Clinical and Translational Radiation Oncology最新文献

{"title":"Integrative prediction model for radiation pneumonitis incorporating genetic and clinical-pathological factors using machine learning","authors":"","doi":"10.1016/j.ctro.2024.100819","DOIUrl":"10.1016/j.ctro.2024.100819","url":null,"abstract":"<div><h3>Purpose</h3><p>We aimed to develop a machine learning-based prediction model for severe radiation pneumonitis (RP) by integrating relevant clinicopathological and genetic factors, considering the associations of clinical, dosimetric parameters, and single nucleotide polymorphisms (SNPs) of genes in the TGF-β1 pathway with RP.</p></div><div><h3>Methods</h3><p>We prospectively enrolled 59 primary lung cancer patients undergoing radiotherapy and analyzed pretreatment blood samples, clinicopathological/dosimetric variables, and 11 functional SNPs in TGFβ pathway genes. Using the Synthetic Minority Over-sampling Technique (SMOTE) and nested cross-validation, we developed a machine learning-based prediction model for severe RP (grade ≥ 2). Feature selection was conducted using four methods (filtered-based, wrapper-based, embedded, and logistic regression), and performance was evaluated using three machine learning models.</p></div><div><h3>Results</h3><p>Severe RP occurred in 20.3 % of patients with a median follow-up of 39.7 months. In our final model, age (&gt;66 years), smoking history, PTV volume (&gt;300 cc), and AG/GG genotype in BMP2 rs1979855 were identified as the most significant predictors. Additionally, incorporating genomic variables for prediction alongside clinicopathological variables significantly improved the AUC compared to using clinicopathological variables alone (0.822 vs. 0.741, p = 0.029). The same feature set was selected using both the wrapper-based method and logistic model, demonstrating the best performance across all machine learning models (AUC: XGBoost 0.815, RF 0.805, SVM 0.712, respectively).</p></div><div><h3>Conclusion</h3><p>We successfully developed a machine learning-based prediction model for RP, demonstrating age, smoking history, PTV volume, and BMP2 rs1979855 genotype as significant predictors. Notably, incorporating SNP data significantly enhanced predictive performance compared to clinicopathological factors alone.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563082400096X/pdfft?md5=7853d13bbac25b9b535a0aab602f6093&pid=1-s2.0-S240563082400096X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141950533","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}

{"title":"Exploring long-term outcomes following CyberKnife robotic radiosurgery for trigeminal neuralgia","authors":"","doi":"10.1016/j.ctro.2024.100821","DOIUrl":"10.1016/j.ctro.2024.100821","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Radiosurgery has been extensively studied for its efficacy and safety in the management of trigeminal neuralgia (TN). However, among the plethora of relevant studies in the literature, only a restricted number have been conducted targeting an elongated trigeminal nerve segment with the CyberKnife radiosurgery (CKRS) system. Herein, we report long-term clinical outcomes of TN patients treated with CKRS.</p></div><div><h3>Materials and methods</h3><p>Fifty patients treated with CKRS for medically refractory TN were analyzed. Pain response and sensory dysfunction post CKRS were assessed using the Barrow Neurological Institute (BNI) scale. Kaplan-Meier analysis was used to assess the maintenance of pain control and the risk of onset of facial numbness. The Cox proportional hazards regression model was employed for both univariate and multivariate analyses to identify predictive factors among the collected variables.</p></div><div><h3>Results</h3><p>The median follow-up period was 63 months (range: 12–174 months). The median values of treated nerve volume, prescription dose, and integral dose were 59 mm³, 60 Gy and 3.9 mJ, respectively. Pain control (BNI I-III) was achieved in 37 patients (74%). Among them, the actuarial freedom from pain (FFP) rate was 82%, 78% and 74% at 24, 36 and beyond 48 months post-CKRS, respectively. A correlation of FFP rate with patient gender, treated nerve volume, and mean dose was revealed in multivariate analysis. Twenty-three patients (62%) reported onset of new or aggravation of pre-existing, facial numbness with twenty-one of them (57%) characterizing it as “mild facial numbness, not bothersome” (BNI-II) and two (5%) as “somewhat bothersome” (BNI-III). We did not encounter any case with very bothersome facial numbness (BNI-IV).</p></div><div><h3>Conclusions</h3><p>Long-term results of this work contribute to the body of evidence supporting the safety and efficacy of CKRS in the treatment of TN patients, in view of excellent pain control for an acceptable toxicity profile.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000983/pdfft?md5=007801ba618919f521e07bc1715f0930&pid=1-s2.0-S2405630824000983-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141949542","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}

{"title":"Validity test of small cell lung cancer (SCLC) graded prognostic assessment and proposal of a new index for patients with brain metastases from SCLC","authors":"","doi":"10.1016/j.ctro.2024.100820","DOIUrl":"10.1016/j.ctro.2024.100820","url":null,"abstract":"<div><h3>Background and purpose</h3><p>We performed a validity test of a recently-reported, small cell lung cancer (SCLC) graded prognostic assessment (GPA) system for SCLC patients with brain metastases (BMs). Thereafter, we created a new prognostic index, the SCLC Grade, for such patients.</p></div><div><h3>Materials and methods</h3><p>We studied 508 SCLC patients selected from among nearly 7000 consecutive patients undergoing gamma knife SRS for BMs since 1998.</p></div><div><h3>Results</h3><p>In the SCLC GPA, there were no median survival time (MST) differences among pairs of the neighboring subgroups. Therefore, the 508 patients were randomly divided into the two series, i.e., a test (340 patients) and a validity (168) series. In the test series, five factors were identified by univariable analyses as favoring longer survival (rounded lower 95 % CI of the HR was at least 1.3): Sex, Karnofsky Performance Status, tumor numbers, primary tumor status and extracerebral metastases. This new index is the sum of scores (0 and 1) of these five factors: SCLC-Grade 4–6 (score of 4, 5 or 6), 2–3 (2 or 3), and 0–1 (0 or 1). This new system showed highly statistically significant MST differences among subclasses. Next, this SCLC-Grade was applied to the verification series. Consistent results were obtained, i.e., there were highly statistically significant MST differences among subclasses.</p></div><div><h3>Conclusions</h3><p>Our validity test results for the SCLC GPA demonstrated this system to not precisely reflect the outcomes of SCLC patients with BMs. Our results suggest the herein-proposed SCLC-Grade to have superior prognostic value.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000971/pdfft?md5=c0b81453b4a2b570145c50f0bf387d63&pid=1-s2.0-S2405630824000971-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846220","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}

{"title":"CT-guided online adaptive stereotactic body radiotherapy for pancreas ductal adenocarcinoma: Dosimetric and initial clinical experience","authors":"","doi":"10.1016/j.ctro.2024.100813","DOIUrl":"10.1016/j.ctro.2024.100813","url":null,"abstract":"<div><h3>Purpose/Objectives</h3><p>Retrospective analysis suggests that dose escalation to a biologically effective dose of more than 70 Gy may improve overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but such treatments in practice are limited by proximity of organs at risk (OARs). We hypothesized that CT-guided online adaptive radiotherapy (OART) can account for interfraction movement of OARs and allow for safe delivery of ablative doses.</p></div><div><h3>Materials/Methods</h3><p>This is a single institution retrospective analysis of patients with PDAC treated with OART on the Ethos platform (Varian Medical Systems, a Siemens Healthineers Company, Palo Alto). All patients were treated to 40 Gy in 5 fractions. PTV overlapping with a 5 mm planning risk volume expansion on the stomach, duodenum and bowel received 25 Gy. Initial treatment plans were created conventionally. For each fraction, PTV and OAR volumes were recontoured with AI assistance after initial cone beam CT (CBCT). The adapted plan was calculated, underwent QA, and then compared to the scheduled plan. A second CBCT was obtained prior to delivery of the selected plan. Total treatment time (first CBCT to end of radiation delivery) and active physician time (first to second CBCT) were recorded. PTV_4000 V95 %, PTV_2500 V9 5%, and D0.03 cc to stomach, duodenum and bowel were reported for scheduled (S) and adapted (A) plans. CTCAEv5.0 toxicities were recorded. Statistical analysis was performed using a two-sided T test and α of 0.05.</p></div><div><h3>Results</h3><p>21 patients with unresectable or locally-recurrent PDAC were analyzed, with a total of 105 fractions. Average total time was 29 min and 16 s (16:36–49:40) and average active physician time was 19:41 min (9:25–39:34). All fractions were treated with adapted plans. 97 % of adapted plans met PTV_4000 V95.0 % &gt;95.0 % coverage goal and 100 % of adapted plans met OAR dose constraints. Median follow up was 6.6 months. Only 1 patient experienced acute grade 3+ toxicity directly attributable to radiation. Only 1 patient experienced late grade 3+ toxicity directly attributable to radiation.</p></div><div><h3>Conclusions</h3><p>Daily CT-based OART was associated with significantly reduced dose OARs while achieving superior PTV coverage. Given the relatively quick total treatment time, radiation delivery was generally well tolerated and easily incorporated into the clinic workflow. Our initial clinical experience demonstrates OART allows for safe dose escalation in the treatment of PDAC.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000909/pdfft?md5=536b0e2ba1c47332838bbbea0b719e87&pid=1-s2.0-S2405630824000909-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728788","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}

{"title":"The value of intervention with radiotherapy after first-line chemo-immunotherapy in locally advanced or metastatic esophageal squamous cell carcinoma: A multi-center retrospective study","authors":"Hui-Hui Hu ,&nbsp;Xin Xu ,&nbsp;Xiao-Yang Li ,&nbsp;Ya Zeng ,&nbsp;Yue Li ,&nbsp;Xin-Yun Song ,&nbsp;Xiao-Long Fu ,&nbsp;Xiu-Mei Ma ,&nbsp;Wen Yu","doi":"10.1016/j.ctro.2024.100818","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100818","url":null,"abstract":"<div><h3>Background</h3><p>Chemotherapy plus immunotherapy has become the standard first-line treatment of advanced or metastatic esophageal squamous cell carcinoma (ESCC), but median duration of response is only 7.0–8.3 months and progression-free survival (PFS, ∼6 months) is still far from satisfactory. We aim to evaluate whether early involvement of radiotherapy might improve the treatment outcome if objective response to first-line chemo-immunotherapy was observed in locally advanced or metastatic ESCC.</p></div><div><h3>Methods</h3><p>Patients were retrospectively collected from 3 institutions in China. Patients with histopathologically confirmed diagnoses of locally advanced or metastatic ESCC were identified, who objectively responded to first-line chemo-immunotherapy (complete or partial response, or stable disease) and also received radiotherapy of primary lesions with radiation dose of over 40 Gy, with or without radiotherapy of metastatic lesions before the first disease progression.</p></div><div><h3>Results</h3><p>A total of 72 eligible patients were identified. With median follow-up duration of 14.6 (range, 7.1–34.8) months, median progression-free survival (PFS) and overall survival (OS) were 13.5 (95 % CI,10.4-NA) months and 31.8 (95 % CI, 23.0-NA) months, respectively. Median duration from initiation of chemo-immunotherapy to radiotherapy was 2.9 (range, 0–15.1) months. Besides lower tumor burden as a significant factor of better treatment outcome, radiation dose ≥ 50 Gy was associated with superior PFS, while OS might be mainly related to tumor response to the induction chemo-immunotherapy. A low incidence of Grade 3 or above treatment-related adverse events were observed (19 %), and no treatment-related death occurred.</p></div><div><h3>Conclusion</h3><p>Our multi-center retrospective study showed survival benefit brought by early involvement of radiotherapy after first-line chemo-immunotherapy for patients with locally advanced or metastatic ESCC. However, further investigation is warranted in future prospective, controlled trials to assess the value of radio-immunotherapy in advanced or metastatic ESCC.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000958/pdfft?md5=c360767c2f2e98e9df0fc41ec05314b8&pid=1-s2.0-S2405630824000958-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141594922","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}

{"title":"Clinical outcomes of esophageal squamous cell carcinoma in patients with cirrhosis","authors":"","doi":"10.1016/j.ctro.2024.100817","DOIUrl":"10.1016/j.ctro.2024.100817","url":null,"abstract":"<div><h3>Purpose</h3><p>Alcohol consumption is a strong risk factor for both cirrhosis and esophageal squamous cell carcinoma (ESCC). Few studies have been conducted on the treatment of ESCC in patients with cirrhosis. This study aimed to analyze the clinical outcomes of ESCC in patients with cirrhosis.</p></div><div><h3>Materials and methods</h3><p>Medical records of patients with esophageal cancer between January 2009 and December 2023 were retrospectively reviewed. A total of 479 patients with ESCC were included and divided into cirrhotic (n = 69) and non-cirrhotic (n = 410) groups. Clinical outcomes and survival according to treatment were compared between these groups.</p></div><div><h3>Results</h3><p>The cirrhotic group was younger (median age 64 years vs. 69 years, <em>p</em> = 0.022) and had a higher proportion of male (97.1 % vs. 88.3 %, <em>p</em> = 0.042) than the non-cirrhotic group. Patients with cirrhosis were less likely to undergo surgery (31.9 % vs. 47.8 %, <em>p</em> = 0.015) and were more likely to receive no active cancer treatment (26.1 % vs. 13.7 %, <em>p</em> = 0.010). Overall survival was lower in the cirrhotic group (hazard ratio [HR], 1.41; 95 % confidence interval [CI], 1.01–1.99; <em>p</em> = 0.045), however, no difference was found between Child-Pugh class A patients and those in the non-cirrhotic group (HR, 1.04 [95 % CI, 0.69–1.56]; <em>p</em> = 0.864). Postoperative mortality was significantly higher in cirrhotic group (27.3 % vs. 8.7 %, <em>p</em> = 0.011). Upon performing concurrent chemoradiotherapy (CRT), the clinical complete response rate (84.2 % vs. 43.3 %, <em>p</em> = 0.004) was better in the cirrhotic group. CRT yielded better overall survival for patients with cancer in the resectable stages in the cirrhotic group compared to surgery (HR, 0.19 [95 % CI, 0.42–0.84]; <em>p</em> = 0.029].</p></div><div><h3>Conclusions</h3><p>In patient with ESCC and cirrhosis, chemoradiotherapy may be a better treatment option than surgery.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000946/pdfft?md5=9753b7c2851cb347005d824441236c0e&pid=1-s2.0-S2405630824000946-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636808","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}

{"title":"HDR brachytherapy versus robotic-based and linac-based stereotactic ablative body radiotherapy in the treatment of liver metastases – A dosimetric comparison study of three radioablative techniques","authors":"Mateusz Bilski ,&nbsp;Katarzyna Korab ,&nbsp;Małgorzata Stąpór-Fudzińska ,&nbsp;Julia Ponikowska ,&nbsp;Agnieszka Brzozowska ,&nbsp;Łukasz Sroka ,&nbsp;Ewa Wojtyna ,&nbsp;Sylwia Sroka ,&nbsp;Marta Szlag ,&nbsp;Paweł Cisek ,&nbsp;Aleksandra Napieralska","doi":"10.1016/j.ctro.2024.100815","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100815","url":null,"abstract":"<div><h3>Purpose</h3><p>The aim of our study was to compare dosimetric aspects of three radioablation modalities – direct high-dose-rate brachytherapy (HDR-BT) and virtually planned stereotactic body radiation therapy performed on CyberKnife (SBRTck) and Elekta Versa HD LINAC (SBRTe) applied in patients with liver metastases.</p></div><div><h3>Material and methods</h3><p>We selected 30 patients with liver metastases, who received liver interstitial HDR-BT and virtually prepared plans for SBRTck and SBRTe. In all the cases, the prescribed dose was a single fraction of 25 Gy. Treatment delivery time, doses delivered to PTV and organs at risk, as well as conformity indices, were calculated and compared.</p></div><div><h3>Results</h3><p>The longest median treatment delivery time was observed in SBRTck in contrast to HDR-BT and SBRTe which were significantly shorter and comparable. HDR-BT plans achieved better coverage of PTV (except for D98%) in contrast to SBRT modalities. Between both SBRT modalities, SBRTck plans resulted in better dose coverage in Dmean, D50%, and D90% values compared to SBRTe without difference in D98%. The SBRTe was the most advantageous considering the PCI and R100%. SBRTck plans achieved the best HI, while R50% value was comparable between SBRTe and SBRTck. The lowest median doses delivered to uninvolved liver volume (V5Gy, V9.1Gy) were achieved with HDR-BT, while the difference between SBRT modalities was insignificant. SBRT plans were better regarding more favourable dose distribution in the duodenum and right kidney, while HDR-BT achieved lower doses in the stomach, heart, great vessels, ribs, skin and spinal cord. There were no significant differences in bowel and biliary tract dose distribution between all selected modalities.</p></div><div><h3>Conclusions</h3><p>HDR-BT resulted in more favourable dose distribution within PTVs and lower doses in organs at risk, which suggests that this treatment modality could be regarded as an alternative to other local ablative therapies in carefully selected patients’ with liver malignancies. Future studies should further address the issue of comparing treatment modalities in different liver locations and clinical scenarios.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000922/pdfft?md5=85f50cc6633cdd43d2b5e3104d677fca&pid=1-s2.0-S2405630824000922-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141543294","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}

{"title":"Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility","authors":"","doi":"10.1016/j.ctro.2024.100816","DOIUrl":"10.1016/j.ctro.2024.100816","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Peer review is an important component of quality assurance in radiotherapy. To our knowledge, there are no studies reporting on the feasibility and outcomes of the peer review process for magnetic resonance (MR) guided radiotherapy (MRgRT) on the MR linear accelerator (MR-Linac) despite the planning complexity involved and its evolving clinical indications. This study aimed to quantify the rate of change in treatment plans post-peer review and the time and resources required.</p></div><div><h3>Materials and methods</h3><p>Fifty-five cases presented at weekly MR-Linac peer review meetings across two centres from 8 June to 21<!--> <!-->September 2023 were prospectively collected. Cases were analysed to determine the rate and extent of plan changes based on the Peer Review Audit Tool for radiation oncology (PRAT) developed by the Royal Australian and New Zealand College of Radiologists (RANZCR).</p></div><div><h3>Results</h3><p>Peer review resulted in changes to 36.4 % of treatment plans (n = 20), with 3.6 % (n = 2) having major changes requiring deferment of treatment. The most frequent changes were to organs at risk (OAR) volumes involving both delineation and increased OAR sparing (16.4 %, n = 9), total dose and fractionation (10.9 %, n = 6) and target volume dose coverage (5.5 %, n = 3). Patients with SBRT plans (39.1 % cf 22.2 %), oligometastatic/oligoprogressive sites (38.1 % cf 30.7 %) and reirradiation cases (41.2 % cf 34.2 %) had higher rates of change. Cases took a mean of 7 min (range 2–15 minutes) to discuss.</p></div><div><h3>Conclusion</h3><p>The high rates of plan changes support the value of peer review in MRgRT. We recommend, where possible that all MRgRT cases, particularly those involving SBRT plans, oligometastatic/oligoprogressive sites, and/or reirradiation, be subject to peer review.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000934/pdfft?md5=318f6d97a80ce220a0a988fb2cf6b780&pid=1-s2.0-S2405630824000934-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636809","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}

{"title":"Selection criteria and method for deep inspiration breath-hold in patients with left breast cancer undergoing PMRT/IMRT","authors":"Yingying Zhou ,&nbsp;Jinfeng Xu ,&nbsp;Fumin Xu ,&nbsp;Yanning Li ,&nbsp;Huali Li ,&nbsp;Lisheng Pan ,&nbsp;Yang Li ,&nbsp;Shuyi Cao ,&nbsp;Longmei Cai ,&nbsp;Lin Yang ,&nbsp;Bo Chen ,&nbsp;Hongmei Wang","doi":"10.1016/j.ctro.2024.100812","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100812","url":null,"abstract":"<div><h3>Purpose</h3><p>This study explored whether a free-breathing mean heart dose (FB-MHD) of 4 Gy is a reliable dose threshold for selecting left breast cancer patients after modified radical mastectomy suitable for deep inspiration breath-hold (DIBH) and developed anatomical indicators to predict FB-MHD for rapid selection.</p></div><div><h3>Materials and methods</h3><p>Twenty-three patients with left breast cancer treated with DIBH were included to compare FB and DIBH plans. The patients were divided into the high-risk (FB-MHD ≥ 4 Gy) and low-risk (FB-MHD &lt; 4 Gy) groups to compare dose difference, normal tissue complication probability (NTCP) and the DIBH benefits. Another 30 patients with FB only were included to analyze the capacity of distinguishing high-risk heart doses patients according to anatomical metrics, such as cardiac-to-chest Euclidean distance (CCED), cardiac-to-chest gap (CCG), and cardiac-to-chest combination (CCC).</p></div><div><h3>Results</h3><p>All heart doses were significantly lower in patients with DIBH plans than in those with FB plans. Based on FB-MHD of 4 Gy cutoff, the heart dose, NTCP for cardiac death, and benefits from DIBH were significantly higher in the high-risk group than in the low-risk group. The CCED was a valid anatomical indicator with the largest area under the curve (AUC) of 0.83 and maintained 95 % sensitivity and 70 % specificity at the optimal cutoff value of 2.5 mm.</p></div><div><h3>Conclusions</h3><p>An FB-MHD of 4 Gy could be used as an efficient dose threshold for selecting patients suitable for DIBH. The CCED may allow a reliable prediction of FB-MHD in left breast cancer patients at CT simulation.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000892/pdfft?md5=0d5516f40ba3ab24dd8a634cb1fae08f&pid=1-s2.0-S2405630824000892-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485829","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}

{"title":"A single-center experience of the upright proton therapy for skull-base chordomas and chondrosarcomas: Updated results","authors":"Alyona Lemaeva ,&nbsp;Igor Gulidov ,&nbsp;Daniil Smyk ,&nbsp;Yuliya Agapova ,&nbsp;Sergey Koryakin ,&nbsp;Irina Eremina ,&nbsp;Elena Gantsova ,&nbsp;Timur Fatkhudinov ,&nbsp;Andrey Kaprin ,&nbsp;Konstantin Gordon","doi":"10.1016/j.ctro.2024.100814","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100814","url":null,"abstract":"<div><h3>Aim</h3><p>To access efficacy and safety of the upright proton therapy for the skull-base chordomas and chondrosarcomas.</p></div><div><h3>Materials and methods</h3><p>The study encompasses single-center experience of proton therapy in chordomas (CA) and chondrosarcomas (CSA) of skull-base localization. We evaluate overall survival, local control and toxicity. Tumor response was assessed in accordance with RANO criteria. Treatment-related toxicity was evaluated with the help of CTCAE v 5.0 scale.</p></div><div><h3>Results</h3><p>Proton therapy in the upright position was utilized for 51pts (patients) with CA-CSA (40 pts with chordoma and 11pts with chondrosarcoma) at the A. Tsyb Medical Radiological Research Center in 2016–2023. Median tumor volume constituted 30 cm³ (IQR (interquartile range) 15–41 cm³). Median total dose was 70 Gy_RBE. Median number of fractions was 35. Overall survival (OS) at 1-, 2- and 3-year rates reached 98.0 %, 88.6 % and 82.7 %, respectively. Median follow-up time was 36 months. The 1-, 2- and 3-year local control (LC) rates constituted, respectively, 98 %, 78.6 % and 66.3 %. Prior surgery showed statistically significant association with better prognosis (p = 0.023). Brainstem-to-tumor dose coverage compromise became the major pattern of LC failure (p = 0.03). The late radiation toxicity reactions included temporal lobe necrosis grade 2 in 2 pts, xerostomia grade 1 in 1pt, radiation cataract grade 2 in 1pt and persistent headache grade 2 in 4 pts. Severe late toxicity reactions were observed in 2 cases (4 %): 1 myelitis grade 3 and brainstem damage grade 5 in 1pt.</p></div><div><h3>Conclusion</h3><p>Local control was achieved in the majority of patients receiving the scanning-beam upright proton therapy for skull-base CA-CSA. The LC rates after a surgery-radiotherapy combination treatment were higher compared with irradiation alone. Pattern of failure is mostly brainstem-tumor dose compromise. The high OS and LC rates were accompanied by low toxicity incidence. Even in complex case of the skull base CA-CSA upright proton therapy shows promising clinical outcomes.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000910/pdfft?md5=63a62ecb01c62db19667413e0d36234b&pid=1-s2.0-S2405630824000910-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485828","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}