Pub Date : 2025-09-19DOI: 10.1016/j.ctro.2025.101050
Taylor L. Schanel , Manoj Kumar , Lauren C. Nassour-Caswell , Sreelakshmi Cherakara , Rhea Pandit , Andee M. Beierle , Joshua C. Anderson , Patrica H. Hicks , Rex Cardan , Anita B. Hjelmeland , Christopher D. Willey
Ultra-high dose rate (FLASH-RT) and conventional proton beam radiotherapy to intracranial glioblastoma PDX were compared for tumor control and normal tissue toxicity via DNA and RNA damage response markers. Both conventional and FLASH radiotherapy yielded similar survival benefits; however, conventional radiotherapy resulted in greater normal tissue DNA and RNA damage.
{"title":"No differences in therapeutic efficacy while sparing healthy tissue for orthotopic glioblastoma patient-derived xenografts in context of proton FLASH","authors":"Taylor L. Schanel , Manoj Kumar , Lauren C. Nassour-Caswell , Sreelakshmi Cherakara , Rhea Pandit , Andee M. Beierle , Joshua C. Anderson , Patrica H. Hicks , Rex Cardan , Anita B. Hjelmeland , Christopher D. Willey","doi":"10.1016/j.ctro.2025.101050","DOIUrl":"10.1016/j.ctro.2025.101050","url":null,"abstract":"<div><div>Ultra-high dose rate (FLASH-RT) and conventional proton beam radiotherapy to intracranial glioblastoma PDX were compared for tumor control and normal tissue toxicity via DNA and RNA damage response markers. Both conventional and FLASH radiotherapy yielded similar survival benefits; however, conventional radiotherapy resulted in greater normal tissue DNA and RNA damage.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101050"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099742","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 : 2025-09-15DOI: 10.1016/j.ctro.2025.101048
Himanshu Shekhar, Parth Aphale, Shashank Dokania
{"title":"Comments on “Efficacy of radiotherapy and radiotherapy with hyperthermia to delay change of systemic therapy in patients with metastatic melanoma”","authors":"Himanshu Shekhar, Parth Aphale, Shashank Dokania","doi":"10.1016/j.ctro.2025.101048","DOIUrl":"10.1016/j.ctro.2025.101048","url":null,"abstract":"","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101048"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217973","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 : 2025-09-15DOI: 10.1016/j.ctro.2025.101046
Anna Kirstein , Dan Ionascu , Michael A.S. Lamba , Bianca M. Ruffolo , Katherine J. Crail , Anthony E. Mascia , Mathieu G. Sertorio , Benjamin H. Hinrichs , Chad Zender , Maria A. Lehn , Trisha M. Wise-Draper , John P. Perentesis , Yi Zheng , Susanne I. Wells
{"title":"In vitro determination of patient-specific variation challenges the universal RBE gold standard for proton radiation therapy","authors":"Anna Kirstein , Dan Ionascu , Michael A.S. Lamba , Bianca M. Ruffolo , Katherine J. Crail , Anthony E. Mascia , Mathieu G. Sertorio , Benjamin H. Hinrichs , Chad Zender , Maria A. Lehn , Trisha M. Wise-Draper , John P. Perentesis , Yi Zheng , Susanne I. Wells","doi":"10.1016/j.ctro.2025.101046","DOIUrl":"10.1016/j.ctro.2025.101046","url":null,"abstract":"","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101046"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109636","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 : 2025-09-15DOI: 10.1016/j.ctro.2025.101049
Levi Burns , Jillian Tsai , Philip Wong , Amy Parent , Yat Tsang , Monica Serban , Jelena Lukovic
Spatially fractionated radiotherapy (SFRT) is emerging as an option to deliver high dose radiation to bulky disease sites with an improved therapeutic ratio compared to established radiotherapy techniques. SFRT has not been previously studied for re-irradiation. We describe three patients with previously irradiated bulky oligometastatic disease to different sites (lung, thigh, and adrenal gland) who were re-treated with SFRT, with intention to relieve or prevent worsening of symptoms. Dose prescription was 66.7 Gy in 5 fractions to uniformly spaced lattice vertices in the gross tumour volume (GTV), with the planning target volume (PTV) receiving 20 Gy at the periphery and a mean dose of approximately 27 Gy. Dose summation and image registration techniques, and selection of organs at risk and dose constraints, were defined on a case-by-case basis. GTV volumes ranged from 272 cm3 to 3183 cm3, and mean dose delivered to the PTV ranged from 26.2 to 27.4 Gy. Two treatment plans met all clinical goals, while one plan had marginal excess dose to two structures. All three patients tolerated SFRT at least as well as their initial radiotherapy courses, with no severe radiation-related adverse events. Two patients were symptomatic prior to SFRT and achieved clinically significant symptom improvement following treatment. SFRT offers a feasible and safe re-irradiation option for bulky metastatic disease in the palliative setting.
{"title":"Spatially fractionated radiotherapy for re-irradiation: feasibility, safety, treatment planning, and outcomes","authors":"Levi Burns , Jillian Tsai , Philip Wong , Amy Parent , Yat Tsang , Monica Serban , Jelena Lukovic","doi":"10.1016/j.ctro.2025.101049","DOIUrl":"10.1016/j.ctro.2025.101049","url":null,"abstract":"<div><div>Spatially fractionated radiotherapy (SFRT) is emerging as an option to deliver high dose radiation to bulky disease sites with an improved therapeutic ratio compared to established radiotherapy techniques. SFRT has not been previously studied for re-irradiation. We describe three patients with previously irradiated bulky oligometastatic disease to different sites (lung, thigh, and adrenal gland) who were re-treated with SFRT, with intention to relieve or prevent worsening of symptoms. Dose prescription was 66.7 Gy in 5 fractions to uniformly spaced lattice vertices in the gross tumour volume (GTV), with the planning target volume (PTV) receiving 20 Gy at the periphery and a mean dose of approximately 27 Gy. Dose summation and image registration techniques, and selection of organs at risk and dose constraints, were defined on a case-by-case basis. GTV volumes ranged from 272 cm<sup>3</sup> to 3183 cm<sup>3</sup>, and mean dose delivered to the PTV ranged from 26.2 to 27.4 Gy. Two treatment plans met all clinical goals, while one plan had marginal excess dose to two structures. All three patients tolerated SFRT at least as well as their initial radiotherapy courses, with no severe radiation-related adverse events. Two patients were symptomatic prior to SFRT and achieved clinically significant symptom improvement following treatment. SFRT offers a feasible and safe re-irradiation option for bulky metastatic disease in the palliative setting.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101049"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217970","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 : 2025-09-11DOI: 10.1016/j.ctro.2025.100990
Shengjin Dou , Guopei Zhu
We appreciate the insightful letter from Topkan et al., which highlights important considerations regarding postoperative concurrent chemoradiotherapy (CCRT) in highrisk head and neck adenoid cystic carcinoma (ACC) and offers valuable perspectives on future directions. First of all, we agree that the standard use of CCRT cannot be recommended until prospective evidence is available. While chemotherapy may offer some benefit in local control and overall survival in ACC patients, it inevitably increases the risk of treatment-related toxicities. Therefore, the routine use of CCRT in ACC patients cannot be recommended unless sufficient survival benefit is demonstrated in prospective trials. Second, we recognize that one of the limitations of the study was the relatively small sample size, which may have limited its ability to detect statistically significant differences between the CCRT and RT-alone groups. Given the low incidence of ACC, recruiting an adequately large cohort across multiple centers would require substantial collaboration and coordination. This presents a significant challenge, as the rarity of ACC often results in slow patient recruitment, potentially affecting the generalizability of the findings. Nevertheless, with robust multi-institutional collaboration, such studies remain feasible and could yield valuable insights into treatment outcomes for this patient population.
{"title":"Letter to the Editor: Reply to Topkan et al.","authors":"Shengjin Dou , Guopei Zhu","doi":"10.1016/j.ctro.2025.100990","DOIUrl":"10.1016/j.ctro.2025.100990","url":null,"abstract":"<div><div>We appreciate the insightful letter from Topkan et al., which highlights important considerations regarding postoperative concurrent chemoradiotherapy (CCRT) in highrisk head and neck adenoid cystic carcinoma (ACC) and offers valuable perspectives on future directions. First of all, we agree that the standard use of CCRT cannot be recommended until prospective evidence is available. While chemotherapy may offer some benefit in local control and overall survival in ACC patients, it inevitably increases the risk of treatment-related toxicities. Therefore, the routine use of CCRT in ACC patients cannot be recommended unless sufficient survival benefit is demonstrated in prospective trials. Second, we recognize that one of the limitations of the study was the relatively small sample size, which may have limited its ability to detect statistically significant differences between the CCRT and RT-alone groups. Given the low incidence of ACC, recruiting an adequately large cohort across multiple centers would require substantial collaboration and coordination. This presents a significant challenge, as the rarity of ACC often results in slow patient recruitment, potentially affecting the generalizability of the findings. Nevertheless, with robust multi-institutional collaboration, such studies remain feasible and could yield valuable insights into treatment outcomes for this patient population.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"55 ","pages":"Article 100990"},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043954","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 : 2025-09-06DOI: 10.1016/j.ctro.2025.101044
Taliah Lansing , Wendy Harris , Mitchell Yu , Zaid Cheema , Xiuxiu He , Yabo Fu , Sang Kyu Lee , Laura Cervino , Tianfang Li , Xiang Li , Jean Moran , Boris Mueller , Daphna Gelblum , Sean Berry , Hao Zhang
Purpose
To compare the dosimetry and treatment efficiency of lung stereotactic body radiation therapy (SBRT) using the deep inspiration breath hold (DIBH), free breathing (FB), and respiratory gating (RG) strategies.
Methods and Materials
308 lung SBRT patients with middle to lower zone lung tumors were included in this retrospective study. The prescriptions were 1000 cGy x 5 fractions, 1200 cGy x 4 fractions, or 1800 cGy x 3 fractions. They were all treated with a volumetric modulated arc therapy (VMAT) technique and 6 MV flattening filter free (FFF) beam on C-arm linear accelerators, but using different motion management strategies (151 DIBH, 136 FB, 21 RG). The lung dose (mean lung dose (MLD), V5, V20) and treatment time (on table, imaging & verification, delivery) of these patients were retrospectively collected for statistical comparison.
Results
The average doses (MLD, V5, V20) to the ipsilateral lung were 408.2 cGy, 20.1 %, 5.7 % for the DIBH cohort, 569.8 cGy, 27.6 %, 8.4 % for the FB cohort, and 519.6 cGy, 23.5 %, 7.5 % for the RG patients. Correspondingly, the average time (on table/imaging & verification/delivery) for the three patient cohorts was 22.3/16.0/6.3 min, 13.6/10.5/3.1 min, and 22.7/14.6/8.1 min, respectively.
Conclusion
Quantitative comparison of lung dose and treatment efficiency for three commonly used motion management strategies in lung SBRT is reported. While the relative advantages and disadvantages of these strategies are well recognized, our findings further confirm these differences and provide clinicians with quantitative data to support informed decision-making in clinical practice.
{"title":"Dosimetric and treatment efficiency comparison of lung SBRT using three different motion management strategies","authors":"Taliah Lansing , Wendy Harris , Mitchell Yu , Zaid Cheema , Xiuxiu He , Yabo Fu , Sang Kyu Lee , Laura Cervino , Tianfang Li , Xiang Li , Jean Moran , Boris Mueller , Daphna Gelblum , Sean Berry , Hao Zhang","doi":"10.1016/j.ctro.2025.101044","DOIUrl":"10.1016/j.ctro.2025.101044","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the dosimetry and treatment efficiency of lung stereotactic body radiation therapy (SBRT) using the deep inspiration breath hold (DIBH), free breathing (FB), and respiratory gating (RG) strategies.</div></div><div><h3>Methods and Materials</h3><div>308 lung SBRT patients with middle to lower zone lung tumors were included in this retrospective study. The prescriptions were 1000 cGy x 5 fractions, 1200 cGy x 4 fractions, or 1800 cGy x 3 fractions. They were all treated with a volumetric modulated arc therapy (VMAT) technique and 6 MV flattening filter free (FFF) beam on C-arm linear accelerators, but using different motion management strategies (151 DIBH, 136 FB, 21 RG). The lung dose (mean lung dose (MLD), V5, V20) and treatment time (on table, imaging & verification, delivery) of these patients were retrospectively collected for statistical comparison.</div></div><div><h3>Results</h3><div>The average doses (MLD, V5, V20) to the ipsilateral lung were 408.2 cGy, 20.1 %, 5.7 % for the DIBH cohort, 569.8 cGy, 27.6 %, 8.4 % for the FB cohort, and 519.6 cGy, 23.5 %, 7.5 % for the RG patients. Correspondingly, the average time (on table/imaging & verification/delivery) for the three patient cohorts was 22.3/16.0/6.3 min, 13.6/10.5/3.1 min, and 22.7/14.6/8.1 min, respectively.</div></div><div><h3>Conclusion</h3><div>Quantitative comparison of lung dose and treatment efficiency for three commonly used motion management strategies in lung SBRT is reported. While the relative advantages and disadvantages of these strategies are well recognized, our findings further confirm these differences and provide clinicians with quantitative data to support informed decision-making in clinical practice.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101044"},"PeriodicalIF":2.7,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010899","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 : 2025-09-06DOI: 10.1016/j.ctro.2025.101042
Martha M. Matuszak , Charles B. Simone II , Charles K. Matrosic , Dawn Owen , Annemarie F Shepherd , Ane Appelt , Charles Mayo , Kelly C. Paradis , Ellen Yorke , Nicolaus Andratschke
Introduction
Thoracic reirradiation is increasingly used globally, but prospective evidence is scarce, leading to practice based primarily on institutional experience. Recognizing the need for guidance, international multi-professional experts convened at the first Reirradiation Collaborative Group (ReCOG) Meeting. This report presents results from a survey on best practices, challenges, and knowledge gaps among experts on thoracic reirradiation.
Methods
A comprehensive 50-question survey was developed by experts and discussed within the thoracic focus group at ReCOG. It included questions on participant demographics and clinical experience, patient-related clinical conditions and selection, imaging and targets, treatment planning, and dose accumulation. Participants were asked for perceived challenges as well as gaps in knowledge.
Results
The survey was completed by 34/51 invited experts (67 % response rate). Most respondents (79 %) were experienced physicists and radiation oncologists (>10 years) primarily at university hospitals (65 %). The most common tumors treated were locally recurrent lung cancer, mediastinal nodes, or thoracic metastases. Reirradiation goals included prolonging local control and survival, and alleviating/preventing symptoms. Conditions precluding reirradiation were persistent grade 3+ toxicity and progressive disease. Major toxicity concerns were bleeding, airway injury/fistula, and esophageal ulceration/fistula. Technical practices varied with regards to image registration, dose accumulation and recovery factors. Advanced treatment planning techniques and IGRT were consistent amongst respondents. Major challenges included lack of clinical guidelines and lack of software support tools.
Conclusion
Thoracic reirradiation is an increasingly prevalent area of interest despite scarcity of prospective data. The major focus currently still is primarily on treatment-related factors and the question of how to combine reirradiation with systemic therapy. However, there is little guidance on whether and how to modify a planned reirradiation dose based on patient comorbidities or recovery from the prior radiation course. This survey identified emerging areas of consensus as well as relevant variations and gaps in practice.
{"title":"Thoracic reirradiation clinical and technical practices: a survey from the reirradiation Collaborative Group (ReCOG)","authors":"Martha M. Matuszak , Charles B. Simone II , Charles K. Matrosic , Dawn Owen , Annemarie F Shepherd , Ane Appelt , Charles Mayo , Kelly C. Paradis , Ellen Yorke , Nicolaus Andratschke","doi":"10.1016/j.ctro.2025.101042","DOIUrl":"10.1016/j.ctro.2025.101042","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic reirradiation is increasingly used globally, but prospective evidence is scarce, leading to practice based primarily on institutional experience. Recognizing the need for guidance, international multi-professional experts convened at the first Reirradiation Collaborative Group (ReCOG) Meeting. This report presents results from a survey on best practices, challenges, and knowledge gaps among experts on thoracic reirradiation.</div></div><div><h3>Methods</h3><div>A comprehensive 50-question survey was developed by experts and discussed within the thoracic focus group at ReCOG. It included questions on participant demographics and clinical experience, patient-related clinical conditions and selection, imaging and targets, treatment planning, and dose accumulation. Participants were asked for perceived challenges as well as gaps in knowledge.</div></div><div><h3>Results</h3><div>The survey was completed by 34/51 invited experts (67 % response rate). Most respondents (79 %) were experienced physicists and radiation oncologists (>10 years) primarily at university hospitals (65 %). The most common tumors treated were locally recurrent lung cancer, mediastinal nodes, or thoracic metastases. Reirradiation goals included prolonging local control and survival, and alleviating/preventing symptoms. Conditions precluding reirradiation were persistent grade 3+ toxicity and progressive disease. Major toxicity concerns were bleeding, airway injury/fistula, and esophageal ulceration/fistula. Technical practices varied with regards to image registration, dose accumulation and recovery factors. Advanced treatment planning techniques and IGRT were consistent amongst respondents. Major challenges included lack of clinical guidelines and lack of software support tools.</div></div><div><h3>Conclusion</h3><div>Thoracic reirradiation is an increasingly prevalent area of interest despite scarcity of prospective data. The major focus currently still is primarily on treatment-related factors and the question of how to combine reirradiation with systemic therapy. However, there is little guidance on whether and how to modify a planned reirradiation dose based on patient comorbidities or recovery from the prior radiation course. This survey identified emerging areas of consensus as well as relevant variations and gaps in practice.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101042"},"PeriodicalIF":2.7,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156051","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 : 2025-09-04DOI: 10.1016/j.ctro.2025.101043
Alba Domínguez Domínguez , Niels den Haan , Jan Wiersma , Josephina C.C. Koppes , Karel A. Hinnen , Bradley R. Pieters
Background and purpose
Focal high-dose-rate (HDR) salvage brachytherapy has emerged as a treatment for radiorecurrent prostate cancer. This study aims to evaluate patterns of recurrence after focal salvage brachytherapy and to assess the adequacy of current treatment margins.
Materials and methods
Between March 2015 and December 2021, 39 patients with radiorecurrent prostate cancer underwent focal HDR brachytherapy. All patients had biopsy-confirmed local recurrence and were staged using Choline- or PSMA-PET/CT and multiparametric MRI. A 5 mm margin around the GTV was applied to define the CTV. Post-treatment recurrences were analyzed using rigid image registration of PET/CT and MRI to assess spatial relationships among the initial recurrence (Rec1), the recurrence following salvage brachytherapy (Rec2), and the brachytherapy dose distribution. The recurrences were categorized into infield, marginal, and outfield based on overlap of relapse with the treated CTV and based on dose received on the site of the relapse. Additionally, spatial analysis measured minimal distances between Rec1 and Rec2.
Results
Nineteen of 39 patients experienced clinical recurrence, with 12 exhibiting 25 local lesions. Based on spatial overlap, 20 % of Rec2 lesions were infield, 28 % marginal, and 52 % outfield. Dose-based classification indicated 52 % infield, 8 % marginal, and 40 % outfield recurrence. The median distance between Rec1 and Rec2 in outfield cases was 11.9–13.4 mm.
Conclusion
A substantial proportion of local recurrences after focal salvage brachytherapy occur outside the treated volume. Current 5 mm margins may be insufficient.
{"title":"Patterns of prostate recurrence after focal salvage prostate brachytherapy for radiorecurrent prostate cancer","authors":"Alba Domínguez Domínguez , Niels den Haan , Jan Wiersma , Josephina C.C. Koppes , Karel A. Hinnen , Bradley R. Pieters","doi":"10.1016/j.ctro.2025.101043","DOIUrl":"10.1016/j.ctro.2025.101043","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Focal high-dose-rate (HDR) salvage brachytherapy has emerged as a treatment for radiorecurrent prostate cancer. This study aims to evaluate patterns of recurrence after focal salvage brachytherapy and to assess the adequacy of current treatment margins.</div></div><div><h3>Materials and methods</h3><div>Between March 2015 and December 2021, 39 patients with radiorecurrent prostate cancer underwent focal HDR brachytherapy. All patients had biopsy-confirmed local recurrence and were staged using Choline- or PSMA-PET/CT and multiparametric MRI. A 5 mm margin around the GTV was applied to define the CTV. Post-treatment recurrences were analyzed using rigid image registration of PET/CT and MRI to assess spatial relationships among the initial recurrence (Rec1), the recurrence following salvage brachytherapy (Rec2), and the brachytherapy dose distribution. The recurrences were categorized into infield, marginal, and outfield based on overlap of relapse with the treated CTV and based on dose received on the site of the relapse. Additionally, spatial analysis measured minimal distances between Rec1 and Rec2.</div></div><div><h3>Results</h3><div>Nineteen of 39 patients experienced clinical recurrence, with 12 exhibiting 25 local lesions. Based on spatial overlap, 20 % of Rec2 lesions were infield, 28 % marginal, and 52 % outfield. Dose-based classification indicated 52 % infield, 8 % marginal, and 40 % outfield recurrence. The median distance between Rec1 and Rec2 in outfield cases was 11.9–13.4 mm.</div></div><div><h3>Conclusion</h3><div>A substantial proportion of local recurrences after focal salvage brachytherapy occur outside the treated volume. Current 5 mm margins may be insufficient.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101043"},"PeriodicalIF":2.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145047411","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 : 2025-09-02DOI: 10.1016/j.ctro.2025.101041
Yun Yang , Bichun Xu , Hong Zhu , Weikai Sun , Aibin Liang , Judong Luo
Background
Radiotherapy and Chimeric Antigen Receptor(CAR)-T therapy may exhibit a synergistic effect, suggesting that incorporating radiotherapy into CAR-T could improve the prognosis for patients with refractory/relapsed diffuse large B-cell lymphoma (R/R DCBCL). A lack of standardized treatment protocols and relevant guidelines in bridging radiotherapy(BRT) prior to CAR-T therapy still exists. Consequently, we retrospectively analyzed the outcomes of R/R DLBCL patients treated with BRT prior to CAR-T therapy or not, aiming to evaluate the efficacy and satety of BRT as well as the impact of radiotherapy dose on prognosis.
Methods
Between December 2017 and January 2025, 80 patients diagnosed with R/R DLBCL were treated with CAR-T. Thirty-five of them received BRT during leukapheresis and lymphodepletion. The primary endpoint of this study was progression free survival(PFS), and secondary endpoints included overall survival(OS), disease-specific survival(DSS), in-field PFS, best objective response rate(ORR), and complete response rate(CRR). PFS and OS of CAR-T were compared between BRT group and no BRT group. In the subgroup of radiotherapy patients, PFS, OS and in-field PFS were compared between the low-Equivalent dose to 2 Gy per fraction(EQD2) subgroup and the high-EQD2 subgroup.
Results
BRT group showed obviously longer PFS and OS than no BRT group(p = 0.001, p = 0.043). In addition, BRT did not increase the incidence of CAR-T toxicities during follow-up (median:35.27 months). Comprehensive BRT subgroup improved prognosis in PFS(p = 0.015) and OS(p = 0.029) when compared with focal BRT subgroup, no significant effect on DSS was noted(p = 0.109). High-EQD2 subgroup did not significantly improve PFS(p = 0.181) and OS(p = 0.665) except for local control(p = 0.079) especially in patients with high tumor burden(p = 0.005). There is no impact on prognosis between early salvage radiotherapy(SRT) and salvage chemotherapy(SCT) cohorts in patients with PR response to CAR-T therapy.
Conclusions
Our analysis demonstrated that BRT is a effective and safe approach for patients with R/R DLBCL preparing for CAR T-cell therapy, which indicated that BRT may enhance the anti-tumor effect of CAR T-cells.
{"title":"Combining CAR-T therapy with radiotherapy or not in refractory/relapsed diffuse large B-cell lymphoma: A comparative study","authors":"Yun Yang , Bichun Xu , Hong Zhu , Weikai Sun , Aibin Liang , Judong Luo","doi":"10.1016/j.ctro.2025.101041","DOIUrl":"10.1016/j.ctro.2025.101041","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy and Chimeric Antigen Receptor(CAR)-T therapy may exhibit a synergistic effect, suggesting that incorporating radiotherapy into CAR-T could improve the prognosis for patients with refractory/relapsed diffuse large B-cell lymphoma (R/R DCBCL). A lack of standardized treatment protocols and relevant guidelines in bridging radiotherapy(BRT) prior to CAR-T therapy still exists. Consequently, we retrospectively analyzed the outcomes of R/R DLBCL patients treated with BRT prior to CAR-T therapy or not, aiming to evaluate the efficacy and satety of BRT as well as the impact of radiotherapy dose on prognosis.</div></div><div><h3>Methods</h3><div>Between December 2017 and January 2025, 80 patients diagnosed with R/R DLBCL were treated with CAR-T. Thirty-five of them received BRT during leukapheresis and lymphodepletion. The primary endpoint of this study was progression free survival(PFS), and secondary endpoints included overall survival(OS), disease-specific survival(DSS), in-field PFS, best objective response rate(ORR), and complete response rate(CRR). PFS and OS of CAR-T were compared between BRT group and no BRT group. In the subgroup of radiotherapy patients, PFS, OS and in-field PFS were compared between the low-Equivalent dose to 2 Gy per fraction(EQD<sub>2</sub>) subgroup and the high-EQD<sub>2</sub> subgroup.</div></div><div><h3>Results</h3><div>BRT group showed obviously longer PFS and OS than no BRT group(p = 0.001, p = 0.043). In addition, BRT did not increase the incidence of CAR-T toxicities during follow-up (median:35.27 months). Comprehensive BRT subgroup improved prognosis in PFS(p = 0.015) and OS(p = 0.029) when compared with focal BRT subgroup, no significant effect on DSS was noted(p = 0.109). High-EQD2 subgroup did not significantly improve PFS(p = 0.181) and OS(p = 0.665) except for local control(p = 0.079) especially in patients with high tumor burden(p = 0.005). There is no impact on prognosis between early salvage radiotherapy(SRT) and salvage chemotherapy(SCT) cohorts in patients with PR response to CAR-T therapy.</div></div><div><h3>Conclusions</h3><div>Our analysis demonstrated that BRT is a effective and safe approach for patients with R/R DLBCL preparing for CAR T-cell therapy, which indicated that BRT may enhance the anti-tumor effect of CAR T-cells.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"55 ","pages":"Article 101041"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004047","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 : 2025-09-01DOI: 10.1016/j.ctro.2025.101040
Laura Mazzitelli-Fuentes , Lara Negrin , Virginia Venier , Humberto Romano , Lucia Pereira , Jerónimo Leberle , Maria Soledad Ausas , Ananya Choudhury , Luisa V. Biolatti
Background and purpose
Targeted radionuclide therapy (TRT) is a promising cancer treatment, but insufficient knowledge of the biological dose–response relationships limits its efficacy. The aim of this study was to characterize DNA damage in peripheral blood mononuclear cells (PBMCs) exposed to β-continuous irradiation (131I), and to assess its relationship with the absorbed dose, using two biomarkers: dicentric chromosomes and γ-H2AX foci.
Materials and methods
PBMCs from healthy donors were exposed to 131I at various activities (0.37–3.7 MBq) and times (1, 4, 24 h). Absorbed doses were calculated using the Medical Internal Radiation Dose formalism. DNA damage was assessed by chromosomal aberration frequency and γ-H2AX foci quantification. Lithium chloride (LiCl) was used to evaluate the rescue of delayed foci formation after 24 h exposure.
Results
Continuous β-irradiation induced a linear increase in CAs (α = 0.0643 ± 0.0068), in contrast to the linear-quadratic response observed in acute X-ray exposure (α = 0.0359 ± 0.0093, β = 0.0673 ± 0.0042). The frequency of CAs is lower under radionuclide irradiation compared to X-rays. γ-H2AX increased significantly at 1 and 4 h of continuous exposure but diminished at 24 h, despite continuous irradiation. LiCl treatment partially restored γ-H2AX foci levels at 24 h.
Conclusion
Dose-response relationship under continuous β-irradiation, assessed by CAs, follows a linear trend. DNA damage induced foci show a time-dependent dynamic. The decline in foci at 24 h, reversible with LiCl, highlights the limitations of γ-H2AX as a biomarker under prolonged irradiation conditions. These findings emphasize the need for optimized dosimetry methods and identify reliable biomarkers in TRT.
{"title":"Continuous β− particle exposure: A study of DNA damage in ex vivo peripheral blood mononuclear cells irradiation with Radioiodine","authors":"Laura Mazzitelli-Fuentes , Lara Negrin , Virginia Venier , Humberto Romano , Lucia Pereira , Jerónimo Leberle , Maria Soledad Ausas , Ananya Choudhury , Luisa V. Biolatti","doi":"10.1016/j.ctro.2025.101040","DOIUrl":"10.1016/j.ctro.2025.101040","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Targeted radionuclide therapy (TRT) is a promising cancer treatment, but insufficient knowledge of the biological dose–response relationships limits its efficacy. The aim of this study was to characterize DNA damage in peripheral blood mononuclear cells (PBMCs) exposed to β-continuous irradiation (<sup>131</sup>I), and to assess its relationship with the absorbed dose, using two biomarkers: dicentric chromosomes and γ-H2AX foci.</div></div><div><h3>Materials and methods</h3><div>PBMCs from healthy donors were exposed to <sup>131</sup>I at various activities (0.37–3.7 MBq) and times (1, 4, 24 h). Absorbed doses were calculated using the Medical Internal Radiation Dose formalism. DNA damage was assessed by chromosomal aberration frequency and γ-H2AX foci quantification. Lithium chloride (LiCl) was used to evaluate the rescue of delayed foci formation after 24 h exposure.</div></div><div><h3>Results</h3><div>Continuous β-irradiation induced a linear increase in CAs (α = 0.0643 ± 0.0068), in contrast to the linear-quadratic response observed in acute X-ray exposure (α = 0.0359 ± 0.0093, β = 0.0673 ± 0.0042). The frequency of CAs is lower under radionuclide irradiation compared to X-rays. γ-H2AX increased significantly at 1 and 4 h of continuous exposure but diminished at 24 h, despite continuous irradiation. LiCl treatment partially restored γ-H2AX foci levels at 24 h.</div></div><div><h3>Conclusion</h3><div>Dose-response relationship under continuous β-irradiation, assessed by CAs, follows a linear trend. DNA damage induced foci show a time-dependent dynamic. The decline in foci at 24 h, reversible with LiCl, highlights the limitations of γ-H2AX as a biomarker under prolonged irradiation conditions. These findings emphasize the need for optimized dosimetry methods and identify reliable biomarkers in TRT.</div><div>Abbreviations: TRT, targeted radionuclide therapy; MIRD, Medical Internal Radiation Dose; EBRT, external beam radiotherapy; LQ, linear-quadratic; DCA, dicentric chromosome assay; DSB, double strand break; PBMCs, peripheral blood mononuclear cells; PB, peripheral blood; FBS, fetal bovine serum; PBS, phosphate-buffered saline; CAs, chromosomal aberrations; RT, room temperature.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"55 ","pages":"Article 101040"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932562","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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