Pub Date : 2025-11-10DOI: 10.1016/j.ctro.2025.101075
J.J. Laan , D.L.J. Barten , Z. van Kesteren , L.J.S. Ewals , A. Bel , K.A. Hinnen , B.R. Pieters , L.J.A. Stalpers , H. Westerveld
Introduction
Gastrointestinal toxicity is a major concern after radiotherapy for gynaecologic cancer. Strong dose–effect relationships for the bowel and individual loops are lacking, which might be explained by challenges in accurate radiation dose estimation due to continuous motion of the bowel loops. The objective of this study was to evaluate whether changes in bowel loop motion occur over the course of radiotherapy, with the use of three-dimensional (3D) cine-MRI.
Methods and Materials
This study prospectively enrolled patients with gynaecologic cancer undergoing primary radiotherapy with curative intent. To measure bowel loop motion, three 3D cine-MRI scans were acquired: before external beam radiotherapy (EBRT), in the last week of EBRT, and on the day of brachytherapy. A MR image was acquired every 3.7 s during a 10-minute scan. Deformable image registration was used to generate a motion map and a motion volume histogram. Changes in bowel loop motion over the course of treatment were assessed by the Wilcoxon signed-rank test using the median bowel loop motion in millimetres per 3.7 s of 50% of all voxels.
Results
For 15 of the 22 patients, 3D cine-MR scans were available at all three time points. Median bowel loop motion per 3.7 s was 1.8 mm (range 0.6–3.3 mm) before EBRT, 1.0 mm (range 0.6–2.3 mm) in the last week of EBRT, and 0.7 mm (range 0.4–1.1 mm) at brachytherapy. Most patients (14 out of 15) showed reduced bowel loop motion in the last week of EBRT compared to the first MR, with the lowest motion at brachytherapy in 13 patients (87 %). Median bowel loop motion decreased significantly with each subsequent MRI scan (p = 0.005 and p = 0.020, respectively).
Conclusions
The results of this study demonstrate a statistically significant decrease in bowel loop motion over the course of primary radiotherapy for gynaecological cancer.
{"title":"Reduction of bowel loop motion during radiotherapy for gynaecological cancer assessed by 3D cine-MRI","authors":"J.J. Laan , D.L.J. Barten , Z. van Kesteren , L.J.S. Ewals , A. Bel , K.A. Hinnen , B.R. Pieters , L.J.A. Stalpers , H. Westerveld","doi":"10.1016/j.ctro.2025.101075","DOIUrl":"10.1016/j.ctro.2025.101075","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastrointestinal toxicity is a major concern after radiotherapy for gynaecologic cancer. Strong dose–effect relationships for the bowel and individual loops are lacking, which might be explained by challenges in accurate radiation dose estimation due to continuous motion of the bowel loops. The objective of this study was to evaluate whether changes in bowel loop motion occur over the course of radiotherapy, with the use of three-dimensional (3D) cine-MRI.</div></div><div><h3>Methods and Materials</h3><div>This study prospectively enrolled patients with gynaecologic cancer undergoing primary radiotherapy with curative intent. To measure bowel loop motion, three 3D cine-MRI scans were acquired: before external beam radiotherapy (EBRT), in the last week of EBRT, and on the day of brachytherapy. A MR image was acquired every 3.7 s during a 10-minute scan. Deformable image registration was used to generate a motion map and a motion volume histogram. Changes in bowel loop motion over the course of treatment were assessed by the Wilcoxon signed-rank test using the median bowel loop motion in millimetres per 3.7 s of 50% of all voxels.</div></div><div><h3>Results</h3><div>For 15 of the 22 patients, 3D cine-MR scans were available at all three time points. Median bowel loop motion per 3.7 s was 1.8 mm (range 0.6–3.3 mm) before EBRT, 1.0 mm (range 0.6–2.3 mm) in the last week of EBRT, and 0.7 mm (range 0.4–1.1 mm) at brachytherapy. Most patients (14 out of 15) showed reduced bowel loop motion in the last week of EBRT compared to the first MR, with the lowest motion at brachytherapy in 13 patients (87 %). Median bowel loop motion decreased significantly with each subsequent MRI scan (<em>p</em> = 0.005 and <em>p</em> = 0.020, respectively).</div></div><div><h3>Conclusions</h3><div>The results of this study demonstrate a statistically significant decrease in bowel loop motion over the course of primary radiotherapy for gynaecological cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101075"},"PeriodicalIF":2.7,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ctro.2025.101067
Steffen Löck , Lydia Koi , Kristin Gurtner , Fabian Lohaus , Max Kemper , Dominik Haim , Inge Tinhofer , Goda Kalinauskaite , Martin Stuschke , Maximilian Fleischmann , Claus Rödel , Anca-Ligia Grosu , Jürgen Debus , Claus Belka , Stephanie Combs , Simon Boeke , Gustavo Baretton , Michael Baumann , Mechthild Krause , Annett Linge
In a previous preclinical trial on human HNSCC xenografts, 18 genes were predictive for adding cetuximab to fractionated radiotherapy. Here, we apply the corresponding 18-gene classifier to two HNSCC patient cohorts treated with combined radiochemotherapy (without cetuximab). We show that the classifier is related to EGFR expression and stratifies patients for loco-regional control (LRC) in both cohorts.
{"title":"Application of a preclinical 18-gene classifier to patients with locally advanced HNSCC","authors":"Steffen Löck , Lydia Koi , Kristin Gurtner , Fabian Lohaus , Max Kemper , Dominik Haim , Inge Tinhofer , Goda Kalinauskaite , Martin Stuschke , Maximilian Fleischmann , Claus Rödel , Anca-Ligia Grosu , Jürgen Debus , Claus Belka , Stephanie Combs , Simon Boeke , Gustavo Baretton , Michael Baumann , Mechthild Krause , Annett Linge","doi":"10.1016/j.ctro.2025.101067","DOIUrl":"10.1016/j.ctro.2025.101067","url":null,"abstract":"<div><div>In a previous preclinical trial on human HNSCC xenografts, 18 genes were predictive for adding cetuximab to fractionated radiotherapy. Here, we apply the corresponding 18-gene classifier to two HNSCC patient cohorts treated with combined radiochemotherapy (without cetuximab). We show that the classifier is related to EGFR expression and stratifies patients for loco-regional control (LRC) in both cohorts.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101067"},"PeriodicalIF":2.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ctro.2025.101066
Prasoon Garg , S. Shyama Prem , Madhusudhanan Ponnusamy , Sathappan Muthuveerappan , K. Saravanan , N. Sreekumaran Nair , R. Anusuya
Purpose
This study evaluates the efficacy of submandibular gland sparing radiotherapy in reducing salivary dysfunction using dynamic 99mTechnetium pertechnetate scintigraphy.
Materials and Methods
Adults with head and neck squamous cell carcinoma planned for radical radiation using volumetric modulated arc radiotherapy were recruited in the study. The salivary function was assessed using 99mTechnetium pertechnetate scintigraphy at baseline, 3-, 6-, and 12 months post-radiation. Maximum Uptake (Umax), Salivary Excretion Fraction (SEF), relative change in SEF (rSEF), and SEF ratio were calculated and compared at different time points.
Results
Between June 2022 and January 2024, 113 patients were recruited, with scintigraphy data available for 27 patients with spared and 53 with unspared submandibular glands. At baseline, the mean Umax was 82.7 counts/second (cps) (spared) versus 81.5 cps (unspared). There was a decline at 3 months (66.5 cps vs. 72.7 cps), with significantly greater recovery by 12 months in the spared glands (81.2 cps vs. 54.8 cps; p = 0.035). SEF values at 3, 6, and 12 months respectively were 27.6 (IQR 19.6–42.1), 23.9 (IQR 17.7–31.2), and 29.9 (IQR 18.3–34.7) in spared glands compared to 2.8 (IQR −2.9–6.9), 4.4 (IQR 1.8–9.1), and 5.8 (IQR 2.6–7.6; p < 0.01 at all timepoints) in the unspared glands. At 3, 6, and 12 months, spared glands retained 78.5 %, 89.6 %, and 87.0 % function, compared to 10.5 %, 17.4 %, and 14.0 % in unspared glands (p < 0.01 at all time points). No recurrences occurred near the spared glands during the study period.
Conclusion
Submandibular gland sparing is safe and significantly reduces radiation-induced salivary dysfunction. Dynamic 99mTc-pertechnetate scintigraphy is a reliable, minimally invasive method for evaluating gland function.
{"title":"Evaluation of submandibular gland function using quantitative 99mTc-pertechnetate scintigraphy in submandibular gland sparing radiotherapy for head-neck cancers, a prospective longitudinal study","authors":"Prasoon Garg , S. Shyama Prem , Madhusudhanan Ponnusamy , Sathappan Muthuveerappan , K. Saravanan , N. Sreekumaran Nair , R. Anusuya","doi":"10.1016/j.ctro.2025.101066","DOIUrl":"10.1016/j.ctro.2025.101066","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the efficacy of submandibular gland sparing radiotherapy in reducing salivary dysfunction using dynamic <sup>99m</sup>Technetium pertechnetate scintigraphy.</div></div><div><h3>Materials and Methods</h3><div>Adults with head and neck squamous cell carcinoma planned for radical radiation using volumetric modulated arc radiotherapy were recruited in the study. The salivary function was assessed using <sup>99m</sup>Technetium pertechnetate scintigraphy at baseline, 3-, 6-, and 12 months post-radiation. Maximum Uptake (Umax), Salivary Excretion Fraction (SEF), relative change in SEF (rSEF), and SEF ratio were calculated and compared at different time points.</div></div><div><h3>Results</h3><div>Between June 2022 and January 2024, 113 patients were recruited, with scintigraphy data available for 27 patients with spared and 53 with unspared submandibular glands. At baseline, the mean Umax was 82.7 counts/second (cps) (spared) versus 81.5 cps (unspared). There was a decline at 3 months (66.5 cps vs. 72.7 cps), with significantly greater recovery by 12 months in the spared glands (81.2 cps vs. 54.8 cps; p = 0.035). SEF values at 3, 6, and 12 months respectively were 27.6 (IQR 19.6–42.1), 23.9 (IQR 17.7–31.2), and 29.9 (IQR 18.3–34.7) in spared glands compared to 2.8 (IQR −2.9–6.9), 4.4 (IQR 1.8–9.1), and 5.8 (IQR 2.6–7.6; p < 0.01 at all timepoints) in the unspared glands. At 3, 6, and 12 months, spared glands retained 78.5 %, 89.6 %, and 87.0 % function, compared to 10.5 %, 17.4 %, and 14.0 % in unspared glands (p < 0.01 at all time points). No recurrences occurred near the spared glands during the study period.</div></div><div><h3>Conclusion</h3><div>Submandibular gland sparing is safe and significantly reduces radiation-induced salivary dysfunction. Dynamic 99mTc-pertechnetate scintigraphy is a reliable, minimally invasive method for evaluating gland function.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101066"},"PeriodicalIF":2.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.ctro.2025.101065
Abdullah Saad, Rutaba Darooj, Ayesha Ismail
The study by Ding et al. on deep-learning-assisted organ-at-risk delineation for pediatric flank irradiation offers a valuable advancement toward automation in radiotherapy planning. However, several methodological and analytical gaps limit the confidence with which these findings can be generalized. Key issues include insufficient transparency of the manual annotation protocol and absence of baseline inter-observer variability metrics; possible circularity from using STAPLE consensus incorporating deep-learning contours; reliance solely on geometric similarity indices (Dice, HD95) without accompanying dosimetric validation; lack of uncertainty quantification or failure-mode analysis; and omission of workflow assessments beyond controlled settings. Together, these constraints obscure the true clinical impact of deep learning in radiotherapy contouring. Future investigations should prioritize transparent multicenter annotation standards, integrate probabilistic or uncertainty-aware models, include dosimetric endpoints, and evaluate performance within real-world clinical environments. Such measures will ensure that the promise of AI-assisted contouring translates into reproducible, safe, and clinically meaningful improvements in pediatric radiotherapy.
{"title":"Comment on “Deep learning in CT-based organ-at-risk delineation for pediatric flank irradiation”: Methodological and clinical considerations","authors":"Abdullah Saad, Rutaba Darooj, Ayesha Ismail","doi":"10.1016/j.ctro.2025.101065","DOIUrl":"10.1016/j.ctro.2025.101065","url":null,"abstract":"<div><div>The study by Ding et al. on deep-learning-assisted organ-at-risk delineation for pediatric flank irradiation offers a valuable advancement toward automation in radiotherapy planning. However, several methodological and analytical gaps limit the confidence with which these findings can be generalized. Key issues include insufficient transparency of the manual annotation protocol and absence of baseline inter-observer variability metrics; possible circularity from using STAPLE consensus incorporating deep-learning contours; reliance solely on geometric similarity indices (Dice, HD95) without accompanying dosimetric validation; lack of uncertainty quantification or failure-mode analysis; and omission of workflow assessments beyond controlled settings. Together, these constraints obscure the true clinical impact of deep learning in radiotherapy contouring. Future investigations should prioritize transparent multicenter annotation standards, integrate probabilistic or uncertainty-aware models, include dosimetric endpoints, and evaluate performance within real-world clinical environments. Such measures will ensure that the promise of AI-assisted contouring translates into reproducible, safe, and clinically meaningful improvements in pediatric radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101065"},"PeriodicalIF":2.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.ctro.2025.101068
Chiara Mattioli , Lucy A. van Werkhoven , M. Loi , Joost J. Nuyttens
Background and purpose
To evaluate survival and toxicity in patients with recurrent esophageal cancer treated with curative (cRT) and palliative (pRT) reirradiation.
Materials and methods
From May 2015 to August 2024, 41 patients with locally recurrent esophageal cancer received cRT or pRT. Toxicity was assessed using CTCAE v5.0. Overall survival (OS) was analyzed using the Kaplan-Meier method. Clinical benefit of pRT (reduction in dysphagia, pain or bleeding) was assessed 4 weeks after reRT.
Results
The cohort consisted of 41 patients (median age 73 years). At reirradiation, 36 patients received pRT (20 Gy/5fx or 30 Gy/10fx), and 5 received cRT (50.4 Gy/28fx with chemotherapy). Sixteen patients (39%) had metastatic disease (M1). Median OS was 11.9 months for M0 cRT, 9.8 months for M0 pRT, and 2.8 months for M1 pRT (p = 0.003). The pRT provided clinical benefit in 72% of patients: the median OS for M0 patients who did and did not experience symptoms improvement from reirradiation was 9.8 and 5 months, respectively; M1 patients with and without therapeutic effect had a median OS of 4.5 and 2.2 months, respectively (p < 0.001). Acute toxicity was low, with 5 pRT patients requiring a nasogastric tube and 1 patient developing grade 3 skin toxicity. No grade ≥ 4 toxicities were reported.
Conclusion
Palliative reirradiation in patients with recurrent esophageal cancer showed clinical benefit in 72% of the patients, with impact on OS both in M0 and M1 patients and low rate of acute toxicity. These findings support the use of reirradiation as a feasible and effective strategy in selected patients with recurrent esophageal cancer.
{"title":"Re-irradiation for recurrent esophageal cancer: clinical benefit, survival outcomes, and toxicity profile","authors":"Chiara Mattioli , Lucy A. van Werkhoven , M. Loi , Joost J. Nuyttens","doi":"10.1016/j.ctro.2025.101068","DOIUrl":"10.1016/j.ctro.2025.101068","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To evaluate survival and toxicity in patients with recurrent esophageal cancer treated with curative (cRT) and palliative (pRT) reirradiation.</div></div><div><h3>Materials and methods</h3><div>From May 2015 to August 2024, 41 patients with locally recurrent esophageal cancer received cRT or pRT. Toxicity was assessed using CTCAE v5.0. Overall survival (OS) was analyzed using the Kaplan-Meier method. Clinical benefit of pRT (reduction in dysphagia, pain or bleeding) was assessed 4 weeks after reRT.</div></div><div><h3>Results</h3><div>The cohort consisted of 41 patients (median age 73 years). At reirradiation, 36 patients received pRT (20 Gy/5fx or 30 Gy/10fx), and 5 received cRT (50.4 Gy/28fx with chemotherapy). Sixteen patients (39%) had metastatic disease (M1). Median OS was 11.9 months for M0 cRT, 9.8 months for M0 pRT, and 2.8 months for M1 pRT (p = 0.003). The pRT provided clinical benefit in 72% of patients: the median OS for M0 patients who did and did not experience symptoms improvement from reirradiation was 9.8 and 5 months, respectively; M1 patients with and without therapeutic effect had a median OS of 4.5 and 2.2 months, respectively (p < 0.001). Acute toxicity was low, with 5 pRT patients requiring a nasogastric tube and 1 patient developing grade 3 skin toxicity. No grade ≥ 4 toxicities were reported.</div></div><div><h3>Conclusion</h3><div>Palliative reirradiation in patients with recurrent esophageal cancer showed clinical benefit in 72% of the patients, with impact on OS both in M0 and M1 patients and low rate of acute toxicity. These findings support the use of reirradiation as a feasible and effective strategy in selected patients with recurrent esophageal cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101068"},"PeriodicalIF":2.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1016/j.ctro.2025.101064
Lukas Bauer , Katharina Weusthof , Sebastian Regnery , Maximilian Deng , Philipp Schröter , Florian Stritzke , Nils Netzer , Henrik Franke , Kristin Uzun-Lang , Julius Moratin , Oliver Ristow , Rubens Thoelken , Semi B. Harrabi , Klaus Herfarth , Sebastian Adeberg , Jürgen Debus , Thomas Held
Background
Local control of high-risk sinonasal squamous cell carcinoma (SCC) remains challenging and often involves significant morbidity. Management of the node-negative neck is still debated. This study evaluated treatment outcomes, neck management strategies, and toxicity rates in patients treated with intensity-modulated radiotherapy (IMRT) combined with a carbon ion boost.
Methods
We evaluated 43 patients with sinonasal SCC treated with IMRT and carbon ion boost between 2011 and 2019. Follow-up followed head and neck cancer guidelines. Patient and tumor characteristics, treatment outcomes, and toxicity (per CTCAE v5.0) were assessed. Statistical analysis was performed using R version 4.1.0.
Results
Median age was 64 years (range 19–83). Most patients had T3–4 tumors (n = 36; 83.7 %) and were clinically node-negative (n = 40; 93.0 %). The predominant regimen was 24 Gy (RBE) carbon ion boost in 8 fractions, followed by 50 Gy IMRT in 25 fractions. Postoperative RT was delivered to 25 patients (58.1 %), while 18 (41.9 %) received definitive RT. Elective or therapeutic neck dissection was performed in 10 patients (23.3 %), none showing lymph node metastases. In total, 22 distinct cervical lymph node treatment strategies were applied. Median follow-up for overall survival (OS) was 25.1 months. Tumor recurrence occurred in 11 patients (25.6 %), primarily due to local failure (n = 7; 63.6 %). OS and local progression-free survival (L-PFS) at 12/24 months were 93.0 %/89.3 % and 88.4 %/79.0 %, respectively. Grade III acute and late toxicity occurred in 9.3 % and 4.7 % of patients, respectively. No grade IV toxicity was reported. Mean numbers of grade I–II toxicities per patient were 4.8 (acute) and 2.4 (late).
Conclusion
IMRT with carbon ion boost provides promising OS and local control in high-risk sinonasal SCC. The management of the node-negative-neck was highly individualized. Toxicity was acceptable and may be further reduced by tailoring cervical lymph node treatment in selected patients.
{"title":"Intensity-modulated radiotherapy with carbon ion boost for high-risk sinonasal squamous cell carcinoma: clinical outcomes and the management of the node-negative neck","authors":"Lukas Bauer , Katharina Weusthof , Sebastian Regnery , Maximilian Deng , Philipp Schröter , Florian Stritzke , Nils Netzer , Henrik Franke , Kristin Uzun-Lang , Julius Moratin , Oliver Ristow , Rubens Thoelken , Semi B. Harrabi , Klaus Herfarth , Sebastian Adeberg , Jürgen Debus , Thomas Held","doi":"10.1016/j.ctro.2025.101064","DOIUrl":"10.1016/j.ctro.2025.101064","url":null,"abstract":"<div><h3>Background</h3><div>Local control of high-risk sinonasal squamous cell carcinoma (SCC) remains challenging and often involves significant morbidity. Management of the node-negative neck is still debated. This study evaluated treatment outcomes, neck management strategies, and toxicity rates in patients treated with intensity-modulated radiotherapy (IMRT) combined with a carbon ion boost.</div></div><div><h3>Methods</h3><div>We evaluated 43 patients with sinonasal SCC treated with IMRT and carbon ion boost between 2011 and 2019. Follow-up followed head and neck cancer guidelines. Patient and tumor characteristics, treatment outcomes, and toxicity (per CTCAE v5.0) were assessed. Statistical analysis was performed using R version 4.1.0.</div></div><div><h3>Results</h3><div>Median age was 64 years (range 19–83). Most patients had T3–4 tumors (n = 36; 83.7 %) and were clinically node-negative (n = 40; 93.0 %). The predominant regimen was 24 Gy (RBE) carbon ion boost in 8 fractions, followed by 50 Gy IMRT in 25 fractions. Postoperative RT was delivered to 25 patients (58.1 %), while 18 (41.9 %) received definitive RT. Elective or therapeutic neck dissection was performed in 10 patients (23.3 %), none showing lymph node metastases. In total, 22 distinct cervical lymph node treatment strategies were applied. Median follow-up for overall survival (OS) was 25.1 months. Tumor recurrence occurred in 11 patients (25.6 %), primarily due to local failure (n = 7; 63.6 %). OS and local progression-free survival (L-PFS) at 12/24 months were 93.0 %/89.3 % and 88.4 %/79.0 %, respectively. Grade III acute and late toxicity occurred in 9.3 % and 4.7 % of patients, respectively. No grade IV toxicity was reported. Mean numbers of grade I–II toxicities per patient were 4.8 (acute) and 2.4 (late).</div></div><div><h3>Conclusion</h3><div>IMRT with carbon ion boost provides promising OS and local control in high-risk sinonasal SCC. The management of the node-negative-neck was highly individualized. Toxicity was acceptable and may be further reduced by tailoring cervical lymph node treatment in selected patients.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101064"},"PeriodicalIF":2.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1016/j.ctro.2025.101062
Gustavo R. Sarria , Santiago Torales , Florencia Rossi , Leandro Ricagni , Dante Baldeon , Armando Felix , Benjamin Li , Eleni Gkika , Gustavo Ferraris , Gustavo J. Sarria
Introduction
Radiotherapy (RT) is essential for cancer treatment, yet access in Latin America remains highly unequal due to socio-economic and systemic disparities. This study aims to identify and analyze the key socio-economic determinants influencing RT access, infrastructure, and workforce distribution across 11 Latin American countries.
Methods
A comprehensive database was created using 29 demographic, economic, and healthcare-related variables from public sources and expert input. Countries included were Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Paraguay, Peru, Uruguay, and Venezuela. Variables were categorized under access, demand, and supply of RT services. Correlation analyses and linear/exponential regression models were applied in an exploratory way to evaluate relationships between socio-economic indicators and RT availability.
Results
Higher GDP per capita and adjusted GDP (PPP) correlated significantly with better RT infrastructure, including EBRT and megavoltage units (r > 0.68, p < 0.05). Urban population percentage strongly correlated with RT access (r = -0.77, p = 0.005), while social security coverage was linked to lower inhabitants per RT center (r = -0.67, p = 0.025). Notably, the number of radiation oncologists correlated perfectly with patients requiring EBRT (r = 1.0, p < 0.001), but showed no correlation with poverty or urbanization, highlighting workforce capacity constraints. Rural areas were underserved due to infrastructure centralization in urban zones. High out-of-pocket expenditure and low public health investment would be associated with limited access to these treatments.
Conclusion
Socio-economic disparities—particularly GDP, healthcare coverage, and urbanization—are strongly associated with RT access inequities in Latin America. For the medical community and public policymakers, confirming these assumptions requires a different scope about discussions regarding access to these highly complex services, when they are not associated with the population’s health needs but rather with the countries’ mere organizational and financial capabilities. Some possible formats require the definition of new clinical and financial management models. Our findings underscore the need for targeted health policies, investment in infrastructure and workforce, and decentralized care models. Expanding RT services beyond urban centers and improving funding models are critical to ensuring equitable cancer treatment across the region.
放疗对于癌症治疗至关重要，但由于社会经济和体制差异，在拉丁美洲，放疗的可及性仍然高度不平等。本研究旨在确定和分析影响11个拉丁美洲国家RT访问、基础设施和劳动力分布的关键社会经济决定因素。方法利用来自公共资源和专家意见的29个人口、经济和卫生保健相关变量建立一个综合数据库。这些国家包括阿根廷、玻利维亚、巴西、智利、哥伦比亚、厄瓜多尔、墨西哥、巴拉圭、秘鲁、乌拉圭和委内瑞拉。变量按照RT服务的访问、需求和供应进行分类。采用相关分析和线性/指数回归模型探索性地评价社会经济指标与RT有效性之间的关系。结果较高的人均GDP和调整后GDP （PPP）与较好的公交基础设施（包括EBRT和兆压单位）显著相关（r > 0.68, p < 0.05）。城市人口百分比与RT访问密切相关（r = -0.77, p = 0.005），而社会保障覆盖率与每个RT中心的较低居民相关（r = -0.67, p = 0.025）。值得注意的是，放射肿瘤学家的数量与需要EBRT的患者完全相关（r = 1.0, p < 0.001），但与贫困或城市化没有相关性，突出了劳动力能力的限制。由于城市地区的基础设施集中，农村地区服务不足。高自付费用和低公共卫生投资将与获得这些治疗的机会有限有关。在拉丁美洲，社会经济差异——特别是GDP、医疗保健覆盖率和城市化——与RT获取不公平密切相关。对于医学界和公共政策制定者来说，要确认这些假设，就需要在讨论获得这些高度复杂的服务时采用不同的范围，因为这些服务与人口的健康需求无关，而仅仅与国家的组织和财政能力有关。一些可能的形式需要定义新的临床和财务管理模式。我们的研究结果强调需要有针对性的卫生政策、对基础设施和劳动力的投资以及分散的护理模式。将RT服务扩大到城市中心以外，并改善筹资模式，对于确保整个地区的公平癌症治疗至关重要。
{"title":"Radiotherapy access in Latin America: Socio-economic determinants and equity challenges socio-economic determinants in Latin America for radiotherapy","authors":"Gustavo R. Sarria , Santiago Torales , Florencia Rossi , Leandro Ricagni , Dante Baldeon , Armando Felix , Benjamin Li , Eleni Gkika , Gustavo Ferraris , Gustavo J. Sarria","doi":"10.1016/j.ctro.2025.101062","DOIUrl":"10.1016/j.ctro.2025.101062","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiotherapy (RT) is essential for cancer treatment, yet access in Latin America remains highly unequal due to socio-economic and systemic disparities. This study aims to identify and analyze the key socio-economic determinants influencing RT access, infrastructure, and workforce distribution across 11 Latin American countries.</div></div><div><h3>Methods</h3><div>A comprehensive database was created using 29 demographic, economic, and healthcare-related variables from public sources and expert input. Countries included were Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Paraguay, Peru, Uruguay, and Venezuela. Variables were categorized under access, demand, and supply of RT services. Correlation analyses and linear/exponential regression models were applied in an exploratory way to evaluate relationships between socio-economic indicators and RT availability<strong>.</strong></div></div><div><h3>Results</h3><div>Higher GDP per capita and adjusted GDP (PPP) correlated significantly with better RT infrastructure, including EBRT and megavoltage units (r > 0.68, p < 0.05). Urban population percentage strongly correlated with RT access (r = -0.77, p = 0.005), while social security coverage was linked to lower inhabitants per RT center (r = -0.67, p = 0.025). Notably, the number of radiation oncologists correlated perfectly with patients requiring EBRT (r = 1.0, p < 0.001), but showed no correlation with poverty or urbanization, highlighting workforce capacity constraints. Rural areas were underserved due to infrastructure centralization in urban zones. High out-of-pocket expenditure and low public health investment would be associated with limited access to these treatments.</div></div><div><h3>Conclusion</h3><div>Socio-economic disparities—particularly GDP, healthcare coverage, and urbanization—are strongly associated with RT access inequities in Latin America. For the medical community and public policymakers, confirming these assumptions requires a different scope about discussions regarding access to these highly complex services, when they are not associated with the population’s health needs but rather with the countries’ mere organizational and financial capabilities. Some possible formats require the definition of new clinical and financial management models. Our findings underscore the need for targeted health policies, investment in infrastructure and workforce, and decentralized care models. Expanding RT services beyond urban centers and improving funding models are critical to ensuring equitable cancer treatment across the region.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101062"},"PeriodicalIF":2.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1016/j.ctro.2025.101063
Lorenzo Lo Faro , Hubert S. Gabryś , Simon Burgermeister , Daniel Abler , Maksym Fritsak , Maiwand Ahmadsei , Ciro Franzese , Adrien Depeursinge , Michel A. Cuendet , Stephanie Tanadini-Lang , Panagiotis Balermpas , Marta Scorsetti , Matthias Guckenberger , Sebastian M. Christ
Background and purpose
Artificial intelligence is increasingly used in radiation oncology, yet its application for tumor burden (TB) estimation remains limited. This study evaluated the performance of a [18F]-fluorodeoxyglucose positron emission tomography/computerized tomography ([18F]-FDG-PET/CT)-based deep learning model, PET-Assisted Reporting System (“PARS”, Siemens Healthineers), for lesion detection, segmentation, and TB estimation in patients with metastatic melanoma undergoing immunotherapy.
Materials and methods
This retrospective study included 165 stage IV melanoma patients who underwent [18F]-FDG-PET/CT imaging prior to immunotherapy. Gross tumor volumes were segmented using PARS and compared with manual delineations performed by radiation oncologists. Performance was assessed through lesion detection metrics (precision and recall), individual lesion volume agreement, and overall TB estimation accuracy.
Results
PARS demonstrated an overall recall (sensitivity) of 68.9 %, though with modest precision (46.8 %). Performance was location-dependent, with highest precision observed for lung lesions (74.0 %) and lowest for bone lesions (32.9 %). For lesions detected by both methods, PARS tended to underestimate lesion volumes by an average (median) of 0.9 cc (median relative percentage difference (MRPD) = −34.3 %), with a good agreement (intraclass correlations coefficient (ICC) = 0.77). The global TB in the whole cohort was overestimated by 28.3 %, but patient-level TB was on average (median) underestimated by 1.1 cc (MRPD = −18.4 %) with high variability with a median absolute relative percentage difference (MARPD) = 68.6 %) and poor agreement (intraclass correlation coefficient (ICC) = 0.28).
Conclusions
PARS shows potential for treatment decision support with moderate accuracy in lesion detection and lesion volume estimation, but demonstrates significant variability in TB estimation, highlighting the need for further model refinements before clinical adoption.
{"title":"Deep learning [18F]-FDG-PET/CT‑based algorithm for tumor burden estimation in metastatic melanoma patients under immunotherapy","authors":"Lorenzo Lo Faro , Hubert S. Gabryś , Simon Burgermeister , Daniel Abler , Maksym Fritsak , Maiwand Ahmadsei , Ciro Franzese , Adrien Depeursinge , Michel A. Cuendet , Stephanie Tanadini-Lang , Panagiotis Balermpas , Marta Scorsetti , Matthias Guckenberger , Sebastian M. Christ","doi":"10.1016/j.ctro.2025.101063","DOIUrl":"10.1016/j.ctro.2025.101063","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Artificial intelligence is increasingly used in radiation oncology, yet its application for tumor burden (TB) estimation remains limited. This study evaluated the performance of a [<sup>18</sup>F]-fluorodeoxyglucose positron emission tomography/computerized tomography ([<sup>18</sup>F]-FDG-PET/CT)-based deep learning model, PET-Assisted Reporting System (“PARS”, <em>Siemens Healthineers</em>), for lesion detection, segmentation, and TB estimation in patients with metastatic melanoma undergoing immunotherapy.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included 165 stage IV melanoma patients who underwent [<sup>18</sup>F]-FDG-PET/CT imaging prior to immunotherapy. Gross tumor volumes were segmented using PARS and compared with manual delineations performed by radiation oncologists. Performance was assessed through lesion detection metrics (precision and recall), individual lesion volume agreement, and overall TB estimation accuracy.</div></div><div><h3>Results</h3><div>PARS demonstrated an overall recall (sensitivity) of 68.9 %, though with modest precision (46.8 %). Performance was location-dependent, with highest precision observed for lung lesions (74.0 %) and lowest for bone lesions (32.9 %). For lesions detected by both methods, PARS tended to underestimate lesion volumes by an average (median) of 0.9 cc (median relative percentage difference (MRPD) = −34.3 %), with a good agreement (intraclass correlations coefficient (ICC) = 0.77). The global TB in the whole cohort was overestimated by 28.3 %, but patient-level TB was on average (median) underestimated by 1.1 cc (MRPD = −18.4 %) with high variability with a median absolute relative percentage difference (MARPD) = 68.6 %) and poor agreement (intraclass correlation coefficient (ICC) = 0.28).</div></div><div><h3>Conclusions</h3><div>PARS shows potential for treatment decision support with moderate accuracy in lesion detection and lesion volume estimation, but demonstrates significant variability in TB estimation, highlighting the need for further model refinements before clinical adoption.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101063"},"PeriodicalIF":2.7,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-25DOI: 10.1016/j.ctro.2025.101061
Lukas Grajewski , Alicia Greiner , Georg Wurschi , Orlando Guntinas-Lichius , Alexander Rühle , Klaus Pietschmann , Maximilian Römer
Background and purpose
Treatment of patients with recurrent head and neck squamous cell cancer in a previously irradiated field remains challenging. We performed a meta-analysis, comparing the efficacy and safety of definitive and post-operative intensity-modulated radiotherapy (IMRT) based reirradiation.
Material and methods
MEDLINE, Cochrane Library, Web of Science, SCOPUS and PsycINFO were systematically searched. The Newcastle-Ottawa Scale was used to assess the risk of bias. A meta-analysis was performed using the random-effects model.
Results
10 eligible studies with a median follow up of 24.9 months (9.6–78.1) and a total of 958 patients were identified, two of which are prospective trials. 455 were patients treated with post-operative/ adjuvant IMRT (aIMRT), while 503 patients received definitive IMRT (dIMRT). Median age was 62 years (48–63), 78 % were males and the rate of concomitant systemic therapy varied between 0 and 100 %.
Post-operative IMRT showed significantly higher 1-year overall survival of 68 %, compared to 55 % for dIMRT, with a risk reduction (RR) of 0.84 (95 % CI: 0.76–0.93). aIMRT achieved superior 1-year locoregional control (65 %) in comparison to dIMRT (58 %) with an RR of 0.89 (95 % CI: 0.798 to 0.997). All other endpoints did not reach statistical significance. The certainty of our findings was low, due to limitations in the included studies. Radiotoxicity was insufficiently reported and does not allow any conclusions.
Conclusion
Post-operative IMRT achieves superior survival and tumor control and should be the preferred option for patients eligible for surgery. Careful patient evaluation and selection are fundamental to maximizing therapeutic efficacy while minimizing treatment-related toxicities.
{"title":"Challenges in recurrent head and neck squamous cell cancer treatment: systematic review and meta-analysis comparing efficacy and toxicity between post-operative and definitive IMRT-based reirradiation","authors":"Lukas Grajewski , Alicia Greiner , Georg Wurschi , Orlando Guntinas-Lichius , Alexander Rühle , Klaus Pietschmann , Maximilian Römer","doi":"10.1016/j.ctro.2025.101061","DOIUrl":"10.1016/j.ctro.2025.101061","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Treatment of patients with recurrent head and neck squamous cell cancer in a previously irradiated field remains challenging. We performed a <em>meta</em>-analysis, comparing the efficacy and safety of definitive and post-operative intensity-modulated radiotherapy (IMRT) based reirradiation.</div></div><div><h3>Material and methods</h3><div>MEDLINE, Cochrane Library, Web of Science, SCOPUS and PsycINFO were systematically searched. The Newcastle-Ottawa Scale was used to assess the risk of bias. A <em>meta</em>-analysis was performed using the random-effects model.</div></div><div><h3>Results</h3><div>10 eligible studies with a median follow up of 24.9 months (9.6–78.1) and a total of 958 patients were identified, two of which are prospective trials. 455 were patients treated with post-operative/ adjuvant IMRT (aIMRT), while 503 patients received definitive IMRT (dIMRT). Median age was 62 years (48–63), 78 % were males and the rate of concomitant systemic therapy varied between 0 and 100 %.</div><div>Post-operative IMRT showed significantly higher 1-year overall survival of 68 %, compared to 55 % for dIMRT, with a risk reduction (RR) of 0.84 (95 % CI: 0.76–0.93). aIMRT achieved superior 1-year locoregional control (65 %) in comparison to dIMRT (58 %) with an RR of 0.89 (95 % CI: 0.798 to 0.997). All other endpoints did not reach statistical significance. The certainty of our findings was low, due to limitations in the included studies. Radiotoxicity was insufficiently reported and does not allow any conclusions.</div></div><div><h3>Conclusion</h3><div>Post-operative IMRT achieves superior survival and tumor control and should be the preferred option for patients eligible for surgery. Careful patient evaluation and selection are fundamental to maximizing therapeutic efficacy while minimizing treatment-related toxicities.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101061"},"PeriodicalIF":2.7,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-20DOI: 10.1016/j.ctro.2025.101059
Ryan Bonate , Musaddiq Awan , Heather Himburg , Stuart Wong , Monica Shukla , Joseph Zenga , Eric S. Paulson
Background and Purpose
Quantitative MRI (qMRI) is an emerging technique for characterizing tissue microenvironments. Prior work has shown that daily qMRI during MR-guided radiotherapy (MRgRT) detects differential responses to hypofractionated radiotherapy (RT) in head and neck squamous cell carcinoma (HNSCC) within the primary gross tumor volume (GTVp). This exploratory study investigates whether subregions of HNSCC tumors show distinct qMRI responses to hypofractionated RT using contoured GTVp subregions and voxelwise data.
Materials and Methods
Eighteen subjects with advanced HNSCC underwent MRgRT with daily qMRI over 15 fractions (total dose 50, 55, or 60 Gy). Daily intravoxel incoherent motion (IVIM) and relaxometry sequences were acquired on a 1.5 T MR-Linac. Median ADC, D, D*, f, T1, and T2 were calculated for concentric GTVp subregions and an intra-subject control contour in paraspinal muscle. Mixed effect models were fit for each parameter. Voxelwise analysis included quantile tracking, histograms, and paired tests over the length of RT.
Results
Significant changes (p < 0.05) were observed in ADC, D, f, T2, and T1 within GTVp subregions. ADC, D, f, and T2 changes were uniform, while T1 varied spatially. Spatial patterns were detected in ADC and T1, with marginal effects in D, f, and T2. Voxelwise analysis revealed significant changes in all parameters except D* after correction. ADC, D, and f increased consistently; T1 and T2 changes were quantile dependent. These trends may reflect biological processes such as declining cellularity, reperfusion, or edema.
Conclusions
In this exploratory study, qMRI detected spatial heterogeneity in HNSCC. These findings support its potential role in guiding biologically adaptive RT strategies.
背景与目的定量磁共振成像（qMRI）是一种新兴的表征组织微环境的技术。先前的研究表明，在mri引导放疗（MRgRT）期间，每日qMRI可检测原发性总肿瘤体积（GTVp）内头颈部鳞状细胞癌（HNSCC）对低分割放疗（RT）的差异反应。本探索性研究使用轮廓GTVp亚区和体向数据调查HNSCC肿瘤亚区是否对低分割RT表现出不同的qMRI反应。材料和方法18例晚期鳞状细胞癌患者接受MRgRT治疗，每日进行15次qMRI（总剂量50、55或60 Gy）。在1.5 T MR-Linac上获得每日体素内非相干运动（IVIM）和松弛测量序列。计算同心GTVp亚区和椎旁肌内对照轮廓的中位ADC、D、D*、f、T1和T2。对各参数拟合混合效应模型。体素分析包括分位数跟踪、直方图和rt长度的配对检验。结果在GTVp子区域内，ADC、D、f、T2和T1的变化显著（p < 0.05）。ADC、D、f和T2的变化是均匀的，而T1的变化是有空间差异的。在ADC和T1中检测到空间模式，在D、f和T2中存在边际效应。体素分析显示，除D*外，校正后各参数均有显著变化。ADC、D、f持续增加；T1和T2的变化是分位数相关的。这些趋势可能反映了诸如细胞减少、再灌注或水肿等生物学过程。结论在本探索性研究中，qMRI检测了HNSCC的空间异质性。这些发现支持其在指导生物适应性RT策略中的潜在作用。
{"title":"Patterns of response in head and neck cancer subregions using daily Quantitative MRI from MR-guided radiation therapy","authors":"Ryan Bonate , Musaddiq Awan , Heather Himburg , Stuart Wong , Monica Shukla , Joseph Zenga , Eric S. Paulson","doi":"10.1016/j.ctro.2025.101059","DOIUrl":"10.1016/j.ctro.2025.101059","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Quantitative MRI (qMRI) is an emerging technique for characterizing tissue microenvironments. Prior work has shown that daily qMRI during MR-guided radiotherapy (MRgRT) detects differential responses to hypofractionated radiotherapy (RT) in head and neck squamous cell carcinoma (HNSCC) within the primary gross tumor volume (GTVp). This exploratory study investigates whether subregions of HNSCC tumors show distinct qMRI responses to hypofractionated RT using contoured GTVp subregions and voxelwise data.</div></div><div><h3>Materials and Methods</h3><div>Eighteen subjects with advanced HNSCC underwent MRgRT with daily qMRI over 15 fractions (total dose 50, 55, or 60 Gy). Daily intravoxel incoherent motion (IVIM) and relaxometry sequences were acquired on a 1.5 T MR-Linac. Median ADC, D, D*, f, T<sub>1</sub>, and T<sub>2</sub> were calculated for concentric GTVp subregions and an intra-subject control contour in paraspinal muscle. Mixed effect models were fit for each parameter. Voxelwise analysis included quantile tracking, histograms, and paired tests over the length of RT.</div></div><div><h3>Results</h3><div>Significant changes (p < 0.05) were observed in ADC, D, f, T<sub>2</sub>, and T<sub>1</sub> within GTVp subregions. ADC, D, f, and T<sub>2</sub> changes were uniform, while T<sub>1</sub> varied spatially. Spatial patterns were detected in ADC and T<sub>1</sub>, with marginal effects in D, f, and T<sub>2</sub>. Voxelwise analysis revealed significant changes in all parameters except D* after correction. ADC, D, and f increased consistently; T<sub>1</sub> and T<sub>2</sub> changes were quantile dependent. These trends may reflect biological processes such as declining cellularity, reperfusion, or edema.</div></div><div><h3>Conclusions</h3><div>In this exploratory study, qMRI detected spatial heterogeneity in HNSCC. These findings support its potential role in guiding biologically adaptive RT strategies.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101059"},"PeriodicalIF":2.7,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145358578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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