Clinical and Translational Radiation Oncology最新文献_第8页

Definitive particle therapy using protons or carbon ions for dedifferentiated liposarcoma 利用质子或碳离子对已分化脂肪肉瘤进行确定性粒子治疗

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-22 DOI: 10.1016/j.ctro.2024.100864

Hikaru Kubota , Yusuke Demizu , Kazuma Iwashita , Nobuyoshi Fukumitsu , Daiki Takahashi , SungChul Park , Shintaro Tsuruoka , Yoshiro Matsuo , Kazuki Terashima , Sunao Tokumaru , Tomoaki Okimoto , Toshinori Soejima

Background

Particle therapy is effective for the treatment of soft tissue sarcomas. However, the clinical outcomes of definitive particle therapy, particularly for dedifferentiated liposarcoma (DDLS), remain unknown.

Purpose

To analyze the treatment outcomes of proton and carbon ion particle therapies for DDLS.

Methods

We retrospectively included patients with DDLS who were treated with particle therapy between 2008 and 2022. The local control (LC), progression-free survival (PFS), and overall survival (OS) rates were evaluated.

Results

Fifty-seven patients were included in this analysis. The median patient age was 68 years (range, 36–91 years). The most common tumor site was the retroperitoneum (n = 37), with a median gross tumor volume (GTV) of 181 cm³. Twenty-nine patients received proton therapy, and 28 patients received carbon ion therapy. The most common fractionation dose was 70.4 Gy (relative biological effectiveness) in 32 fractions (72.7 Gy equivalent dose in 2 Gy fractions [EQD2]). The median follow-up time was 33 months (range, 1–128 months). The 3-year LC, PFS, and OS rates were 73.1 %, 44.6 %, and 70.6 %, respectively. Patients who received a higher prescribed dose (≥72.7 Gy EQD2) showed significantly better LC (p = 0.04) than did those who received a lower prescribed dose. Moreover, those with a larger GTV (≥181 cm³) had significantly worse OS (p = 0.04) than did those with a smaller GTV. Late adverse events occurred in five (9 %) patients.

Conclusions

Particle therapy using protons or carbon ions for the treatment of DDLS is safe and provides good OS and LC. However, further studies with longer follow-up periods and larger cohorts are warranted.

背景粒子疗法是治疗软组织肉瘤的有效方法。目的分析质子和碳离子粒子疗法对 DDLS 的治疗效果。方法我们回顾性地纳入了 2008 年至 2022 年期间接受粒子疗法治疗的 DDLS 患者，并对其局部控制率（LC）、无进展生存率（PFS）和总生存率（OS）进行了评估。方法我们回顾性地纳入了 2008 年至 2022 年间接受粒子治疗的 DDLS 患者，评估了局部控制率（LC）、无进展生存率（PFS）和总生存率（OS）。患者年龄中位数为 68 岁（36-91 岁）。最常见的肿瘤部位是腹膜后（37 例），中位肿瘤总体积（GTV）为 181 立方厘米。29名患者接受了质子治疗，28名患者接受了碳离子治疗。最常见的分次剂量为 70.4 Gy（相对生物效应），分 32 次进行（72.7 Gy 等效剂量，分 2 Gy [EQD2]）。中位随访时间为33个月（1-128个月）。3年LC、PFS和OS率分别为73.1%、44.6%和70.6%。与接受较低处方剂量的患者相比，接受较高处方剂量（≥72.7 Gy EQD2）的患者的LC明显更好（p = 0.04）。此外，GTV较大（≥181 cm3）的患者的OS明显比GTV较小的患者差（p = 0.04）。结论使用质子或碳离子进行粒子疗法治疗DDLS是安全的，并能提供良好的OS和LC。然而，还需要进行随访时间更长、队列更大的进一步研究。

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引用次数: 0

Artificial intelligence in interventional radiotherapy (brachytherapy): Enhancing patient-centered care and addressing patients’ needs 介入放射治疗（近距离放射治疗）中的人工智能：加强以患者为中心的护理，满足患者需求

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-22 DOI: 10.1016/j.ctro.2024.100865

Bruno Fionda , Elisa Placidi , Mischa de Ridder , Lidia Strigari , Stefano Patarnello , Kari Tanderup , Jean-Michel Hannoun-Levi , Frank-André Siebert , Luca Boldrini , Maria Antonietta Gambacorta , Marco De Spirito , Evis Sala , Luca Tagliaferri

This review explores the integration of artificial intelligence (AI) in interventional radiotherapy (IRT), emphasizing its potential to streamline workflows and enhance patient care. Through a systematic analysis of 78 relevant papers spanning from 2002 to 2024, we identified significant advancements in contouring, treatment planning, outcome prediction, and quality assurance. AI-driven approaches offer promise in reducing procedural times, personalizing treatments, and improving treatment outcomes for oncological patients. However, challenges such as clinical validation and quality assurance protocols persist. Nonetheless, AI presents a transformative opportunity to optimize IRT and meet evolving patient needs.

这篇综述探讨了人工智能（AI）在介入放射治疗（IRT）中的应用，强调了人工智能在简化工作流程和加强患者护理方面的潜力。通过对 2002 年至 2024 年期间的 78 篇相关论文进行系统分析，我们发现了轮廓塑造、治疗计划、结果预测和质量保证方面的重大进展。人工智能驱动的方法有望缩短手术时间、实现个性化治疗并改善肿瘤患者的治疗效果。然而，临床验证和质量保证协议等挑战依然存在。不过，人工智能为优化 IRT 和满足不断变化的患者需求提供了一个变革性的机会。

引用次数: 0

A phase I clinical trial evaluating the application of hydrogel in reducing rectal dose during cervical cancer brachytherapy 评估水凝胶在宫颈癌近距离治疗中减少直肠剂量应用的 I 期临床试验

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.ctro.2024.100867

Yuxuan Wang , Hongnan Zhen , Ke Hu , Lang Yu , Jie Zhang , Chunli Luo , Lihua Yu , Junfang Yan , Fuquan Zhang

Purpose

This study represents a prospective phase I clinical research to verify the effectiveness and reliability of hydrogel application in Chinese cervical cancer patients.

Materials and Methods

Eight patients were enrolled in the study. After completing intensity-modulated radiotherapy at 50.4 Gy/28 fractions, a 10 mL injection of hydrogel was administered to each patient through the posterior vaginal fornix under CT-guidance. Image-guided brachytherapy under CT or MRI guidance was given with a target dose of 6 Gy in 5 fractions to the high-risk clinical target volume. Rectal, sigmoid colon, and bladder D2cm3 were recorded for each brachytherapy. MRI scans were performed to measure the distance between the rectum and the cervix or tumor, as well as the spacer gel volume. Patients’ QLQ-C30 and QLQ-CX24 scores were recorded to assess treatment outcomes, and all adverse events were documented.

Results

Among the eight patients, the average D2cc was 60.9 ± 3.4 Gy for the rectum, 64.7 ± 6.8 Gy for sigmoid colon and 77.1 ± 7.4 Gy for bladder, respectively. The distance between the cervix and rectum significantly increased after gel injection. None of the eight patients experienced grade 3 or higher acute toxic reactions during brachytherapy. None patient experienced late rectal toxicity. No adverse events definitively associated with the hydrogel were observed. Patients’ subjective quality of life scores did not significantly change before and after gel injection. The reduction ro the volume of the hydrogel were observed during the 24 to 36 weeks after injection.

Conclusion

The application of the hydrogel effectively increased the distance between the cervix and rectum in brachytherapy for cervical cancer, limiting the rectal dose without increasing doses to other critical organs. In the short term, no severe adverse events were observed, indicating the safety and reliability of this approach. Further research is warranted to confirm its long-term safety and effectiveness.

目的本研究是一项前瞻性 I 期临床研究，旨在验证水凝胶在中国宫颈癌患者中应用的有效性和可靠性。每位患者在完成 50.4 Gy/28 分次的调强放疗后，在 CT 引导下经阴道后穹窿注射 10 mL 水凝胶。在 CT 或 MRI 引导下，对高风险临床靶区进行了图像引导近距离放射治疗，目标剂量为 6 Gy，分 5 次进行。每次近距离治疗都记录了直肠、乙状结肠和膀胱的 D2cm3。磁共振成像扫描用于测量直肠与宫颈或肿瘤之间的距离以及间隔凝胶体积。记录患者的 QLQ-C30 和 QLQ-CX24 评分，以评估治疗效果，并记录所有不良事件。结果八名患者的直肠平均 D2cc 为 60.9 ± 3.4 Gy，乙状结肠为 64.7 ± 6.8 Gy，膀胱为 77.1 ± 7.4 Gy。注射凝胶后，宫颈和直肠之间的距离明显增加。八名患者在近距离治疗过程中均未出现 3 级或以上急性毒性反应。没有患者出现晚期直肠毒性反应。没有观察到与水凝胶明确相关的不良反应。注射凝胶前后，患者的主观生活质量评分没有明显变化。结论在宫颈癌近距离放射治疗中，水凝胶的应用有效地增加了宫颈与直肠之间的距离，限制了直肠的剂量，而不会增加其他重要器官的剂量。在短期内，没有观察到严重的不良反应，表明这种方法安全可靠。要确认其长期安全性和有效性，还需要进一步的研究。

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引用次数: 0

Physician reported toxicities and patient reported quality of life of transperineal ultrasound-guided radiotherapy of prostate cancer 医生报告的经会阴超声引导前列腺癌放射治疗毒性和患者报告的生活质量

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.ctro.2024.100868

Jing Ma , Paul Rogowski , Christian Trapp , Farkhad Manapov , Bin Xu , Alexander Buchner , Shun Lu , Nina Sophie Schmidt-Hegemann , Xuanbin Wang , Cheng Zhou , Christian Stief , Claus Belka , Minglun Li

Purpose

This study aims to address therapy-related toxicities and quality of life in prostate cancer patients undergoing transperineal ultrasound (TPUS) guided radiotherapy (RT).

Methods

Acute and late gastrointestinal (GI) and genitourinary (GU) toxicities were assessed by physicians using CTCAE v5.0. Patient-reported quality of life outcomes were evaluated using EORTC QLQ-C30, -PR25 and IPSS. We utilized Volumetric Modulated Arc Therapy (VMAT) or intensity modulated radiation therapy (IMRT) as the RT technique for this study. The assessments were carried out before RT, at RT end, 3 months after RT and subsequently at 1-year intervals. Prostate-specific antigen (PSA) was also evaluated at each follow-up.

Results

In this study, a total of 164 patients were enrolled, while among them, 112 patients delivered quality-of-life data in a prospective evaluation. The median pre-treatment PSA was 7.9 ng/mL (range: 1.8–169 ng/ml). At the median follow-up of 19 months (3–82 months), the median PSA decreased to 0.22 ng/ml. Acute grade II GI and GU toxicities occurred in 8.6 % and 21.5 % patients at RT end. Regarding late toxicities, 2.2 % patients experienced grade II GI toxicities at 27 months and only one patient at 51 months, whereas no grade II GU late toxicities were reported at these time points. Quality of life scores also indicated a well-tolerated treatment. Patients mainly experienced acute clinically relevant symptoms of fatigue, pain, as well as deterioration in bowel and urinary symptoms. However, most symptoms normalized at 3 months and remained stable thereafter. Overall functioning showed a similar decline at RT end but improved over time.

Conclusion

The outcomes of TPUS-guided RT demonstrated promising results in terms of minimal physician-reported toxicities and satisfactory patient-reported QoL.

方法医生使用 CTCAE v5.0 评估急性和晚期胃肠道（GI）和泌尿生殖系统（GU）毒性。患者报告的生活质量结果采用 EORTC QLQ-C30、-PR25 和 IPSS 进行评估。本研究采用容积调强弧线疗法（VMAT）或调强放射疗法（IMRT）作为 RT 技术。评估分别在放疗前、放疗结束时、放疗后 3 个月以及之后每隔 1 年进行一次。结果在这项研究中，共有 164 名患者接受了前瞻性评估，其中 112 名患者提供了生活质量数据。治疗前 PSA 的中位数为 7.9 纳克/毫升（范围：1.8-169 纳克/毫升）。中位随访时间为 19 个月（3-82 个月），PSA 中位值降至 0.22 纳克/毫升。在 RT 结束时，分别有 8.6% 和 21.5% 的患者出现急性 II 级消化道和泌尿系统毒性。在晚期毒性方面，2.2%的患者在27个月时出现了II级消化道毒性，只有一名患者在51个月时出现了II级消化道毒性，而在这些时间点均未报告II级泌尿系统晚期毒性。生活质量评分也表明治疗耐受性良好。患者主要出现疲劳、疼痛以及肠道和泌尿系统症状恶化等急性临床相关症状。不过，大多数症状在 3 个月后恢复正常，此后保持稳定。结论TPUS引导的RT治疗结果表明，医生报告的毒性极小，患者报告的生活质量令人满意。

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引用次数: 0

Immunological responses to brain metastasis stereotactic radiosurgery in patient-matched longitudinal blood and tumour samples 患者匹配的纵向血液和肿瘤样本对脑转移立体定向放射手术的免疫反应

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-21 DOI: 10.1016/j.ctro.2024.100863

Joseph Sia , Criselle D’Souza , Rebecca Castle , Yu-Kuan Huang , Han Xian Aw Yeang , Rejhan Idrizi , Metta Jana , Shankar Siva , Claire Phillips , Paul Neeson

Background

Stereotactic radiosurgery (SRS) is highly effective as focal treatment for brain metastases (BrMs), but whether it can promote anti-tumour immune responses that synergise with immunotherapy remains unclear. We investigated this by examining blood samples from a clinical trial for HER2-amplified breast cancer (HER2-BC) BrMs, matched with longitudinal HER2-BC BrM samples resected from the same location in the same patient.

Methods

Blood samples from 10 patients taken pre- and 7–14 days post-SRS were analysed by mass and flow cytometry. One patient received pre-operative SRS for a BrM that recurred 7 months after resection, followed by planned re-resection 8 days post-SRS. Pre- and post-SRS tumours from this patient were analysed by bulk RNAseq, multiplex immunohistochemistry (mIHC), and TCR sequencing.

Results

Monocytes, central memory CD8+ T and regulatory T cells were enriched in blood post-SRS, together with increased MHC-II expression on monocytes, conventional DCs, and monocytic MDSCs. In tumour, SRS upregulated antigen presentation, T cell proliferation and T cell co-stimulation signatures, alongside an influx of tumour-associated macrophages (TAMs) and CD4+ T cells. Specifically, TAMs and CD4+ T cells, but not CD8+ T cells, demonstrated spatial co-localisation post-SRS. These TAMs were lowly PD-L1 expressing, but CD4+ T cells showed increased PD-1 expression. A sizeable proportion of T cell clonotypes were retained post-SRS, and four clones demonstrated significant, non-stochastic expansion.

Conclusion

Systemic and local immunological changes in this homogenous patient cohort suggest that SRS may facilitate MHC-II-restricted T cell priming responses involving the monocyte-macrophage lineage and CD4+ T cells, which should be further explored.

背景立体定向放射手术（SRS）作为脑转移瘤（BrMs）的病灶治疗非常有效，但它是否能促进与免疫疗法协同作用的抗肿瘤免疫反应仍不清楚。我们通过研究来自HER2-扩增乳腺癌（HER2-BC）脑转移灶临床试验的血液样本，以及从同一患者同一部位切除的纵向HER2-BC脑转移灶样本，对此进行了调查。方法通过质谱和流式细胞术分析了10名患者在SRS术前和术后7-14天采集的血液样本。其中一名患者在术前接受了SRS治疗，该肿瘤在切除术后7个月复发，在SRS术后8天按计划进行了再次切除。结果SRS术后血液中的单核细胞、中心记忆CD8+ T细胞和调节性T细胞富集，单核细胞、传统DC和单核MDSCs上的MHC-II表达增加。在肿瘤中，SRS 上调了抗原呈递、T 细胞增殖和 T 细胞协同刺激特征，同时肿瘤相关巨噬细胞（TAMs）和 CD4+ T 细胞也大量涌入。具体来说，TAMs 和 CD4+ T 细胞（而非 CD8+ T 细胞）在 SRS 后表现出空间共定位。这些TAM的PD-L1表达量很低，但CD4+ T细胞的PD-1表达量却很高。结论这组同质患者的系统和局部免疫学变化表明，SRS 可促进涉及单核-巨噬细胞系和 CD4+ T 细胞的 MHC-II 限制性 T 细胞引物反应，这一点应进一步探讨。

{"title":"Immunological responses to brain metastasis stereotactic radiosurgery in patient-matched longitudinal blood and tumour samples","authors":"Joseph Sia , Criselle D’Souza , Rebecca Castle , Yu-Kuan Huang , Han Xian Aw Yeang , Rejhan Idrizi , Metta Jana , Shankar Siva , Claire Phillips , Paul Neeson","doi":"10.1016/j.ctro.2024.100863","DOIUrl":"10.1016/j.ctro.2024.100863","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic radiosurgery (SRS) is highly effective as focal treatment for brain metastases (BrMs), but whether it can promote anti-tumour immune responses that synergise with immunotherapy remains unclear. We investigated this by examining blood samples from a clinical trial for HER2-amplified breast cancer (HER2-BC) BrMs, matched with longitudinal HER2-BC BrM samples resected from the same location in the same patient.</div></div><div><h3>Methods</h3><div>Blood samples from 10 patients taken pre- and 7–14 days post-SRS were analysed by mass and flow cytometry. One patient received pre-operative SRS for a BrM that recurred 7 months after resection, followed by planned re-resection 8 days post-SRS. Pre- and post-SRS tumours from this patient were analysed by bulk RNAseq, multiplex immunohistochemistry (mIHC), and TCR sequencing.</div></div><div><h3>Results</h3><div>Monocytes, central memory CD8+ T and regulatory T cells were enriched in blood post-SRS, together with increased MHC-II expression on monocytes, conventional DCs, and monocytic MDSCs. In tumour, SRS upregulated antigen presentation, T cell proliferation and T cell co-stimulation signatures, alongside an influx of tumour-associated macrophages (TAMs) and CD4+ T cells. Specifically, TAMs and CD4+ T cells, but not CD8+ T cells, demonstrated spatial co-localisation post-SRS. These TAMs were lowly PD-L1 expressing, but CD4+ T cells showed increased PD-1 expression. A sizeable proportion of T cell clonotypes were retained post-SRS, and four clones demonstrated significant, non-stochastic expansion.</div></div><div><h3>Conclusion</h3><div>Systemic and local immunological changes in this homogenous patient cohort suggest that SRS may facilitate MHC-II-restricted T cell priming responses involving the monocyte-macrophage lineage and CD4+ T cells, which should be further explored.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100863"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563082400140X/pdfft?md5=12649680110201c143c95f7fd3305912&pid=1-s2.0-S240563082400140X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315816","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}

引用次数: 0

The oxygen puzzle in FLASH radiotherapy: A comprehensive review and experimental outlook FLASH 放射治疗中的氧气难题：全面回顾与实验展望

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-18 DOI: 10.1016/j.ctro.2024.100860

Andrea Scarmelotto , Victor Delprat , Carine Michiels , Stéphane Lucas , Anne-Catherine Heuskin

FLASH radiotherapy is attracting increasing interest because it maintains tumor control while inflicting less damage to normal tissues compared to conventional radiotherapy. This sparing effect, the so-called FLASH effect, is achieved when radiation is delivered at ultra-high dose rates (≥40 Gy/s). Although the FLASH effect has already been demonstrated in several preclinical models, a complete mechanistic description explaining why tumors and normal tissues respond differently is still missing. None of the current hypotheses fully explains the experimental evidence. A common point between many of these is the role of oxygen, which is described as a major factor, either through transient hypoxia in the form of dissolved molecules, or reactive oxygen species (ROS). Therefore, this review focuses on both forms of this molecule, retracing old and more recent theories, while proposing new mechanisms that could provide a complete description of the FLASH effect based on preclinical and experimental evidence. In addition, this manuscript describes a set of experiments designed to provide the FLASH community with new tools for exploring the post-irradiation fate of ROS and their potential biological implications.

与传统放疗相比，FLASH 放疗既能控制肿瘤，又能减少对正常组织的损伤，因此越来越受到关注。当以超高剂量率（≥40 Gy/s）进行放射治疗时，就能达到这种疏导效果，即所谓的 "FLASH效应"。虽然 FLASH 效应已在多个临床前模型中得到证实，但仍缺乏完整的机理描述来解释肿瘤和正常组织为何会产生不同的反应。目前没有一种假说能完全解释实验证据。许多假说的共同点是氧的作用，氧被描述为一个主要因素，要么是通过溶解分子形式的瞬时缺氧，要么是活性氧（ROS）。因此，本综述将重点放在这两种形式的分子上，追溯旧的和最新的理论，同时根据临床前和实验证据提出新的机制，以完整描述 FLASH效应。此外，本手稿还描述了一组实验，旨在为 FLASH 社区提供探索 ROS 辐射后命运及其潜在生物学影响的新工具。

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引用次数: 0

A pilot study to evaluate the combination of surgery and brachytherapy for local tumor control in young children with perianal rhabdomyosarcoma 评估手术和近距离放射治疗相结合对肛周横纹肌肉瘤患儿局部肿瘤控制效果的试点研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-18 DOI: 10.1016/j.ctro.2024.100862

Andreas Schmidt , David Baumann , Ulf Lamprecht , Benjamin Mayer , Cristian Urla , Benjamin Bender , Jürgen Schäfer , Frank Fideler , Maximilian Niyazi , Frank Paulsen , Jörg Fuchs

Background

Perianal rhabdomyosarcoma ((P)RMS) are rare and have a poor prognosis. Data in young children are limited and local therapy is not well defined. Combined brachytherapy and surgery is routinely being used for RMS at other sites in children as it provides good oncologic outcomes and allows for organ-sparing surgery. The objective of this study was to evaluate this combination treatment for local tumor control and organ-sparing surgery in young children with (P)RMS.

Methods

A retrospective review of the medical records of all children who underwent surgery and brachytherapy for (P)RMS at our institution since 2009 was conducted.

Results

Surgery for (P)RMS was performed in 6 patients at a median age of 19 months (range 8–50). Embryonal RMS was diagnosed in 4 patients and alveolar RMS in 2 patients, of which 1 patient had FOXO1 fusion-positive RMS. All patients underwent postoperative high-dose rate (HDR) brachytherapy. Organ-preserving surgery was achieved in 5 of 6 patients (83 %). In 1 patient, the entire sphincter was infiltrated, making organ-preserving resection impossible. 5 of 6 patients (83 %) exhibited an event-free and overall survival at a median follow-up of 26 months (range 8–107). One patient died due to locoregional recurrence. Complications were urethral leakage in 1 patient followed by urethral stenosis and delayed wound healing and vaginal stenosis in another patient. No patient reported fecal incontinence.

Conclusions

Combined treatment with surgery and HDR brachytherapy is feasible in very young children with (P)RMS and leads to a favorable oncologic outcome. Preliminary data show a good functional preservation.

背景肛门横纹肌肉瘤（(P)RMS）非常罕见，预后较差。幼儿的数据有限，局部治疗方法也不明确。近距离放射治疗与手术相结合是治疗儿童其他部位横纹肌肉瘤的常规方法，因为这种方法具有良好的肿瘤治疗效果，而且可以进行保全器官手术。本研究的目的是评估这种联合治疗方法在局部肿瘤控制和保全器官手术方面对（P）RMS 患儿的疗效。方法回顾性分析自 2009 年以来在我院接受手术和近距离放射治疗的所有（P）RMS 患儿的病历。4名患者被诊断为胚胎型RMS，2名患者被诊断为肺泡型RMS，其中1名患者为FOXO1融合阳性RMS。所有患者都接受了术后高剂量率（HDR）近距离放射治疗。6 名患者中有 5 人（83%）接受了保留器官手术。有一名患者的整个括约肌都被浸润，因此无法进行保留器官的切除手术。6 名患者中有 5 名（83%）在中位 26 个月（8-107 个月）的随访中获得了无事件生存和总生存。一名患者因局部复发而死亡。并发症为一名患者出现尿道漏，随后出现尿道狭窄，另一名患者出现伤口延迟愈合和阴道狭窄。结论对于年幼的（P）RMS患儿来说，手术和HDR近距离放射治疗联合治疗是可行的，并可获得良好的肿瘤治疗效果。初步数据显示功能保留良好。

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引用次数: 0

Anatomical and dosimetric variations during volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma after induction therapy: Implications for adaptive radiation therapy 局部晚期鼻咽癌患者在诱导治疗后接受容积调制弧治疗期间的解剖和剂量变化：适应性放射治疗的意义

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-17 DOI: 10.1016/j.ctro.2024.100861

Shuhan Zhao , Jun Han , Zhiyong Yang , Xi Chen , Xixi Liu , Fangyuan Zhou , Yajie Sun , Ye Wang , Gang Liu , Bian Wu , Sheng Zhang , Jing Huang , Kunyu Yang

Purpose

To investigate anatomical and dosimetric changes during volumetric modulated arc therapy (VMAT) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) after induction therapy (IT) and explore characteristics of patients with notable variations.

Materials and methods

From July 2021 to June 2023, 60 LA-NPC patients undergoing VMAT after IT were retrospectively recruited. Adaptive computed tomography (aCT), reconstructed from weekly cone-beam computed tomography(CBCT), facilitates recontouring and planning transplantation. Volume, dice similarity coefficients, and dose to target volumes and organs at risk(OARs) on planning CT(pCT) and aCT were compared to identify changing patterns. Multivariate logistic regression was used to investigate risk factors.

Results

The volumes of PGTVnasopharynx (PGTVp), PGTVnode (PGTVn), ipsilateral and contralateral parotid glands decreased during VMAT, with reductions of 2.25 %, 6.98 %, 20.09 % and 18.00 %, respectively, at 30 fractions from baseline (P < 0.001). After 25 fractions, D99 and D95 of PGTVn decreased by 7.94 % and 4.18 % from baseline, respectively, while the Dmean of ipsilateral and contralateral parotid glands increased by 7.80 % and 6.50 %, marking the peak rates of dosimetric variations (P < 0.001). The dosimetric fluctuations in PGTVp, the brainstem, and the spinal cord remained within acceptable limits. Furthermore, an initial BMI ≥ 23.5 kg/m² and not-achieving objective response (OR) after IT were regarded as risk factors for a remarkable PGTVn dose reduction in the later stages of VMAT.

Conclusions

Replanning for post-IT LA-NPC patients appears reasonable at 25F during VMAT. Patients with an initial BMI ≥ 23.5 kg/m² and not-achieving OR after IT should be considered for adaptive radiation therapy to stabilize the delivered dose.

目的研究诱导治疗（IT）后局部晚期鼻咽癌（LA-NPC）患者在容积调控弧治疗（VMAT）期间的解剖学和剂量学变化，并探索有显著变化的患者的特征。材料和方法从2021年7月到2023年6月，回顾性招募了60名IT后接受VMAT治疗的LA-NPC患者。根据每周锥束计算机断层扫描（CBCT）重建的自适应计算机断层扫描（aCT）有助于重新构图和规划移植。比较了计划 CT（pCT）和 aCT 的体积、骰子相似系数以及目标体积和危险器官（OAR）的剂量，以确定变化的模式。结果在 VMAT 期间，PGTVnasopharynx (PGTVp)、PGTVnode (PGTVn)、同侧和对侧腮腺的体积均有所减少，在 30 次分割时，与基线相比分别减少了 2.25 %、6.98 %、20.09 % 和 18.00 %（P < 0.001）。25 个分次后，PGTVn 的 D99 和 D95 分别比基线下降了 7.94 % 和 4.18 %，而同侧和对侧腮腺的 Dmean 则分别上升了 7.80 % 和 6.50 %，达到了剂量变化的峰值（P <0.001）。PGTVp、脑干和脊髓的剂量波动仍在可接受范围内。此外，初始 BMI ≥ 23.5 kg/m2 和 IT 后未达到客观反应 (OR) 被视为 VMAT 后期 PGTVn 剂量显著降低的风险因素。初始 BMI ≥ 23.5 kg/m2 和 IT 后未达到 OR 的患者应考虑进行适应性放疗，以稳定给药剂量。

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引用次数: 0

Feasibility of using contrast-free quantitative magnetic resonance imaging for liver sparing stereotactic ablative body radiotherapy 使用无对比定量磁共振成像技术进行保肝立体定向烧蚀体放射治疗的可行性

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-13 DOI: 10.1016/j.ctro.2024.100859

Frank Brewster , Zoe Middleton , Alan McWilliam , Andrew Brocklehurst , Ganesh Radhakrishna , Robert Chuter

Background and purpose

Tumours in the liver often develop on a background of liver cirrhosis and impaired liver function. As a result, radiotherapy treatments are limited by radiation-induced liver disease, parameterised by the liver mean dose (LMD). Liver function is highly heterogeneous, especially in liver cancer, but the use of LMD does not take this into account. One possible way to improve liver treatments is to use quantitative imaging techniques to assess liver health and prioritise the sparing of healthy liver tissue.

Materials and methods

Anatomical T2 and quantitative iron-corrected T1 (cT1) images were made available for 10 patients with liver metastases. Functional liver volumes were automatically segmented on the quantitative images using a threshold. Liver stereotactic ablative body radiotherapy (SABR) plans were made using a departmental protocol. Liver-sparing plans were then made by reducing the dose to the functional sub-volume.

Results

The sparing plans achieved a statistically significant (

p = 0.002

) reduction in the functional liver mean dose, with a mean reduction of 1.4 Gy. The LMD was also significantly different (

p = 0.002

) but had a smaller magnitude with a mean reduction of 0.7 Gy. There were some differences in the planning target volume D_99% (

p = 0.04

) but the sparing plans remained within the optimal tolerance and the D_95% was not significantly different (

p = 0.2

).

Conclusions

This study has, for the first time, demonstrated the use of cT1 maps in radiotherapy showing significant reductions in dose to the healthy liver. Further work is needed to validate this in liver cancer patients, who would likely benefit most.

背景和目的肝脏肿瘤通常是在肝硬化和肝功能受损的背景下发生的。因此，放射治疗受到辐射诱发肝病的限制，其参数为肝脏平均剂量（LMD）。肝功能是高度异质性的，尤其是在肝癌患者中，但使用 LMD 并没有考虑到这一点。改善肝脏治疗的一个可行方法是使用定量成像技术评估肝脏健康状况，并优先保留健康的肝脏组织。材料与方法为 10 名肝脏转移患者提供了解剖 T2 和定量铁校正 T1 (cT1) 图像。在定量图像上使用阈值自动分割功能性肝脏体积。肝脏立体定向消融体放射治疗（SABR）计划是根据科室协议制定的。结果疏肝计划实现了肝脏功能性平均剂量的显著降低（P=0.002），平均降低1.4 Gy。LMD也有显著差异（P=0.002），但幅度较小，平均减少0.7 Gy。规划靶体积D99%存在一些差异（p=0.04），但疏导计划仍在最佳容差范围内，D95%也无明显差异（p=0.2）。结论这项研究首次证明了cT1地图在放疗中的应用，显示对健康肝脏的剂量显著减少。还需要进一步在肝癌患者中进行验证，因为肝癌患者可能受益最大。

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引用次数: 0

Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors 喉和下咽肿瘤放射治疗前磁共振成像变量和动态对比增强磁共振成像对放疗疗效的预后价值

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2024-09-12 DOI: 10.1016/j.ctro.2024.100857

Hilde J.G. Smits , Saskia J. Vink , Mischa de Ridder , Marielle E.P. Philippens , Jan W. Dankbaar

Background

This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.

Methods

320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.

Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60_median and AUC60_p95) were determined in the tumor volume.

Results

Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60_p95 (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.

In multivariable analysis, a Cox proportional hazard model showed that a AUC60_p95 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, P<.001). Tumor volume was prognostic for DC (HR=3.42, P<.001) and OS (HR=3.27, P<.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.

Conclusion

Low pretreatment AUC60_p95 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.

背景本研究旨在确定放射学磁共振成像（MRI）变量和动态对比增强（DCE）-MRI对喉癌和下咽癌患者放疗后的局部控制（LC）、疾病控制（DC）和总生存（OS）的预后价值。对治疗前的磁共振成像进行了评估，以确定肿瘤的以下解剖学特征：软骨侵犯、咽外扩散、前会厌、会厌前间隙和咽旁间隙受累。结果可变对数秩检验确定，喉外扩散、肿瘤体积和T期是LC、DC和OS恶化的预后因素。在多变量分析中，Cox比例危险模型显示，AUC60p95≥31.7 mmol-s/L是较好OS的预后指标（HR=0.25，P<.001）。肿瘤体积是DC（HR=3.42，P<.001）和OS（HR=3.27，P<.001）的预后因素。结论治疗前AUC60p95较低是较差OS的预后因素，这表明肿瘤灌注不良导致生存较差。肿瘤体积大也是DC和OS较差的预后因素。在校正了年龄、T期、N期和肿瘤体积等混杂因素后，MRI解剖参数对任何评估的治疗结果都没有预示作用。

{"title":"Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors","authors":"Hilde J.G. Smits , Saskia J. Vink , Mischa de Ridder , Marielle E.P. Philippens , Jan W. Dankbaar","doi":"10.1016/j.ctro.2024.100857","DOIUrl":"10.1016/j.ctro.2024.100857","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.</p></div><div><h3>Methods</h3><p>320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.</p><p>Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60<sub>median</sub> and AUC60<sub>p95</sub>) were determined in the tumor volume.</p></div><div><h3>Results</h3><p>Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60<sub>p95</sub> (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.</p><p>In multivariable analysis, a Cox proportional hazard model showed that a AUC60<sub>p95</sub> ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, <em>P</em><.001). Tumor volume was prognostic for DC (HR=3.42, <em>P</em><.001) and OS (HR=3.27, <em>P</em><.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.</p></div><div><h3>Conclusion</h3><p>Low pretreatment AUC60<sub>p95</sub> is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100857"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001344/pdfft?md5=3576162bf3ca34d1fb03a6dac0e6488b&pid=1-s2.0-S2405630824001344-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233887","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}

引用次数: 0