Clinical and Translational Radiation Oncology最新文献_第4页

Physician reported toxicities and patient reported quality of life of transperineal ultrasound-guided radiotherapy of prostate cancer 医生报告的经会阴超声引导前列腺癌放射治疗毒性和患者报告的生活质量

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.ctro.2024.100868

Jing Ma , Paul Rogowski , Christian Trapp , Farkhad Manapov , Bin Xu , Alexander Buchner , Shun Lu , Nina Sophie Schmidt-Hegemann , Xuanbin Wang , Cheng Zhou , Christian Stief , Claus Belka , Minglun Li

Purpose

This study aims to address therapy-related toxicities and quality of life in prostate cancer patients undergoing transperineal ultrasound (TPUS) guided radiotherapy (RT).

Methods

Acute and late gastrointestinal (GI) and genitourinary (GU) toxicities were assessed by physicians using CTCAE v5.0. Patient-reported quality of life outcomes were evaluated using EORTC QLQ-C30, -PR25 and IPSS. We utilized Volumetric Modulated Arc Therapy (VMAT) or intensity modulated radiation therapy (IMRT) as the RT technique for this study. The assessments were carried out before RT, at RT end, 3 months after RT and subsequently at 1-year intervals. Prostate-specific antigen (PSA) was also evaluated at each follow-up.

Results

In this study, a total of 164 patients were enrolled, while among them, 112 patients delivered quality-of-life data in a prospective evaluation. The median pre-treatment PSA was 7.9 ng/mL (range: 1.8–169 ng/ml). At the median follow-up of 19 months (3–82 months), the median PSA decreased to 0.22 ng/ml. Acute grade II GI and GU toxicities occurred in 8.6 % and 21.5 % patients at RT end. Regarding late toxicities, 2.2 % patients experienced grade II GI toxicities at 27 months and only one patient at 51 months, whereas no grade II GU late toxicities were reported at these time points. Quality of life scores also indicated a well-tolerated treatment. Patients mainly experienced acute clinically relevant symptoms of fatigue, pain, as well as deterioration in bowel and urinary symptoms. However, most symptoms normalized at 3 months and remained stable thereafter. Overall functioning showed a similar decline at RT end but improved over time.

Conclusion

The outcomes of TPUS-guided RT demonstrated promising results in terms of minimal physician-reported toxicities and satisfactory patient-reported QoL.

方法医生使用 CTCAE v5.0 评估急性和晚期胃肠道（GI）和泌尿生殖系统（GU）毒性。患者报告的生活质量结果采用 EORTC QLQ-C30、-PR25 和 IPSS 进行评估。本研究采用容积调强弧线疗法（VMAT）或调强放射疗法（IMRT）作为 RT 技术。评估分别在放疗前、放疗结束时、放疗后 3 个月以及之后每隔 1 年进行一次。结果在这项研究中，共有 164 名患者接受了前瞻性评估，其中 112 名患者提供了生活质量数据。治疗前 PSA 的中位数为 7.9 纳克/毫升（范围：1.8-169 纳克/毫升）。中位随访时间为 19 个月（3-82 个月），PSA 中位值降至 0.22 纳克/毫升。在 RT 结束时，分别有 8.6% 和 21.5% 的患者出现急性 II 级消化道和泌尿系统毒性。在晚期毒性方面，2.2%的患者在27个月时出现了II级消化道毒性，只有一名患者在51个月时出现了II级消化道毒性，而在这些时间点均未报告II级泌尿系统晚期毒性。生活质量评分也表明治疗耐受性良好。患者主要出现疲劳、疼痛以及肠道和泌尿系统症状恶化等急性临床相关症状。不过，大多数症状在 3 个月后恢复正常，此后保持稳定。结论TPUS引导的RT治疗结果表明，医生报告的毒性极小，患者报告的生活质量令人满意。

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引用次数: 0

Immunological responses to brain metastasis stereotactic radiosurgery in patient-matched longitudinal blood and tumour samples 患者匹配的纵向血液和肿瘤样本对脑转移立体定向放射手术的免疫反应

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.ctro.2024.100863

Joseph Sia , Criselle D’Souza , Rebecca Castle , Yu-Kuan Huang , Han Xian Aw Yeang , Rejhan Idrizi , Metta Jana , Shankar Siva , Claire Phillips , Paul Neeson

Background

Stereotactic radiosurgery (SRS) is highly effective as focal treatment for brain metastases (BrMs), but whether it can promote anti-tumour immune responses that synergise with immunotherapy remains unclear. We investigated this by examining blood samples from a clinical trial for HER2-amplified breast cancer (HER2-BC) BrMs, matched with longitudinal HER2-BC BrM samples resected from the same location in the same patient.

Methods

Blood samples from 10 patients taken pre- and 7–14 days post-SRS were analysed by mass and flow cytometry. One patient received pre-operative SRS for a BrM that recurred 7 months after resection, followed by planned re-resection 8 days post-SRS. Pre- and post-SRS tumours from this patient were analysed by bulk RNAseq, multiplex immunohistochemistry (mIHC), and TCR sequencing.

Results

Monocytes, central memory CD8+ T and regulatory T cells were enriched in blood post-SRS, together with increased MHC-II expression on monocytes, conventional DCs, and monocytic MDSCs. In tumour, SRS upregulated antigen presentation, T cell proliferation and T cell co-stimulation signatures, alongside an influx of tumour-associated macrophages (TAMs) and CD4+ T cells. Specifically, TAMs and CD4+ T cells, but not CD8+ T cells, demonstrated spatial co-localisation post-SRS. These TAMs were lowly PD-L1 expressing, but CD4+ T cells showed increased PD-1 expression. A sizeable proportion of T cell clonotypes were retained post-SRS, and four clones demonstrated significant, non-stochastic expansion.

Conclusion

Systemic and local immunological changes in this homogenous patient cohort suggest that SRS may facilitate MHC-II-restricted T cell priming responses involving the monocyte-macrophage lineage and CD4+ T cells, which should be further explored.

背景立体定向放射手术（SRS）作为脑转移瘤（BrMs）的病灶治疗非常有效，但它是否能促进与免疫疗法协同作用的抗肿瘤免疫反应仍不清楚。我们通过研究来自HER2-扩增乳腺癌（HER2-BC）脑转移灶临床试验的血液样本，以及从同一患者同一部位切除的纵向HER2-BC脑转移灶样本，对此进行了调查。方法通过质谱和流式细胞术分析了10名患者在SRS术前和术后7-14天采集的血液样本。其中一名患者在术前接受了SRS治疗，该肿瘤在切除术后7个月复发，在SRS术后8天按计划进行了再次切除。结果SRS术后血液中的单核细胞、中心记忆CD8+ T细胞和调节性T细胞富集，单核细胞、传统DC和单核MDSCs上的MHC-II表达增加。在肿瘤中，SRS 上调了抗原呈递、T 细胞增殖和 T 细胞协同刺激特征，同时肿瘤相关巨噬细胞（TAMs）和 CD4+ T 细胞也大量涌入。具体来说，TAMs 和 CD4+ T 细胞（而非 CD8+ T 细胞）在 SRS 后表现出空间共定位。这些TAM的PD-L1表达量很低，但CD4+ T细胞的PD-1表达量却很高。结论这组同质患者的系统和局部免疫学变化表明，SRS 可促进涉及单核-巨噬细胞系和 CD4+ T 细胞的 MHC-II 限制性 T 细胞引物反应，这一点应进一步探讨。

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引用次数: 0

The oxygen puzzle in FLASH radiotherapy: A comprehensive review and experimental outlook FLASH 放射治疗中的氧气难题：全面回顾与实验展望

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-18 DOI: 10.1016/j.ctro.2024.100860

Andrea Scarmelotto , Victor Delprat , Carine Michiels , Stéphane Lucas , Anne-Catherine Heuskin

FLASH radiotherapy is attracting increasing interest because it maintains tumor control while inflicting less damage to normal tissues compared to conventional radiotherapy. This sparing effect, the so-called FLASH effect, is achieved when radiation is delivered at ultra-high dose rates (≥40 Gy/s). Although the FLASH effect has already been demonstrated in several preclinical models, a complete mechanistic description explaining why tumors and normal tissues respond differently is still missing. None of the current hypotheses fully explains the experimental evidence. A common point between many of these is the role of oxygen, which is described as a major factor, either through transient hypoxia in the form of dissolved molecules, or reactive oxygen species (ROS). Therefore, this review focuses on both forms of this molecule, retracing old and more recent theories, while proposing new mechanisms that could provide a complete description of the FLASH effect based on preclinical and experimental evidence. In addition, this manuscript describes a set of experiments designed to provide the FLASH community with new tools for exploring the post-irradiation fate of ROS and their potential biological implications.

与传统放疗相比，FLASH 放疗既能控制肿瘤，又能减少对正常组织的损伤，因此越来越受到关注。当以超高剂量率（≥40 Gy/s）进行放射治疗时，就能达到这种疏导效果，即所谓的 "FLASH效应"。虽然 FLASH 效应已在多个临床前模型中得到证实，但仍缺乏完整的机理描述来解释肿瘤和正常组织为何会产生不同的反应。目前没有一种假说能完全解释实验证据。许多假说的共同点是氧的作用，氧被描述为一个主要因素，要么是通过溶解分子形式的瞬时缺氧，要么是活性氧（ROS）。因此，本综述将重点放在这两种形式的分子上，追溯旧的和最新的理论，同时根据临床前和实验证据提出新的机制，以完整描述 FLASH效应。此外，本手稿还描述了一组实验，旨在为 FLASH 社区提供探索 ROS 辐射后命运及其潜在生物学影响的新工具。

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引用次数: 0

A pilot study to evaluate the combination of surgery and brachytherapy for local tumor control in young children with perianal rhabdomyosarcoma 评估手术和近距离放射治疗相结合对肛周横纹肌肉瘤患儿局部肿瘤控制效果的试点研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-18 DOI: 10.1016/j.ctro.2024.100862

Andreas Schmidt , David Baumann , Ulf Lamprecht , Benjamin Mayer , Cristian Urla , Benjamin Bender , Jürgen Schäfer , Frank Fideler , Maximilian Niyazi , Frank Paulsen , Jörg Fuchs

Background

Perianal rhabdomyosarcoma ((P)RMS) are rare and have a poor prognosis. Data in young children are limited and local therapy is not well defined. Combined brachytherapy and surgery is routinely being used for RMS at other sites in children as it provides good oncologic outcomes and allows for organ-sparing surgery. The objective of this study was to evaluate this combination treatment for local tumor control and organ-sparing surgery in young children with (P)RMS.

Methods

A retrospective review of the medical records of all children who underwent surgery and brachytherapy for (P)RMS at our institution since 2009 was conducted.

Results

Surgery for (P)RMS was performed in 6 patients at a median age of 19 months (range 8–50). Embryonal RMS was diagnosed in 4 patients and alveolar RMS in 2 patients, of which 1 patient had FOXO1 fusion-positive RMS. All patients underwent postoperative high-dose rate (HDR) brachytherapy. Organ-preserving surgery was achieved in 5 of 6 patients (83 %). In 1 patient, the entire sphincter was infiltrated, making organ-preserving resection impossible. 5 of 6 patients (83 %) exhibited an event-free and overall survival at a median follow-up of 26 months (range 8–107). One patient died due to locoregional recurrence. Complications were urethral leakage in 1 patient followed by urethral stenosis and delayed wound healing and vaginal stenosis in another patient. No patient reported fecal incontinence.

Conclusions

Combined treatment with surgery and HDR brachytherapy is feasible in very young children with (P)RMS and leads to a favorable oncologic outcome. Preliminary data show a good functional preservation.

背景肛门横纹肌肉瘤（(P)RMS）非常罕见，预后较差。幼儿的数据有限，局部治疗方法也不明确。近距离放射治疗与手术相结合是治疗儿童其他部位横纹肌肉瘤的常规方法，因为这种方法具有良好的肿瘤治疗效果，而且可以进行保全器官手术。本研究的目的是评估这种联合治疗方法在局部肿瘤控制和保全器官手术方面对（P）RMS 患儿的疗效。方法回顾性分析自 2009 年以来在我院接受手术和近距离放射治疗的所有（P）RMS 患儿的病历。4名患者被诊断为胚胎型RMS，2名患者被诊断为肺泡型RMS，其中1名患者为FOXO1融合阳性RMS。所有患者都接受了术后高剂量率（HDR）近距离放射治疗。6 名患者中有 5 人（83%）接受了保留器官手术。有一名患者的整个括约肌都被浸润，因此无法进行保留器官的切除手术。6 名患者中有 5 名（83%）在中位 26 个月（8-107 个月）的随访中获得了无事件生存和总生存。一名患者因局部复发而死亡。并发症为一名患者出现尿道漏，随后出现尿道狭窄，另一名患者出现伤口延迟愈合和阴道狭窄。结论对于年幼的（P）RMS患儿来说，手术和HDR近距离放射治疗联合治疗是可行的，并可获得良好的肿瘤治疗效果。初步数据显示功能保留良好。

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引用次数: 0

Anatomical and dosimetric variations during volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma after induction therapy: Implications for adaptive radiation therapy 局部晚期鼻咽癌患者在诱导治疗后接受容积调制弧治疗期间的解剖和剂量变化：适应性放射治疗的意义

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-17 DOI: 10.1016/j.ctro.2024.100861

Shuhan Zhao , Jun Han , Zhiyong Yang , Xi Chen , Xixi Liu , Fangyuan Zhou , Yajie Sun , Ye Wang , Gang Liu , Bian Wu , Sheng Zhang , Jing Huang , Kunyu Yang

Purpose

To investigate anatomical and dosimetric changes during volumetric modulated arc therapy (VMAT) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) after induction therapy (IT) and explore characteristics of patients with notable variations.

Materials and methods

From July 2021 to June 2023, 60 LA-NPC patients undergoing VMAT after IT were retrospectively recruited. Adaptive computed tomography (aCT), reconstructed from weekly cone-beam computed tomography(CBCT), facilitates recontouring and planning transplantation. Volume, dice similarity coefficients, and dose to target volumes and organs at risk(OARs) on planning CT(pCT) and aCT were compared to identify changing patterns. Multivariate logistic regression was used to investigate risk factors.

Results

The volumes of PGTVnasopharynx (PGTVp), PGTVnode (PGTVn), ipsilateral and contralateral parotid glands decreased during VMAT, with reductions of 2.25 %, 6.98 %, 20.09 % and 18.00 %, respectively, at 30 fractions from baseline (P < 0.001). After 25 fractions, D99 and D95 of PGTVn decreased by 7.94 % and 4.18 % from baseline, respectively, while the Dmean of ipsilateral and contralateral parotid glands increased by 7.80 % and 6.50 %, marking the peak rates of dosimetric variations (P < 0.001). The dosimetric fluctuations in PGTVp, the brainstem, and the spinal cord remained within acceptable limits. Furthermore, an initial BMI ≥ 23.5 kg/m² and not-achieving objective response (OR) after IT were regarded as risk factors for a remarkable PGTVn dose reduction in the later stages of VMAT.

Conclusions

Replanning for post-IT LA-NPC patients appears reasonable at 25F during VMAT. Patients with an initial BMI ≥ 23.5 kg/m² and not-achieving OR after IT should be considered for adaptive radiation therapy to stabilize the delivered dose.

目的研究诱导治疗（IT）后局部晚期鼻咽癌（LA-NPC）患者在容积调控弧治疗（VMAT）期间的解剖学和剂量学变化，并探索有显著变化的患者的特征。材料和方法从2021年7月到2023年6月，回顾性招募了60名IT后接受VMAT治疗的LA-NPC患者。根据每周锥束计算机断层扫描（CBCT）重建的自适应计算机断层扫描（aCT）有助于重新构图和规划移植。比较了计划 CT（pCT）和 aCT 的体积、骰子相似系数以及目标体积和危险器官（OAR）的剂量，以确定变化的模式。结果在 VMAT 期间，PGTVnasopharynx (PGTVp)、PGTVnode (PGTVn)、同侧和对侧腮腺的体积均有所减少，在 30 次分割时，与基线相比分别减少了 2.25 %、6.98 %、20.09 % 和 18.00 %（P < 0.001）。25 个分次后，PGTVn 的 D99 和 D95 分别比基线下降了 7.94 % 和 4.18 %，而同侧和对侧腮腺的 Dmean 则分别上升了 7.80 % 和 6.50 %，达到了剂量变化的峰值（P <0.001）。PGTVp、脑干和脊髓的剂量波动仍在可接受范围内。此外，初始 BMI ≥ 23.5 kg/m2 和 IT 后未达到客观反应 (OR) 被视为 VMAT 后期 PGTVn 剂量显著降低的风险因素。初始 BMI ≥ 23.5 kg/m2 和 IT 后未达到 OR 的患者应考虑进行适应性放疗，以稳定给药剂量。

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引用次数: 0

Feasibility of using contrast-free quantitative magnetic resonance imaging for liver sparing stereotactic ablative body radiotherapy 使用无对比定量磁共振成像技术进行保肝立体定向烧蚀体放射治疗的可行性

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-13 DOI: 10.1016/j.ctro.2024.100859

Frank Brewster , Zoe Middleton , Alan McWilliam , Andrew Brocklehurst , Ganesh Radhakrishna , Robert Chuter

Background and purpose

Tumours in the liver often develop on a background of liver cirrhosis and impaired liver function. As a result, radiotherapy treatments are limited by radiation-induced liver disease, parameterised by the liver mean dose (LMD). Liver function is highly heterogeneous, especially in liver cancer, but the use of LMD does not take this into account. One possible way to improve liver treatments is to use quantitative imaging techniques to assess liver health and prioritise the sparing of healthy liver tissue.

Materials and methods

Anatomical T2 and quantitative iron-corrected T1 (cT1) images were made available for 10 patients with liver metastases. Functional liver volumes were automatically segmented on the quantitative images using a threshold. Liver stereotactic ablative body radiotherapy (SABR) plans were made using a departmental protocol. Liver-sparing plans were then made by reducing the dose to the functional sub-volume.

Results

The sparing plans achieved a statistically significant (

p = 0.002

) reduction in the functional liver mean dose, with a mean reduction of 1.4 Gy. The LMD was also significantly different (

p = 0.002

) but had a smaller magnitude with a mean reduction of 0.7 Gy. There were some differences in the planning target volume D_99% (

p = 0.04

) but the sparing plans remained within the optimal tolerance and the D_95% was not significantly different (

p = 0.2

).

Conclusions

This study has, for the first time, demonstrated the use of cT1 maps in radiotherapy showing significant reductions in dose to the healthy liver. Further work is needed to validate this in liver cancer patients, who would likely benefit most.

背景和目的肝脏肿瘤通常是在肝硬化和肝功能受损的背景下发生的。因此，放射治疗受到辐射诱发肝病的限制，其参数为肝脏平均剂量（LMD）。肝功能是高度异质性的，尤其是在肝癌患者中，但使用 LMD 并没有考虑到这一点。改善肝脏治疗的一个可行方法是使用定量成像技术评估肝脏健康状况，并优先保留健康的肝脏组织。材料与方法为 10 名肝脏转移患者提供了解剖 T2 和定量铁校正 T1 (cT1) 图像。在定量图像上使用阈值自动分割功能性肝脏体积。肝脏立体定向消融体放射治疗（SABR）计划是根据科室协议制定的。结果疏肝计划实现了肝脏功能性平均剂量的显著降低（P=0.002），平均降低1.4 Gy。LMD也有显著差异（P=0.002），但幅度较小，平均减少0.7 Gy。规划靶体积D99%存在一些差异（p=0.04），但疏导计划仍在最佳容差范围内，D95%也无明显差异（p=0.2）。结论这项研究首次证明了cT1地图在放疗中的应用，显示对健康肝脏的剂量显著减少。还需要进一步在肝癌患者中进行验证，因为肝癌患者可能受益最大。

{"title":"Feasibility of using contrast-free quantitative magnetic resonance imaging for liver sparing stereotactic ablative body radiotherapy","authors":"Frank Brewster , Zoe Middleton , Alan McWilliam , Andrew Brocklehurst , Ganesh Radhakrishna , Robert Chuter","doi":"10.1016/j.ctro.2024.100859","DOIUrl":"10.1016/j.ctro.2024.100859","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Tumours in the liver often develop on a background of liver cirrhosis and impaired liver function. As a result, radiotherapy treatments are limited by radiation-induced liver disease, parameterised by the liver mean dose (LMD). Liver function is highly heterogeneous, especially in liver cancer, but the use of LMD does not take this into account. One possible way to improve liver treatments is to use quantitative imaging techniques to assess liver health and prioritise the sparing of healthy liver tissue.</div></div><div><h3>Materials and methods</h3><div>Anatomical T2 and quantitative iron-corrected T1 (cT1) images were made available for 10 patients with liver metastases. Functional liver volumes were automatically segmented on the quantitative images using a threshold. Liver stereotactic ablative body radiotherapy (SABR) plans were made using a departmental protocol. Liver-sparing plans were then made by reducing the dose to the functional sub-volume.</div></div><div><h3>Results</h3><div>The sparing plans achieved a statistically significant (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.002</mn></mrow></math></span>) reduction in the functional liver mean dose, with a mean reduction of 1.4 Gy. The LMD was also significantly different (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.002</mn></mrow></math></span>) but had a smaller magnitude with a mean reduction of 0.7 Gy. There were some differences in the planning target volume D<sub>99%</sub> (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.04</mn></mrow></math></span>) but the sparing plans remained within the optimal tolerance and the D<sub>95%</sub> was not significantly different (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.2</mn></mrow></math></span>).</div></div><div><h3>Conclusions</h3><div>This study has, for the first time, demonstrated the use of cT1 maps in radiotherapy showing significant reductions in dose to the healthy liver. Further work is needed to validate this in liver cancer patients, who would likely benefit most.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100859"},"PeriodicalIF":2.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001368/pdfft?md5=de1ba350da198b0fb5d222e61232e6e2&pid=1-s2.0-S2405630824001368-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors 喉和下咽肿瘤放射治疗前磁共振成像变量和动态对比增强磁共振成像对放疗疗效的预后价值

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-12 DOI: 10.1016/j.ctro.2024.100857

Hilde J.G. Smits , Saskia J. Vink , Mischa de Ridder , Marielle E.P. Philippens , Jan W. Dankbaar

Background

This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.

Methods

320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.

Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60_median and AUC60_p95) were determined in the tumor volume.

Results

Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60_p95 (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.

In multivariable analysis, a Cox proportional hazard model showed that a AUC60_p95 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, P<.001). Tumor volume was prognostic for DC (HR=3.42, P<.001) and OS (HR=3.27, P<.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.

Conclusion

Low pretreatment AUC60_p95 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.

背景本研究旨在确定放射学磁共振成像（MRI）变量和动态对比增强（DCE）-MRI对喉癌和下咽癌患者放疗后的局部控制（LC）、疾病控制（DC）和总生存（OS）的预后价值。对治疗前的磁共振成像进行了评估，以确定肿瘤的以下解剖学特征：软骨侵犯、咽外扩散、前会厌、会厌前间隙和咽旁间隙受累。结果可变对数秩检验确定，喉外扩散、肿瘤体积和T期是LC、DC和OS恶化的预后因素。在多变量分析中，Cox比例危险模型显示，AUC60p95≥31.7 mmol-s/L是较好OS的预后指标（HR=0.25，P<.001）。肿瘤体积是DC（HR=3.42，P<.001）和OS（HR=3.27，P<.001）的预后因素。结论治疗前AUC60p95较低是较差OS的预后因素，这表明肿瘤灌注不良导致生存较差。肿瘤体积大也是DC和OS较差的预后因素。在校正了年龄、T期、N期和肿瘤体积等混杂因素后，MRI解剖参数对任何评估的治疗结果都没有预示作用。

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引用次数: 0

Complications leading to hospitalisation 12 months after brachytherapy or high-intensity focused ultrasound for localized prostate cancer: French national from the PMSI-MCO data, 2019 and 2020 局部前列腺癌近距离放射治疗或高强度聚焦超声治疗12个月后导致住院的并发症：2019年和2020年法国全国PMSI-MCO数据

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-12 DOI: 10.1016/j.ctro.2024.100854

Timothée Bourgarit , Clément Larose , Andrea Dagry , Nicolas Martz , Beverley Balkau , Pascal Eschwège , Charles Mazeaud

Background and purpose

Prostate cancer can be treated using either brachytherapy or high-intensity focused ultrasound (HIFU), which are less invasive than surgery. Although both approaches have proved effective, few studies have looked at the specific causes of hospitalisation due to complications, following these treatments. The aim of this study was to compare the causes of hospitalisation.

Methods

A retrospective study was carried out examining the records of patients who had undergone brachytherapy or HIFU treatment for localized prostate cancer in 2019 and 2020, using the French national database: Programme de Médicalisation du Système d’Information − Médecine, Chirurgie, Obstétrique (PMSI-MSO). Data on post-treatment hospitalisations were analyzed.

Results

3090 patients were included in the study, of whom 1699 underwent brachytherapy and 1391 HIFU procedures. The incidence of hospitalisation was much higher after HIFU than after brachytherapy, notably due to a higher rate of obstructive complications (12.94% vs 2.77%). Large differences were also found for infections (8.20% vs 1.47%) and bleeding (6.76% vs 2.18%) leading to hospitalisation. Most of the complications occurred at the initial hospitalization: 12% for HIFU, and 1.4% for brachytherapy.

Conclusion

Complications were more frequent after treatment with HIFU than with brachytherapy in the year following treatment for localized prostate cancer. Further the causes of hospitalisation differed between the two treatments. These differences need to be taken into account in the therapeutic strategy, as well as in post-treatment management.

背景和目的前列腺癌可采用近距离放射治疗或高强度聚焦超声（HIFU）治疗，这两种方法的创伤性都比手术小。尽管这两种方法都被证明是有效的，但很少有研究对这些治疗后因并发症住院的具体原因进行调查。本研究旨在比较住院原因。方法：本研究利用法国国家数据库，对2019年和2020年接受近距离放射治疗或HIFU治疗的局部前列腺癌患者的病历进行了回顾性研究：医疗信息系统计划--医学、外科、妇产科（PMSI-MSO）。研究共纳入3090名患者，其中1699人接受了近距离放射治疗，1391人接受了HIFU治疗。HIFU 治疗后的住院率远高于近距离治疗，主要原因是阻塞性并发症的发生率更高（12.94% 对 2.77%）。感染（8.20% 对 1.47%）和出血（6.76% 对 2.18%）导致的住院率也有很大差异。大多数并发症发生在初次住院时：结论在局部前列腺癌治疗后的一年内，HIFU治疗后的并发症发生率高于近距离治疗。此外，两种治疗方法的住院原因也有所不同。这些差异需要在治疗策略和治疗后管理中加以考虑。

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引用次数: 0

Temporary halo fixation and radiotherapy as alternative to long-construct spondylodesis in patients with multiple unstable cervical metastases 在多发性不稳定颈椎转移瘤患者中，用临时光环固定和放射治疗替代长结构脊柱切除术

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-11 DOI: 10.1016/j.ctro.2024.100858

E.H. Huele , J.M. van der Velden , H.M. Verkooijen , N. Kasperts , J.J. Verlaan

Background and purpose

Currently no minimally invasive surgical treatment exists to provide immediate stability for unstable cervical/cervicothoracic metastases. Long-construct spondylodesis carries a high complication risk and has severe impact on residual range of motion. This study explores temporary halo fixation and radiotherapy as an alternative to long-construct cervical spondylodesis.

Materials and methods

This retrospective cohort study included twenty patients with multiple unstable cervical metastases treated between 2013–2023. All patients underwent halo fixation for an intended duration of three months to allow for safe reossification of lytic lesions following radiotherapy, with a dose fractionation scheme best suited to the histological origin of the tumor.

Results

Immobilization with halo fixation lasted a median 83 days (range, 41–132 days). Radiotherapy started on average 7 days after halo fixation (range, −35–118 days). The median pain score at baseline was 8, and was 0 at halo removal and at last follow-up. All patients had no or minor neurological deficits at baseline and did not develop new neurological deficits. At halo removal, 17/18 patients showed radiographic evidence of reossification. The majority of patients experienced minor limitations or had full range of motion of the neck at last follow-up.

Conclusion

Patients with multiple unstable cervical metastases treated with halo fixation and radiotherapy showed complete pain response or substantial pain reduction, reossification of the vertebrae and a, mostly, preserved range of motion. In selected neurologically intact patients, this treatment might be a patient-friendly alternative to fixation. Prospective evaluation of this treatment combination is needed.

背景和目的目前还没有一种微创手术治疗方法可以为不稳定的颈椎/颈胸椎转移瘤提供即时稳定性。长期脊柱切除术具有很高的并发症风险，并严重影响残余活动范围。本研究探讨了临时光环固定和放疗作为长结构颈椎椎体切除术的替代方法。材料和方法这项回顾性队列研究纳入了 20 例在 2013-2023 年间接受治疗的多发性不稳定颈椎转移瘤患者。所有患者均接受了为期三个月的光环固定术，以便在放疗后安全地对溶解性病灶进行再化疗，并采用最适合肿瘤组织学来源的剂量分馏方案。结果光环固定术的中位持续时间为 83 天（41-132 天不等）。放疗平均在光环固定后7天开始（范围：-35-118天）。基线疼痛评分的中位数为 8 分，去除光环和最后一次随访时的评分为 0 分。所有患者在基线时都没有或只有轻微的神经功能缺损，也没有出现新的神经功能缺损。在去除光环时，17/18 名患者的影像学表现为再硬化。结论接受光环固定和放疗治疗的多发性不稳定颈椎转移瘤患者疼痛反应完全消失或明显减轻，椎体重新变硬，活动范围基本保持不变。对于选定的神经功能完好的患者来说，这种治疗方法可能是固定治疗的一种患者友好型替代疗法。需要对这种治疗组合进行前瞻性评估。

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引用次数: 0

Durable local control with hypofractionated radiation therapy for unresectable or metastatic melanoma 对无法切除的或转移性黑色素瘤采用低分次放射治疗实现持久的局部控制

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-11 DOI: 10.1016/j.ctro.2024.100856

Sydney A. Keatts , Aya F. Salem , David M. Swanson , Ahsan S. Farooqi , Andrew J. Bishop , Rodabe N. Amaria , Jennifer L. McQuade , Isabella C. Glitza Oliva , Adi Diab , Roi Weiser , Sarah B. Fisher , Ryan P. Goepfert , Merrick I. Ross , B. Ashleigh Guadagnolo , Devarati Mitra

Background and purpose

As patients with advanced melanoma live longer in the context of systemic therapy advancements, better strategies for durable control of bulky tumors are needed. In this study, we evaluated if dose-escalated hypofractionated radiation therapy (HFRT) can provide durable local control and improve tumor-associated symptoms in patients with unresectable or bulky metastatic melanoma for whom stereotactic ablative radiotherapy (RT) approaches are not feasible due to tumor size or location.

Materials and methods

We retrospectively reviewed 49 patients with unresectable or bulky metastatic melanoma who were treated to a total of 53 tumor targets with 12–17 fractions HFRT at our institution between 2015–2022. Clinical scenarios included: unresectable, locoregional only disease (26 %); oligometastatic disease (<3 total sites, 17 %); oligoprogressive disease (<3 sites progressing, 17 %); and aggressive palliation (>5 known sites of disease or with at least 3 sites progressing, 40 %).

Results

Of the 53 HFRT targets, 91 % (n = 48) had radiographic evidence of response as defined by either stabilization (6 %, n = 3), decreased size (74 %, n = 39), or decreased FDG avidity (11 %, n = 6). Of the 43 symptomatic patients, 98 % (n = 42) had symptomatic improvement. One −year local control was 79 %, with 2-year progression-free and overall survival of 33 % and 39 % respectively. The most common acute toxicities were radiation dermatitis (16 %, n = 8) or a pain flare (14 %, n = 7). Late toxicities were uncommon and typically grade 1.

Conclusion

HFRT provides favorable local control and symptomatic relief with limited toxicity in tumors not amenable to surgical resection or stereotactic ablative RT.

背景和目的随着系统疗法的发展，晚期黑色素瘤患者的寿命越来越长，因此需要更好的策略来持久控制巨大肿瘤。在这项研究中，我们评估了剂量递增的低分次放射治疗（HFRT）能否为因肿瘤大小或位置而无法进行立体定向消融放疗（RT）的不可切除或巨大转移性黑色素瘤患者提供持久的局部控制并改善肿瘤相关症状。材料与方法我们回顾性研究了本院在2015-2022年间对49例无法切除或体积较大的转移性黑色素瘤患者进行了治疗，共对53个肿瘤靶点进行了12-17次HFRT治疗。临床情况包括：不可切除、仅局部区域性疾病（26%）；少转移性疾病（<共3个部位，17%）；少进展性疾病（<3个部位进展，17%）；侵袭性姑息治疗（>5个已知患病部位或至少3个部位进展，40%）。结果在 53 例 HFRT 靶点中，91%（48 例）有放射学证据表明出现了反应，其定义为稳定（6%，3 例）、缩小（74%，39 例）或 FDG 阳性降低（11%，6 例）。在 43 名有症状的患者中，98%（42 人）的症状有所改善。一年局部控制率为 79%，两年无进展生存率和总生存率分别为 33% 和 39%。最常见的急性毒性是放射性皮炎（16%，n = 8）或疼痛发作（14%，n = 7）。对于不适合手术切除或立体定向消融 RT 的肿瘤，ConclusionHFRT 可提供良好的局部控制和症状缓解，且毒性有限。

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引用次数: 0