Clinical and Translational Radiation Oncology最新文献

{"title":"Determining the gross tumor volume for hepatocellular carcinoma radiotherapy based on multi-phase contrast-enhanced magnetic resonance imaging","authors":"Kangning Meng ,&nbsp;Guanzhong Gong ,&nbsp;Rui Liu ,&nbsp;Shanshan Du ,&nbsp;Ruozheng Wang ,&nbsp;Yong Yin","doi":"10.1016/j.ctro.2024.100877","DOIUrl":"10.1016/j.ctro.2024.100877","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to quantitatively analyze of the differences in determining the gross tumor volume (GTV) for hepatocellular carcinoma (HCC) radiotherapy using multi-phase contrast-enhanced magnetic resonance imaging (CE-MRI) and provide a reference for determining the GTV for radiotherapy of HCC.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 99 HCC patients (145 lesions) who underwent MR simulation. T₁-weighted imaging (T₁WI), contrast-enhanced T₁WI (CE-T₁WI) at 15 s, 45 s, 75 s, 150 s, and 20 min after contrast agent injection were performed, comprising a total of six imaging sequences. The GTVs identified on different sequences were grouped and fused in various combinations. The internal GTV (IGTV), which was the reference structure, was obtained by the fusion of all six sequences. Mean signal intensity (SI), volume, shape, and fibrous capsule (FC) thickness among GTVs were compared.</div></div><div><h3>Results</h3><div>(1) The mean SI value of GTV_-T1WI, GTV_-15s-GTV_-20min in patients with transarterial chemoembolization (TACE) was lower by 14.09 % (GTV_-T1WI) to 31.31 % (GTV_-15s) compared with that in patients without TACE. Except for GTV_-T1WI, the differences in SI values between the two groups for other GTVs were statistically significant (<em>p</em> &lt; 0.05). (2) The volumes of GTV_-T1WI, GTV_-15s-GTV_-20min ranged from 32.66-34.99 cm³. The volume differences between GTV_-45s and the other GTVs were statistically significant (<em>p</em> &lt; 0.05), excluding the GTV_-T1WI. (3) Compared with the IGTV, the change trend of GTV volume reduction rate is consistent with that of dice similarity coefficients (DSC). (4) In the CE-T₁WI sequences (except for CE-T₁WI_-15s), FC measurement was possible in 39.31 % of lesions (57/145), with the largest mean thickness observed at 75 s.</div></div><div><h3>Conclusion</h3><div>Although single-phase CE-MRI introduces uncertainty in HCC GTV determination, combining different phases CE-MRI can enhance accuracy. The CE-T₁WI_-45s should be routinely included as a necessary scanning sequence.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100877"},"PeriodicalIF":2.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539512","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":"Long-term outcomes of more than a decade treating patients with stereotactic body radiation therapy for hepatocellular carcinoma","authors":"Wilhelm den Toom ,&nbsp;Eva M. Negenman ,&nbsp;Francois E.J.A. Willemssen ,&nbsp;Erik van Werkhoven ,&nbsp;Robert J. Porte ,&nbsp;Roeland F. de Wilde ,&nbsp;Dave Sprengers ,&nbsp;Imogeen E. Antonisse ,&nbsp;Ben J.M. Heijmen ,&nbsp;Alejandra Méndez Romero","doi":"10.1016/j.ctro.2024.100878","DOIUrl":"10.1016/j.ctro.2024.100878","url":null,"abstract":"<div><h3>Purpose/Objective(s)</h3><div>To evaluate if stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) has a durable effect on tumor control and can be delivered safely.</div></div><div><h3>Materials/Methods</h3><div>Patients included in this retrospective study have been treated at our institution from January 2008 to December 2022. Eligibility criteria were diagnosis of HCC, BCLC stage 0-A-B, non-cirrhotic liver or liver with cirrhosis Child-Pugh class A, and a maximum of three lesions with a cumulative diameter of ≤ 6 cm. Patients with relapses after surgery, thermal ablation or TACE or patients awaiting transplant were also candidates for SBRT. SBRT was delivered in 6 fractions of 8 or 9 Gy. The primary endpoint was local (target) control (LC). Secondary endpoints were time to progression (TTP), overall survival (OS), response rate (RR) and toxicity.</div></div><div><h3>Results</h3><div>A total of 52 patients received SBRT at our institution and 51 were included in this study. One patient objected and was excluded. Median follow-up was 2.1 years for LC and 2.3 years for OS. Median tumor size was 26 mm. LC rates at 1, 2, and 5 years were 100 %, 95 % and 95 % respectively. Median TTP was 45.6 months. Median OS was 7.1 years. RR was 96 %. No patients in this study have experienced SBRT related CTC AE grade ≥ 3 toxicity.</div></div><div><h3>Conclusion</h3><div>SBRT resulted in excellent long-term local control rates and absence of severe toxicity in a group of HCC patients. The reported outcomes compare favorably with other local therapies. SBRT should be considered as one of the available local treatment options for HCC.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100878"},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533329","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":"Inhibition of OXPHOS induces metabolic rewiring and reduces hypoxia in murine tumor models","authors":"Daan F. Boreel ,&nbsp;Anne P.M. Beerkens ,&nbsp;Sandra Heskamp ,&nbsp;Milou Boswinkel ,&nbsp;Johannes P.W. Peters ,&nbsp;Gosse J. Adema ,&nbsp;Paul N. Span ,&nbsp;Johan Bussink","doi":"10.1016/j.ctro.2024.100875","DOIUrl":"10.1016/j.ctro.2024.100875","url":null,"abstract":"<div><h3>Introduction</h3><div>Tumor hypoxia is a feature of many solid malignancies and is known to cause radio resistance. In recent years it has become clear that hypoxic tumor regions also foster an immunosuppressive phenotype and are involved in immunotherapy resistance. It has been proposed that reducing the tumors’ oxygen consumption will result in an increased oxygen concentration in the tissue and improve radio- and immunotherapy efficacy. The aim of this study is to investigate the metabolic rewiring of cancer cells by pharmacological attenuation of oxidative phosphorylation (OXPHOS) and subsequently reduce tumor hypoxia.</div></div><div><h3>Material and methods</h3><div>The metabolic effects of three OXPHOS inhibitors IACS-010759, atovaquone and metformin were explored by measuring oxygen consumption rate, extra cellular acidification rate, and [¹⁸F]FDG uptake in 2D and 3D cell culture. Tumor cell growth in 2D cell culture and hypoxia in 3D cell culture were analyzed by live cell imaging. Tumor hypoxia and [¹⁸F]FDG uptake <em>in vivo</em> following treatment with IACS-010759 was determined by immunohistochemistry and <em>ex vivo</em> biodistribution respectively.</div></div><div><h3>Results</h3><div><em>In vitro</em> experiments show that tumor cell metabolism is heterogeneous between different models. Upon OXPHOS inhibition, metabolism shifts from oxygen consumption through OXPHOS towards glycolysis, indicated by increased acidification and glucose uptake. Inhibition of OXPHOS by IACS-010759 treatment reduced diffusion limited tumor hypoxia in both 3D cell culture and <em>in vivo</em>. Although immune cell presence was lower in hypoxic areas compared with normoxic areas, it is not altered following short term OXPHOS inhibition.</div></div><div><h3>Discussion</h3><div>These results show that inhibition of OXPHOS causes a metabolic shift from OXPHOS towards increased glycolysis in 2D and 3D cell culture. Moreover, inhibition of OXPHOS reduces diffusion limited hypoxia in 3D cell culture and murine tumor models. Reduced hypoxia by OXPHOS inhibition might enhance therapy efficacy in future studies. However, caution is warranted as systemic metabolic rewiring can cause adverse effects.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100875"},"PeriodicalIF":2.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521188","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":"Health care system factors associated with receipt of treatment and treatment intent in stage III non-small cell lung cancer: A population-based study in Ontario","authors":"Stephane Thibodeau ,&nbsp;Paul Nguyen ,&nbsp;Andrew Robinson ,&nbsp;Fabio Ynoe de Moraes ,&nbsp;Jason Pantarotto ,&nbsp;Timothy P. Hanna","doi":"10.1016/j.ctro.2024.100873","DOIUrl":"10.1016/j.ctro.2024.100873","url":null,"abstract":"<div><h3>Purpose</h3><div>Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease, with a spectrum of anatomic extent, health status, and treatment approaches. Receipt of treatment and its intent should be independent of health system factors where care quality is optimal. We investigated the degree that modifiable health system factors are associated with receipt of treatment and treatment intent in stage III NSCLC in a large, universal health system.</div></div><div><h3>Methods</h3><div>This was a population-based, retrospective cohort study with health administrative data from Ontario, Canada, 2010–2018 for those aged ≥ 20 years, with AJCC 7 or 8 stage III NSCLC. We explored health system factors associated with NSCLC treatment: region of residence, diagnostic interval, travel distance, advanced radiation (e.g. IMRT, VMAT) and systemic therapy treatment volumes, and year of treatment (treatment era). The relative risk (RR) of (1) any treatment versus no treatment, and (2) palliative versus non-palliative treatment was determined, using multivariable stepwise Poisson regression models. We adjusted for patient, disease, and treatment factors.</div></div><div><h3>Results</h3><div>We identified 7,093 people with stage III NSCLC between 2010 and 2018. There were no health system factors associated with receipt of treatment versus no treatment in adjusted analysis. The major health system factor associated with palliative intent was region of residence (RR: Region ranges from 0.88 to 1.67, p &lt; 0.001). Stratifying by era (2010–2012 vs. 2013–2015 vs. 2016–2018), there was an increase in receipt of curative treatment and use of advanced radiotherapy techniques and immunotherapy over time, but regional variation of treatment intent was similar.</div></div><div><h3>Conclusions</h3><div>Region of residence emerged as the major health system factor associated with treatment intent for stage III NSCLC. This variation remained, even as advances in radiotherapy and systemic therapy were adopted. Our study suggests possible opportunities to improve care outcomes by addressing unexplained regional variation in care.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100873"},"PeriodicalIF":2.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722735","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":"Feasibility and safety of single-fraction sub-ablative radiotherapy with systemic therapy in colorectal cancer patients with ≤ 10 metastases: A multicenter pilot study (NCT05375708)","authors":"K. Zwart ,&nbsp;M.N.G.J.A. Braat ,&nbsp;F.H. van der Baan ,&nbsp;A.M. May ,&nbsp;J.M.L. Roodhart ,&nbsp;D. Al-Toma ,&nbsp;J.M.M.B. Otten ,&nbsp;M. Los ,&nbsp;T. Oostergo ,&nbsp;R.J.A. Fijneman ,&nbsp;J.M. van Dodewaard-de Jong ,&nbsp;C.J.A Punt ,&nbsp;G. Meijer ,&nbsp;J.J.W. Lagendijk ,&nbsp;M. Koopman ,&nbsp;M. Intven ,&nbsp;G.M. Bol","doi":"10.1016/j.ctro.2024.100874","DOIUrl":"10.1016/j.ctro.2024.100874","url":null,"abstract":"<div><div>Colorectal cancer patients with ≤10 unresectable metastases were treated with single-fraction sub-ablative radiotherapy in addition to standard of care systemic therapy in a single-arm, open-label, multicenter, pilot study (SIRIUS) to assess feasibility and safety. Results indicate that radiotherapy combined with systemic therapy is feasible and safe in this population.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100874"},"PeriodicalIF":2.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427425","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":"Measuring patient reported outcomes in brachytherapy: Why we should do it and more importantly how","authors":"Aspazia Spyrou ,&nbsp;André-Guy Martin ,&nbsp;Jean-Michel Hannoun-Lévi ,&nbsp;Alexandra Stewart","doi":"10.1016/j.ctro.2024.100870","DOIUrl":"10.1016/j.ctro.2024.100870","url":null,"abstract":"<div><div>As the treatment for cancer improves and advances are made, the clinical focus is often on treatment response and survival. However, these are not the only factors which are important to patients. More patients are living longer after cancer treatment and therefore it is important that we can describe not only the treatment to patients but also what their life will be like during and after treatment. Patient reported outcomes (PROs) allow us to describe these. Although there are a range of patient reported outcome measures (PROMs) available to the clinician to assess these, the use of them in many areas of brachytherapy lags behind ideal levels. Brachytherapy has many features that differ to external beam radiotherapy (EBRT) yet the assessment of quality of life during and after treatment is much more scarce than EBRT. Brachytherapy is often used in the setting of organ preservation or in place of radical surgery, yet there is a paucity of quality of life data comparing the different treatment modalities. This review article will aim to elaborate on the evidence that exists in the use of specific PROMs within prostate, breast and gynaecologic cancers and describe the development of a novel PROMs approach in rectal brachytherapy which aims to identify and resolve symptoms at an early stage.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100870"},"PeriodicalIF":2.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427426","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":"Reirradiation − still navigating uncharted waters?","authors":"Nicolaus Andratschke ,&nbsp;Jonas Willmann ,&nbsp;Ane L Appelt ,&nbsp;Madalyne Day ,&nbsp;Camilla Kronborg ,&nbsp;Mariangela Massaccesi ,&nbsp;Mahmut Ozsahin ,&nbsp;David Pasquier ,&nbsp;Primoz Petric ,&nbsp;Oliver Riesterer ,&nbsp;Dirk De Ruysscher ,&nbsp;Joanne M Van der Velden ,&nbsp;Matthias Guckenberger","doi":"10.1016/j.ctro.2024.100871","DOIUrl":"10.1016/j.ctro.2024.100871","url":null,"abstract":"<div><div>With the emergence of high-precision radiotherapy technologies such as stereotactic ablative radiotherapy (SABR), MR guided brachytherapy, image guided intensity modulated photon and proton radiotherapy and most recently daily adaptive radiotherapy, reirradiation is increasingly recognized as a viable treatment option for many patients. This includes those with recurrent, metastatic or new malignancies post initial radiotherapy. The primary challenge in reirradiation lies in balancing tumor control against the risk of severe toxicity from cumulative radiation doses to previously irradiated normal tissue.</div><div>Although technology for precise delivery has advanced at a fast pace, clinical practice of reirradiation still mostly relies on individual expertise, as prospective evidence is scarce, the level of reporting in clinical studies is not standardized and of low quality − especially with respect to cumulative doses received by organs at risk.</div><div>A recent ESTRO/EORTC initiative proposed a standardized definition of reirradiation and formulated general requirements for minimal reporting in clinical studies <span><span>[1]</span></span>.</div><div>As a consequence we found it timely to convene for an international and interdisciplinary meeting with experts in the field to summarize the current evidence, identify knowledge gaps and explore which best practices can be derived for safe reirradiation. The meeting was held on 15.06.2023 in Zurich and was endorsed by the scientific societies SASRO, DEGRO and ESTRO. Here, we report on available evidence and research priorities in the field of reirradiation, as discussed during the meeting.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100871"},"PeriodicalIF":2.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427429","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 impact of rectal spacers in MR-guided adaptive radiotherapy","authors":"Vikneswary Batumalai ,&nbsp;David Crawford ,&nbsp;Maddison Picton ,&nbsp;Charles Tran ,&nbsp;Urszula Jelen ,&nbsp;Madeline Carr ,&nbsp;Michael Jameson ,&nbsp;Jeremy de Leon","doi":"10.1016/j.ctro.2024.100872","DOIUrl":"10.1016/j.ctro.2024.100872","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The use of stereotactic ablative radiotherapy (SABR) for prostate cancer has increased significantly. However, SABR can elevate the risk of moderate gastrointestinal (GI) side effects. Rectal spacers mitigate this risk by reducing the rectal dose. This study evaluates the impact of rectal spacers in MR-guided adaptive radiotherapy (MRgART) for prostate SABR.</div></div><div><h3>Materials and methods</h3><div>A retrospective analysis was conducted on twenty patients with localised prostate cancer treated on the Unity MR-Linac at a single centre. Half of the cohort (n = 10) had rectal spacers placed before treatment. The adapt-to-shape strategy was used for online MRgART, and non-adapted plans were later generated offline for comparison. Dosimetric assessments were made between spacer and no-spacer cohorts, and between online adapted and non-adapted plans. Clinician-reported outcomes for genitourinary (GU) and GI toxicity were assessed at 3-, 6-, and 12-months post-treatment using Common Terminology Criteria for Adverse Events v.5.0.</div></div><div><h3>Results</h3><div>No grade 2 or higher toxicity was observed in either cohort. Overall, the dosimetric analysis showed comparable results between the cohorts for target volumes, with D95% of 36.3 Gy in the spacer cohort and 36.0 Gy in the no-spacer cohort (p = 0.08). The spacer cohort demonstrated significant benefits in all rectal dose objectives (p &lt; 0.0001) and in some bladder objectives (V40, p = 0.03; V36, p = 0.03). Failure rates for achieving planning objectives were similar between spacer and no-spacer groups for online adapted plans, with most rates ranging from 0 % to 4 % in both groups.</div></div><div><h3>Conclusion</h3><div>The findings from this cohort suggest that MRgART is safe and effective for prostate SABR, with comparable toxicity rates in both spacer and no-spacer cohorts. While rectal spacers offer dosimetric advantages, the adaptive nature of MRgART can mitigate some dosimetric disparities, potentially reducing the need for invasive spacer placement. However, further studies with larger patient populations are needed to confirm these results.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100872"},"PeriodicalIF":2.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427428","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":"Maximum disease diameter is associated with outcomes in stage II follicular lymphoma treated with radiation therapy alone","authors":"Yi Xu ,&nbsp;Belinda A. Campbell ,&nbsp;Matthew Chan ,&nbsp;Jessica Chan ,&nbsp;Pedro Farinha ,&nbsp;Christopher P. Venner ,&nbsp;David W. Scott ,&nbsp;Alina S. Gerrie ,&nbsp;Diego Villa ,&nbsp;Laurie H. Sehn ,&nbsp;Kerry J. Savage ,&nbsp;Andrea C. Lo","doi":"10.1016/j.ctro.2024.100869","DOIUrl":"10.1016/j.ctro.2024.100869","url":null,"abstract":"<div><h3>Purpose</h3><div>The optimal management of stage II follicular lymphoma (FL) is unclear. Radiation therapy (RT) alone has been the gold standard treatment, but a proportion of patients relapse. We sought to characterize outcomes and prognostic factors for stage II FL treated with RT alone to identify a high-risk subgroup of patients who may benefit from treatment intensification.</div></div><div><h3>Methods</h3><div>This was a population-based, province-wide, retrospective study. Included patients had grade 1–3A, non-mesenteric, stage IIA or IIAE FL diagnosed between 1986 and 2016 and treated with curative-intent (≥20 Gy) RT alone.</div></div><div><h3>Results</h3><div>102 patients were included. Median follow-up was 10.4 years (range, 0.3–22.3). Median age was 59 years (range, 33–86). Median greatest disease diameter was 3.6 cm (range, 1.5–11.5). Freedom from progression (FFP) was 60.3% at 5 years and 40.7% at 10 years. Overall survival (OS) was 89.2% at 5 years and 81.8% at 10 years. Greatest disease diameter of &gt;3.6 cm was associated with inferior FFP (10-year FFP 34% vs. 47%, <em>p</em> = 0.013) on univariable analysis and inferior FFP (hazard ratio [HR] 1.87, <em>p</em> = 0.019) and inferior OS (HR 2.12, <em>p</em> = 0.027) on multivariable analysis (MVA). Older age was associated with inferior OS (HR 1.08, unit = 1 year, <em>p</em> &lt; 0.001) on MVA.</div></div><div><h3>Conclusions</h3><div>40.7% of stage II FL patients treated with RT alone remained disease-free at 10 years. Greatest disease diameter &gt;3.6 cm was associated with inferior FFP and OS, representing a novel prognostic indicator in this population that may help in the decision-making process on whether to complement RT with systemic therapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100869"},"PeriodicalIF":2.7,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427427","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":"Bladder-preserving radiation therapy for patients with locally advanced and node-positive bladder cancer","authors":"Patrick Carriere ,&nbsp;Omar Alhalabi ,&nbsp;Jianjun Gao ,&nbsp;Osama Mohamad ,&nbsp;Matthew T. Campbell ,&nbsp;Amishi Shah ,&nbsp;Sangeeta Goswami ,&nbsp;Kelly Bree ,&nbsp;Byron Lee ,&nbsp;Neema Navai ,&nbsp;Henry Mok ,&nbsp;Lauren Mayo ,&nbsp;Charles Guo ,&nbsp;Quynh Nguyen ,&nbsp;Sean McGuire ,&nbsp;Ryan Park ,&nbsp;Shalin Shah ,&nbsp;Karen Hoffman ,&nbsp;Steven Frank ,&nbsp;Chad Tang ,&nbsp;Comron Hassanzadeh","doi":"10.1016/j.ctro.2024.100866","DOIUrl":"10.1016/j.ctro.2024.100866","url":null,"abstract":"<div><h3>Purpose</h3><div>Trimodality therapy for muscle-invasive bladder cancer (MIBC) yields similar oncologic outcomes compared to radical cystectomy in appropriately selected patients; however, data regarding locally advanced MIBC (LA-MIBC) is limited. We explored our experience with LA-MIBC undergoing radiation therapy (RT).</div></div><div><h3>Methods</h3><div>We retrospectively identified 30 patients from an institutional prospectively collated database with non-metastatic, LA-MIBC. Patients with T3-4 N0 or T2-4 N + treated from 2012 to 2022 with definitive-intent RT, who were not candidates for cystectomy were included. Kaplan-Meier analysis was used to estimate time-to-event outcomes, and multivariate analyses were conducted using Cox proportional hazards modeling.</div></div><div><h3>Results</h3><div>43 % had T3N0 disease, 30 % had T4N0 disease, and 27 % had node positive disease.. Neoadjuvant chemotherapy/systemic therapy was administered in 63 % of patients. Median dose and fractionation of RT was 60 Gy in 30 fractions. 23 % of patients received hypofractionated RT, 57 % received nodal RT.</div><div>At a median follow-up of 20 (range, 1–75) months after RT, estimated 1- and 2-year OS was 73 % and 61 %, respectively. Estimated 1-year progression-free survival was 50 %. Local bladder failure was a component of progression in 17 % of patients, and all local bladder failure events occurred within the first 12 months following RT. Lymph node or distant metastases occurred in 23 % of patients. Estimated 1-year OS was 83 % with pure urothelial histology but only 58 % with variant histology (P = 0.001). Late grade 3 + GU and GI toxicity occurred in 7 % and 5 % of patients, respectively.</div></div><div><h3>Conclusions</h3><div>In this cohort with LA-MIBC treated with RT, distant failures predominate, local failures are less common, and toxicity was minimal. Survival outcomes remain encouraging for RT in this challenging patient population. Further investigation is warranted to identify biomarkers for patient selection and strategies to improve distant control.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100866"},"PeriodicalIF":2.7,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358345","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}