Clinical and Translational Radiation Oncology最新文献

英文中文

Outcomes of pelvic and para-aortic stereotactic reirradiation for gynaecological cancer recurrence 骨盆和主动脉旁立体定向再照射治疗妇科癌症复发的疗效

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-10-18 DOI: 10.1016/j.ctro.2025.101060

Benjamin J Thomas , Kallol Bhadra , Ian Zing Tan , Lei Wang , Susan Lalondrelle

Introduction

Recurrence of gynaecological cancer in the pelvis is associated with significant morbidity and can be challenging to treat, particularly when arising in a previously irradiated site. For cases of oligometastatic relapse a targeted approach is preferable, avoiding the need for systemic therapy. Type 1 reirradiation using highly conformal techniques such as stereotactic radiotherapy (SBRT) is increasingly used, aiming for disease ablation at the site of relapse. We present an analysis of our institutional experience of using SBRT for gynaecological cancer reirradiation to identify efficacy, toxicity and other factors for appropriate case selection.

Material and methods

Patients treated with pelvic or para-aortic SBRT reirradiation at our institution for histologically proven gynaecological malignancies between July 2012 and January 2021 were identified from local records. Indications for treatment included soft tissue and nodal recurrences and cases of positive margin following surgery. Data were collected on survival, failure patterns, demographics, planning and dosimetry.

Results

73 patients were identified who had undergone 81 courses of pelvic or para-aortic reirradiation using SBRT. Median prescribed dose was 30 Gy in 5 fractions. Following SBRT reirradiation, median overall survival was 42.9 months (95 % confidence interval, CI 36.0 to 68.9 months), median progression-free survival was 14.0 months (95 % CI 9.2 to 24.3 months). Median time to local failure of the treated lesion following SBRT reirradiation was 35.2 months (95 % CI 24.3 to not reached). SBRT reirradiation was well tolerated with acute grade 3 toxicity reported in two patients. Late grade 3 toxicity was documented in two patients, both occurring over 2 years following treatment.

Conclusion

In selected patients with oligometastatic pelvic or para-aortic relapse of gynaecological cancer following previous pelvic radiotherapy, SBRT reirradiation is an effective and safe treatment modality. SBRT reirradiation can provide durable local control and delay time to further treatment by more than 12 months.

骨盆妇科癌的复发与显著的发病率相关，治疗具有挑战性，特别是在以前接受过放疗的部位。对于低转移性复发的病例，首选有针对性的方法，避免需要全身治疗。使用立体定向放疗（SBRT）等高度适形技术的1型再照射越来越多，目的是在复发部位进行疾病消融。我们提出了一个分析我们的机构经验，使用SBRT妇科癌症再照射，以确定疗效，毒性和其他因素，以适当的病例选择。材料和方法2012年7月至2021年1月期间，在我们机构接受盆腔或主动脉旁SBRT再照射治疗组织学证实的妇科恶性肿瘤的患者从当地记录中确定。治疗指征包括软组织及淋巴结复发及手术后边缘阳性病例。收集了关于生存、失败模式、人口统计学、计划和剂量学的数据。结果73例患者接受了81个疗程的SBRT盆腔或主动脉旁再照射。中位处方剂量为30 Gy，分为5次。SBRT再照射后，中位总生存期为42.9个月（95%可信区间，CI 36.0至68.9个月），中位无进展生存期为14.0个月（95% CI 9.2至24.3个月）。SBRT再照射后治疗病灶局部失效的中位时间为35.2个月（95% CI为24.3至未达到）。SBRT再照射耐受性良好，两例患者报告急性3级毒性。2例患者出现晚期3级毒性，均发生在治疗后2年内。结论对于盆腔放疗后少转移性或腹主动脉旁癌复发的患者，SBRT再照射是一种安全有效的治疗方式。SBRT再照射可以提供持久的局部控制，并将进一步治疗的时间延迟12个月以上。

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引用次数: 0

Corrigendum to “Clinical outcomes of pelvic bone marrow sparing radiotherapy for cervical cancer: A systematic review and meta-analysis of randomised controlled trials”. [Clin. Translat. Radiat. Oncol. 47 (2024) 100801] “保留盆腔骨髓放射治疗宫颈癌的临床结果：随机对照试验的系统回顾和荟萃分析”的更正。(中国。诠释。Radiat。农业学报，47 (2024)100801]

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-10-18 DOI: 10.1016/j.ctro.2025.101057

Marcin Miszczyk , Tao Wu , Kasper Kuna , Magdalena Stankiewicz , Emilia Staniewska , Zuzanna Nowicka , Ziqin Chen , Loren K. Mell , Joachim Widder , Maximilian Schmidt , Rafał Tarnawski , Paweł Rajwa , Shahrokh F. Shariat , Pixiao Zhou

引用次数: 0

Comment on “Examining the role of elective pelvic radiotherapy in patients Diagnosed with high- and very High-Risk Non-Metastatic prostate cancer” 《择期盆腔放疗在高、高危非转移性前列腺癌患者中的作用》评论

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-10-14 DOI: 10.1016/j.ctro.2025.101058

Yawei Guan , Yongliang Lu , Guohui Zhang

引用次数: 0

Re-irradiation of adrenal metastases using MR-guided adaptive SABR: A feasible and effective approach in a high-risk population 磁共振引导下适应性SABR对肾上腺转移瘤的再照射：在高危人群中可行有效的方法

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-10-12 DOI: 10.1016/j.ctro.2025.101056

Miguel A. Palacios , Anna M.E. Bruynzeel , Peter S.N. van Rossum , Omar Bohoudi , Suresh Senan , Famke L. Schneiders

Re-irradiation of adrenal metastases is challenging due to cumulative dose constraints. We present seven patients treated with MR-guided adaptive stereotactic ablative radiotherapy (SABR), leveraging real-time imaging and on-table adaptation for precise dose delivery (5× 10 Gy or 3× 15 Gy). This first report of ablative-dose MR-guided SABR in re-irradiation demonstrates excellent local control and acceptable toxicity, with six patients progression-free at median 8.6 months and no grade ≥3 events (one grade 2 vertebral fracture, one grade 1 nausea). By providing a non-invasive alternative to surgery or palliative radiotherapy, MR-guided adaptive SABR expands therapeutic options for high-risk patients.

由于累积剂量的限制，肾上腺转移瘤的再照射具有挑战性。我们报告了7例接受磁共振引导的自适应立体定向消融放疗（SABR）的患者，利用实时成像和桌上适应精确剂量递送（5× 10 Gy或3× 15 Gy）。这是首个消融剂量mr引导SABR再照射的报告，显示了良好的局部控制和可接受的毒性，6例患者在中位8.6个月无进展，没有3级以上事件（1例2级椎体骨折，1例1级恶心）。通过提供手术或姑息性放疗的非侵入性替代方案，mr引导的适应性SABR扩大了高风险患者的治疗选择。

引用次数: 0

Therapeutic efficacy of external beam radiotherapy combined with anti-PD-L1 inhibition in a preclinical syngeneic head and neck cancer model 外束放疗联合抗pd - l1抑制在临床前同基因头颈癌模型中的治疗效果

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-10-04 DOI: 10.1016/j.ctro.2025.101054

Arshiya Banu , Sophie Langdon , Tanzila Harun , Adam Laouafa , Adam Jones , Kavitha Sunassee , Anthony Kong , Samantha YA Terry

Treating high-grade head and neck squamous cell carcinoma (HNSCC) has recently combined immunotherapy with conventional therapies. However, optimizing the scheduling of anti-PD-L1 with external beam radiation therapy (EBRT) requires further research to improve efficacies.

Methods

In vitro, MTCQ1, MOCL1, and MOCL2 murine HNSCC cell responses to 2 Gy x 6 X-ray EBRT were assessed in metabolic, clonogenic and γH2AX assays. Ex vivo, syngeneic tumors in C57BL/6 mice were stained for haematoxylin and eosin (H&E) and immune cell infiltration. Combination therapeutic in vivo studies using MTCQ1 tumors treated with 2 Gy x 6 or 8 Gy x 1 EBRT with sequential and/or concurrent dosing with anti-PD-L1 were also performed.

Results

MTCQ1 cells exhibited the most marked responses to EBRT in vitro. H&E analysis revealed highest cellular density and most disperse extracellular matrix in MTCQ1 tumors with infiltration of CD8a+ T cells in tumor centres and macrophages predominantly peripheral. The 2 Gy x 6 EBRT regimen slowed tumor progression; average tumor volumes were 129.2 ± 49.0 mm³ on day 10, compared to 234.1 ± 130.7 mm³ in the CT-only control (P = 0.039). However, there was also a reduced CD8a+ T cell infiltration on day 3 post complete treatment, with 0.19 ± 0.17 % CD8a+ T cell area compared to 0.91 ± 0.31 % in the CT-only control. Combining EBRT with anti-PD-L1 (delivered either concurrently or sequentially), resulted in greater median survival compared to the CT-only control (33 and 32 days versus 28 days, respectively). Similarly, statistically insignificant improved survival with 8 Gy x 1 EBRT regimen combined with concurrent anti-PD-L1 was observed.

Conclusion

These results reveal spatial distribution of immune cells in the tumor microenvironment and underscore the role of EBRT regimens in modulating immune cell dynamics. This highlights the importance of optimising radiation protocols to inform combination therapy designs in preclinical models.

治疗高级别头颈部鳞状细胞癌（HNSCC）最近将免疫疗法与常规疗法结合起来。然而，体外束放射治疗（EBRT）抗pd - l1的优化调度需要进一步研究以提高疗效。方法体外观察MTCQ1、MOCL1和MOCL2小鼠HNSCC细胞对2 Gy x 6 x射线EBRT的代谢、克隆生成和γ - h2ax反应。在体外，对C57BL/6小鼠的同基因肿瘤进行血红素和伊红染色（H&；E）和免疫细胞浸润。还进行了MTCQ1肿瘤的体内联合治疗研究，使用2 Gy x 6或8 Gy x 1 EBRT治疗MTCQ1肿瘤，并序贯和/或同时给药抗pd - l1。结果smtcq1细胞对EBRT的体外反应最为显著。H&；E分析显示，MTCQ1肿瘤细胞密度最高，细胞外基质最分散，CD8a+ T细胞浸润于肿瘤中心，巨噬细胞以外周细胞为主。2 Gy x 6 EBRT方案减缓肿瘤进展；第10天肿瘤平均体积为129.2±49.0 mm3，而ct对照组为234.1±130.7 mm3 （P = 0.039）。然而，在完全治疗后的第3天，CD8a+ T细胞浸润也有所减少，CD8a+ T细胞面积为0.19±0.17%，而仅ct对照组为0.91±0.31%。将EBRT与抗pd - l1联合治疗（同时或顺序给予），与仅接受ct治疗的对照组相比，中位生存期更高（分别为33天和32天，而不是28天）。同样，8 Gy x 1 EBRT方案联合并发抗pd - l1治疗的生存率也没有统计学意义。结论这些结果揭示了免疫细胞在肿瘤微环境中的空间分布，强调了EBRT方案在调节免疫细胞动力学中的作用。这突出了优化放射方案的重要性，为临床前模型中的联合治疗设计提供信息。

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引用次数: 0

Response to the Comment on “Examining the role of elective pelvic radiotherapy in patients diagnosed with high- and very high-risk non-metastatic prostate cancer” 对“探讨选择性盆腔放疗在高、高危非转移性前列腺癌患者中的作用”评论的回应

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-09-30 DOI: 10.1016/j.ctro.2025.101055

István Nahaji , Zsuzsa S. Kocsis , Péter Ágoston

First of all, we would like to sincerely thank the colleagues who authored the commentary on our article. It is encouraging to see that this complex and difficult-to-study field stimulates high-level academic discourse. Precisely for this reason, we are pleased to address the questions they have raised.

首先，我们要衷心感谢为我们的文章撰写评论的同事。令人鼓舞的是，这个复杂而难以研究的领域激发了高水平的学术讨论。正是由于这个原因，我们高兴地处理他们提出的问题。

引用次数: 0

Simulation-free palliative radiotherapy using diagnostic CT scans– is less more? A systematic review 使用诊断性CT扫描的无模拟姑息性放疗-是更少吗？系统回顾

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-09-27 DOI: 10.1016/j.ctro.2025.101053

Daniel R. Zwahlen , Stefan Brodmann , Robert Förster , Paul Windisch , Elena Hofmann , André Buchali , Christina Schröder

Background

Cancer incidence continues to rise globally, with nearly half of patients requiring radiotherapy. Simulation-free radiotherapy (SFRT) using diagnostic CT scans instead of dedicated planning CTs is a streamlined alternative that may reduce patient visits and shorten time to treatment without impacting quality of care. This systematic review evaluates the practical aspects, dosimetric accuracy, and clinical outcomes of SFRT in palliative radiotherapy.

Methods

Following PRISMA guidelines, PubMed and Embase were searched for publications on SFRT using multiple search terms. Included studies reported clinical or logistical endpoints such as treatment timing, toxicity, dosimetric errors, and patient-reported outcomes.

Results

Eleven studies met inclusion criteria, comprising retrospective and prospective cohorts with patient numbers ranging from 10 to 1000. SFRT was associated with significantly reduced intervals from consultation to treatment start compared to conventional workflows. Dosimetric uncertainties using diagnostic CT scans were generally low, with higher variability observed in thoracic cases. Patient selection typically excluded treatments involving steep dose gradients, reirradiation, or requiring immobilization devices. Limited clinical outcome data showed favourable toxicity profiles and effective symptom relief.

Conclusions

SFRT offers a practical, efficient alternative for palliative radiotherapy, enabling faster treatment initiation and optimized resource use without compromising safety or efficacy in selected patients. The overall dosimetric accuracy appears acceptable for most cases, though caution is advised for thoracic lesions and complex treatment plans. Additional prospective studies with robust clinical endpoints are needed to further validate the role of SFRT in palliative radiotherapy.

全球癌症发病率持续上升，近一半的患者需要放疗。使用诊断性CT扫描代替专用计划CT的无模拟放射治疗（SFRT）是一种简化的替代方案，可以减少患者就诊次数，缩短治疗时间，而不会影响护理质量。本系统综述评估了SFRT在姑息性放疗中的实用性、剂量学准确性和临床结果。方法按照PRISMA指南，使用多个检索词检索PubMed和Embase中关于SFRT的出版物。纳入了报告临床或后勤终点的研究，如治疗时间、毒性、剂量学误差和患者报告的结果。结果11项研究符合纳入标准，包括回顾性和前瞻性队列，患者人数从10到1000不等。与传统工作流程相比，SFRT显著缩短了从咨询到治疗开始的时间间隔。使用诊断性CT扫描的剂量学不确定性通常较低，在胸部病例中观察到较高的变异性。患者选择通常排除了涉及陡剂量梯度、再照射或需要固定装置的治疗。有限的临床结果数据显示良好的毒性特征和有效的症状缓解。结论ssfrt为姑息性放疗提供了实用、高效的替代方案，在不影响特定患者安全性和有效性的情况下，可以更快地启动治疗并优化资源利用。总体剂量测定的准确性在大多数情况下是可以接受的，但对于胸部病变和复杂的治疗方案建议谨慎。需要更多具有可靠临床终点的前瞻性研究来进一步验证SFRT在姑息性放疗中的作用。

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引用次数: 0

First-in-human e-Flash radiotherapy using a modified conventional C-arm linear accelerator 首次使用改良的传统c臂直线加速器进行人体e-Flash放射治疗

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-09-23 DOI: 10.1016/j.ctro.2025.101047

Jens von der Grün , Riccardo Dal Bello , Serena Psoroulas , Jerome Krayenbuehl , Debra Fesslmeier , Egle Ramelyte , Joanna Mangana , Wendy Smith , Marta Vilalta , Lena Tirpak , Ricky A. Sharma , Matthias Guckenberger , Stephanie Tanadini-Lang , Panagiotis Balermpas

Background

The FLASH effect is considered being the widening of the therapeutic window at (ultra-)high dose rates due to sparing of normal tissues while preserving tumor response. Our goal was to provide first data on the safety in treating a patient using a conventional linear accelerator converted to deliver 9 MeV UHDR electron beams in the research setting.

Material & methods

A conventional Varian TrueBeam linac was converted in the research setting to become capable of delivering 9 MeV UHDR electron beams. A phase I trial protocol was approved by the local authorities (NCT06549439). One patient with ≥ 1 melanoma (sub)-cutaneous lesion(s) was treated with 3x 9 Gy. The first two fractions were applied via e-Flash and the third via conventional electrons.

Results

Here we present the experience of the first patient treated with e-Flash in a modified conventional linac. The e-Flash fractions were successfully delivered according to the protocol. The film in-vivo dosimetry confirmed correctness of the delivered dose. A good tumor response without severe or unexpected toxicity was observed up to six weeks after treatment.

Conclusion

We demonstrate first-in-human application of e-Flash delivered by a modified conventional linear accelerator. Conversion of conventional linacs into e-Flash systems will accelerate testing Flash radiotherapy in clinical trials.

FLASH效应被认为是在（超高）高剂量率下，由于在保留肿瘤反应的同时保留了正常组织，从而扩大了治疗窗口。我们的目标是提供关于在研究环境中使用传统线性加速器转换为提供9 MeV UHDR电子束治疗患者的安全性的第一批数据。材料和方法在研究环境中，将传统的瓦里安TrueBeam直线加速器转换为能够提供9 MeV的UHDR电子束。I期试验方案已获得当地政府批准（NCT06549439）。1例≥1个黑色素瘤（皮下）病变患者接受3x - 9gy治疗。前两部分通过e-Flash应用，第三部分通过常规电子应用。结果在此，我们介绍了在改良的传统直线机中使用e-Flash治疗的第一位患者的经验。e-Flash组分按照实验方案成功交付。薄膜体内剂量测定证实了给药剂量的正确性。治疗后6周观察到良好的肿瘤反应，没有严重或意想不到的毒性。结论我们首次在人体中应用了改良的传统直线加速器产生的e-Flash。将传统直线加速器转换为e-Flash系统将加速Flash放射治疗在临床试验中的测试。

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引用次数: 0

Quantifying the flash effect and its dependence on average dose rate in vivo for 6 MeV electron and 6 MV photon beams 6兆电子伏电子束和6毫伏光子束的闪光效应及其对体内平均剂量率的依赖

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-09-23 DOI: 10.1016/j.ctro.2025.101052

Salomé Paillas, Edward R.J.F. Taylor, Nathalie Lövgren, Iain D.C. Tullis, Kristoffer Petersson

This study shows that an increase in average dose rate delays the onset, and reduces the severity, of radiation induced skin toxicity in mice following hemi-thorax irradiation. The FLASH sparing effect’s magnitude and dependence on dose rate appear similar following irradiations using 6 MV photon and 6 MeV electron beams.

本研究表明，平均剂量率的增加延迟了半胸照射后小鼠皮肤辐射毒性的发生，并降低了其严重程度。6毫伏光子和6兆电子伏特电子束辐照后，闪蒸节约效应的大小和对剂量率的依赖性相似。

引用次数: 0

Impact of deep learning on CT-based organ-at-risk delineation for flank irradiation in paediatric renal tumours: a SIOP-RTSG radiotherapy committee study 深度学习对基于ct的儿科肾肿瘤侧腹放射危险器官描绘的影响：SIOP-RTSG放射委员会研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-09-19 DOI: 10.1016/j.ctro.2025.101051

Mianyong Ding , Matteo Maspero , Semi Harrabi , Emmanuel Jouglar , Sabina Vennarini , Timothy Spencer , Britta Weber , Henriette Magelssen , Karen Van Beek , Remus Stoica , Simonetta Saldi , Tom Boterberg , Patrick Melchior , Marry M. van den Heuvel-Eibrink , Geert O. Janssens

Background and purpose

Integrating deep learning (DL) for auto-contouring has significantly improved organ-at-risk (OAR) delineation in adult radiotherapy. However, its application in paediatric radiotherapy remains limited. This study evaluates DL-based auto-contouring of OARs, followed by manual revisions, for paediatric flank irradiation, focusing on delineation time, accuracy, and inter-observer variability (IOV).

Materials and methods

Twelve paediatric radiation oncologists from nine countries affiliated with the SIOP Renal Tumour Study Group participated in a two-day workshop. Participants were randomly divided into two groups: one performed manual delineation first, followed by DL-based revision, while the other group performed in reverse order. Eight thoracoabdominal OARs were delineated on non-contrast CTs of renal tumour patients (ages 1–6). DL-based contours were generated using a model for paediatric abdominal cases. Delineation time was recorded, accuracy and IOV were assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance, mean surface distance against a STAPLE consensus (threshold = 0.95), and an expert reference.

Results

In total, 122 manual delineations and 254 DL-based revisions were collected. DL-based auto-contouring reduced delineation time by 59 %, from 25.5 to 10.2 min. The mean DSC of all eight OARs improved from 0.91 to 0.97 using STAPLE reference and from 0.89 to 0.93 using expert reference. The pancreas exhibited the largest gain, with mean DSC increases ranging from 0.18 to 0.25. Delineation accuracy was significantly improved for seven OARs (p < 0.05), while IOV significantly decreased for the pancreas and heart in both references (p < 0.05).

Conclusion

Manually revising DL-based auto-contouring reduces delineation time, enhances accuracy, and reduces inter-observer variability in paediatric CT-based OAR delineation.

背景与目的将深度学习（DL）集成到自动轮廓中，可以显著改善成人放疗中器官危险（OAR）的描绘。然而，它在儿科放射治疗中的应用仍然有限。本研究评估了基于dl的OARs自动轮廓，随后进行手动修订，用于儿科侧腹照射，重点关注描绘时间、准确性和观察者间变异性（IOV）。材料和方法来自9个国家的12名儿童放射肿瘤学家参加了为期两天的SIOP肾肿瘤研究组的研讨会。参与者随机分为两组：一组首先进行手工描绘，然后进行基于dl的修订，而另一组则相反。在非对比ct上描绘了8例肾肿瘤患者（1-6岁）的胸腹桨。使用儿童腹部病例模型生成基于dl的轮廓。记录描绘时间，使用Dice相似系数（DSC）、第95百分位Hausdorff距离、与STAPLE一致的平均表面距离（阈值= 0.95）和专家参考来评估准确性和IOV。结果共收集到122份人工圈定和254份基于dl的修订。基于dl的自动等高线绘制减少了59%的描绘时间，从25.5分钟减少到10.2分钟。所有8个桨的平均DSC在使用STAPLE参考时从0.91提高到0.97，在使用专家参考时从0.89提高到0.93。胰腺表现出最大的增益，平均DSC增加范围从0.18到0.25。7个OARs的圈定精度显著提高（p < 0.05），而两个参考文献中胰腺和心脏的IOV显著降低（p < 0.05）。结论：人工修改基于dl的自动轮廓可缩短描绘时间，提高准确性，并减少基于ct的儿科OAR描绘的观察者间差异。

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