menon ,&nbsp;Herney Andres Garcia-Perdomo ,&nbsp;Philippe Spiess ,&nbsp;Gagan Prakash ,&nbsp;Vedang Murthy","doi":"10.1016/j.ctro.2025.101074","DOIUrl":"10.1016/j.ctro.2025.101074","url":null,"abstract":"<div><div>Primary urethral carcinoma (PUC) is a rare malignancy with a complex and site-specific management paradigm. While surgery remains the mainstay for many cases, advances in modern radiotherapy have facilitated organ preservation without compromising oncologic outcomes. This narrative review outlines the clinicopathological features, diagnostic evaluation, and evolving role of radiotherapy in the management of PUC. An illustrative case of a young male with high-grade urothelial carcinoma of the bulbar urethra managed successfully with definitive external beam radiotherapy is presented. We explore the rationale, technique, and outcomes associated with radiotherapy, including external beam and brachytherapy modalities, across disease stages. For locally advanced cases, chemoradiotherapy offers an organ-sparing alternative to mutilating surgery, with promising control rates and acceptable toxicity. This article aims to collate current evidence, highlight gaps, and support the integration of personalised, multidisciplinary care in this rare disease context.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101074"},"PeriodicalIF":2.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576155","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":"Radiation-induced lymphopenia: A data compilation to unveil relevant factors and mitigation strategies","authors":"Vladislav Sandul ,&nbsp;Sarah Salih Al-Hamami ,&nbsp;Jiří Kubeš ,&nbsp;Marco Durante ,&nbsp;Thomas Friedrich","doi":"10.1016/j.ctro.2025.101071","DOIUrl":"10.1016/j.ctro.2025.101071","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation-induced lymphopenia (RIL) is a common complication of radiation therapy (RT) that can undermine antitumor immunity and diminish the efficacy of immunotherapy. While RIL is a known predictor of poor outcomes, its underlying mechanisms and key determinants remain poorly characterized.</div></div><div><h3>Materials and Methods</h3><div>We systematically compiled and quantitatively analyzed published data on absolute lymphocyte count (ALC) dynamics during and after RT. A total of 142 ALC curves from 52 publications were digitized and integrated into a standardized database. This database encompasses various RT modalities, including therapy with X-rays or charged particles, as well as extracorporeal irradiation of blood (ECIB).</div></div><div><h3>Results</h3><div>Analysis revealed consistent lymphocyte depletion during treatment. By the end of RT, median ALCs declined to 24% (range: 1.5–78%) of baseline for intracorporeal exposure and 10% (range: 1–60%) for ECIB. Recovery was incomplete and cancer-type-dependent, reaching only a median of 55% (range: 33–90%) of baseline within one year. We identified baseline ALC, planning target volume (PTV), and dosimetric parameters as key predictors of severe lymphopenia. A low rate of lymphocyte depletion during treatment was frequently associated with impaired long-term recovery. Particle therapy was associated with an average 11% higher end-of-treatment ALC compared to photon therapy, underscoring the lymphocyte-sparing benefit of reduced integral dose.</div></div><div><h3>Conclusions</h3><div>This work establishes a comprehensive, quantitative foundation for understanding RIL. The developed ALC database supports mechanistic investigation and enables model-based approaches to predict lymphocyte dynamics, guiding the design of lymphocyte-sparing treatment strategies, including particle therapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101071"},"PeriodicalIF":2.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516670","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}