Clinical and Translational Radiation Oncology最新文献_第9页

Defining failure patterns and dynamics in locally advanced pharyngeal and laryngeal SCC following radiotherapy: Real-World Insights in the modern Era! 定义局部晚期咽喉癌放疗后的失败模式和动力学：现代现实世界的见解！

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-08-07 DOI: 10.1016/j.ctro.2025.101026

Linda Agolli , Luise Reinhard , Christine Langer , Christoph Arens , Gabriele A. Krombach , Sebastian Harth , Andreas Lurtz , Ann-Katrin Exeli , Stefan Gattenlöhner , Daniel Habermehl

Introduction

We aimed to evaluate the prevalence and patterns of locoregional recurrence (LRR), outcome and prognostic factors in patients with locally advanced squamous cell carcinoma of the oropharynx, hypopharynx, and larynx treated with intensity-modulated or volume-modulated arc therapy definitive radiotherapy (RT) with or without systemic therapy.

Methods

Of the 213 reviewed patients treated between 2016 and 2023, 177 met the inclusion criteria. LRR was defined as recurrence in the primary tumor region or regional nodes. Failure patterns were classified based on a recurrence model, including central high-dose (A), peripheral high-dose (B), central elective(C), peripheral elective (D), and out-of-field recurrence (E).

Results

LRR was observed in 50/177 (28.2%) patients and 81 recurrent lesions. Most recurrences occurred within the first year after RT (39/177, 22.0%), predominantly in HPV-negative patients. The majority of failures were within the high-dose target volume (65% type A, 14% type C), with marginal recurrences (types B and D) occurring in 22% of cases and type E in 5% of patients. HPV-positive patients had fewer LRR (16.0% vs. 34.4% in HPV-negative patients).

Multivariate analysis identified HPV status as a significant prognostic factor for OS, PFS and LRR. The occurrence of distant metastases showed a negative impact on OS, PFS and LRR. LRR showed a trend toward worse OS (p = 0.072). Chemotherapy had a significant effect on PFS and LRR.

Conclusion

LRR remains a challenge, especially in HPV-negative patients. Most failures occurred centrally, but marginal and extra-field recurrences highlight the need for improved target delineation and adaptive RT strategies. Further research is needed to optimize treatment in high-risk patients.

我们的目的是评估口咽、下咽和喉部局部晚期鳞状细胞癌患者在接受调强或调容弧线治疗（RT）加或不加全身治疗的情况下，局部复发（LRR）的患病率和模式、结局和预后因素。方法213例2016 - 2023年收治的患者中，177例符合纳入标准。LRR定义为原发肿瘤区域或区域淋巴结的复发。失效模式根据复发模型进行分类，包括中心高剂量(a)、外周高剂量(B)、中心选择性(C)、外周选择性(D)和场外复发(E)。结果50/177例（28.2%）患者有slrr，复发病变81例。大多数复发发生在放疗后的第一年内（39/177,22.0%），主要发生在hpv阴性患者中。大多数失败发生在高剂量靶体积内（65%为A型，14%为C型），22%的病例出现边缘性复发（B型和D型），5%的患者出现E型。hpv阳性患者的LRR较低（16.0% vs. hpv阴性患者的34.4%）。多变量分析发现HPV状态是OS、PFS和LRR的重要预后因素。远处转移的发生对OS、PFS和LRR均有负面影响。LRR有加重OS的趋势（p = 0.072）。化疗对PFS和LRR有显著影响。结论lrr仍然是一个挑战，特别是在hpv阴性患者中。大多数失败发生在中心，但边缘和场外复发强调需要改进目标描绘和自适应RT策略。需要进一步的研究来优化高危患者的治疗。

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引用次数: 0

Patient experience and shared decision-making in HPV-positive oropharyngeal cancer: A systematic review of qualitative and quantitative evidence hpv阳性口咽癌的患者经验和共同决策：定性和定量证据的系统回顾

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-08-06 DOI: 10.1016/j.ctro.2025.101028

Pierluigi Bonomo , Katherine J. Taylor , Maria Chiara Bassi , Valentina Bressan , Luca Ghirotto

Introduction

Human papillomavirus (HPV)-related oropharyngeal cancer generally has a good prognosis and can be successfully treated with different modalities (including de-escalation); therefore, shared decision-making regarding treatment has a special role. We aimed to assess how the patients experience this diagnosis in light of optimizing shared decision-making.

Materials and Methods

MEDLINE, Embase, CINAHL, PsycINFO, and Scopus were searched in two systematic reviews (CRD42023484134 and CRD42024501211). Studies were included if they described how patients with HPV-positive oropharyngeal cancer experience their illness and what factors they consider when confronted with a treatment decision. A results-based convergent synthesis design was adopted to analyze qualitative and quantitative evidence separately, then integrated through a narrative synthesis approach.

Results

Nine of the 1978 articles met the selection criteria, resulting in a total of 392 patients being included. Five factors influencing patient decision-making were identified from the quantitative evidence: priority for cure and survival, and preference for de-intensification, which resulted in top-ranked issues for over 65% and 73% of patients who expressed them, respectively. Three qualitative themes were identified to encapsulate patient experiences, encompassing domains related to receiving and dealing with the diagnosis, decision-making, and perception of the impact of treatments. Based on these findings, a prompting list was created as a suggested communication toolkit for clinical practice.

Conclusions

Our systematic review of the literature highlighted the multifaceted and complex experiences of patients facing the diagnosis of a curatively treatable HPV-positive oropharyngeal cancer. Our findings should be considered for optimal shared decision-making in clinical practice.

人乳头瘤病毒（HPV）相关口咽癌通常预后良好，可以通过不同的方式（包括降级）成功治疗；因此，共同决策治疗具有特殊的作用。我们的目的是评估患者在优化共同决策的情况下如何经历这种诊断。材料与方法在两篇系统综述（CRD42023484134和CRD42024501211）中检索medline、Embase、CINAHL、PsycINFO和Scopus。如果研究描述hpv阳性口咽癌患者如何经历疾病，以及他们在面对治疗决定时考虑哪些因素，则纳入研究。采用基于结果的趋同综合设计，分别分析定性和定量证据，然后通过叙事综合方法进行整合。结果1978篇文章中有9篇符合入选标准，共纳入392例患者。从定量证据中确定了影响患者决策的五个因素：治愈和生存优先，以及对去强化的偏好，这两个因素分别导致超过65%和73%的患者表达了他们的首选问题。确定了三个定性主题来概括患者体验，包括与接受和处理诊断，决策和治疗影响感知相关的领域。基于这些发现，我们创建了一个提示列表，作为临床实践的建议沟通工具包。结论我们对文献进行了系统回顾，强调了面临可治愈的hpv阳性口咽癌诊断的患者的多方面和复杂的经历。我们的研究结果应考虑在临床实践中最佳的共同决策。

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引用次数: 0

Comment on “Ten-year survival outcomes of concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma in the IMRT era: A retrospective cohort study stratified by high- and low-risk profiles” IMRT时代局部晚期鼻咽癌同步放化疗加或不加辅助化疗的10年生存结果：一项按高风险和低风险分层的回顾性队列研究

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-29 DOI: 10.1016/j.ctro.2025.101025

Erkan Topkan , Efsun Somay , Duriye Ozturk , Ugur Selek

引用次数: 0

Combining radiological and radiation oncology expertise in the delineation of hypopharyngeal tumours: potential effects on treatment volumes and patterns of failure 结合放射学和放射肿瘤学专业知识描述下咽肿瘤：对治疗量和失败模式的潜在影响

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-24 DOI: 10.1016/j.ctro.2025.101022

Gabriella Alexandersson von Döbeln , Eva Onjukka , Halla Sif Ólafsdóttir , Sara Jonmarker Jaraj , Mattias Hedman

Background and purpose

Target definition is one of the greatest uncertainties in the radiotherapy process. We aimed to investigate whether a radiologist specialized in head and neck can improve the target definition of hypopharyngeal cancers.

Materials and methods

We retrospectively identified 54 patients with hypopharyngeal cancer who received curative-intent radiotherapy between 2009–2015. New target structures were defined incorporating head and neck radiology expertise and updated delineation guidelines. The new structures were subsequently compared both quantitively and qualitatively to the original delineations. Loco-regional failures were analyzed in relation to radiotherapy dose and target volumes.

Results

There was a significant reduction in gross tumour volume (GTV) for the primary tumour, decreasing from 14.4 to 9.2 cm³ (−47 %), and in clinical target volume (CTV), decreasing from 203.7 to 93.8 cm³ (−54 %). Mean quantitative values indicated a large overestimation of the original GTV (Dice Coefficient 0.58 ± 0.2 SD, Jaccard index 0.44 ± 0.19 SD, Positive predictive value 0.53 ± 0.24 SD). Only 39 % of the original primary tumour GTV and 19 % of the original lymph node GTV were assessed as acceptable. Twelve patients (22 %) had a locoregional recurrence. In relation to both the original radiation dose and the updated dose distribution, nine recurrences were classified as in field, two as marginal, and one could not be evaluated. The 3-year and 5-year locoregional progression free survival (PFS) was 75.5 % and 66.6 % respectively.

Conclusion

Incorporating radiological expertise in the delineation of hypopharyngeal tumours leads to large changes in tumour volumes and possibly a decrease in radiation volumes which may lead to reduced side effects.

背景与目的靶区定义是放疗过程中最大的不确定性之一。我们的目的是调查一个专门从事头颈部的放射科医生是否可以改善下咽癌的目标定义。材料和方法回顾性分析2009-2015年间接受治疗意图放疗的54例下咽癌患者。结合头颈部放射学专业知识和更新的划定指南，定义了新的目标结构。新的结构随后被定量和定性地与原来的描绘进行比较。局部区域失败分析与放疗剂量和靶体积的关系。结果原发性肿瘤的总肿瘤体积（GTV）从14.4 cm3下降到9.2 cm3(- 47%)，临床靶体积（CTV）从203.7 cm3下降到93.8 cm3（- 54%）。平均定量值显示对原始GTV有较大高估（Dice系数0.58±0.2 SD， Jaccard指数0.44±0.19 SD， Positive预测值0.53±0.24 SD）。只有39%的原发肿瘤GTV和19%的原发淋巴结GTV被评估为可接受的。12例（22%）有局部复发。与原始辐射剂量和更新后的剂量分布相比，9次复发归为现场，2次为边缘，1次无法评价。3年和5年局部无进展生存率（PFS）分别为75.5%和66.6%。结论将放射学知识纳入下咽肿瘤的划定，可使肿瘤体积发生较大变化，并可能减少放射量，从而减少副作用。

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引用次数: 0

Lattice radiotherapy for extensive liver metastases in synchronous EGFR-mutant lung adenocarcinoma and small cell lung cancer 点阵放疗治疗同步egfr突变肺腺癌和小细胞肺癌的广泛肝转移

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-23 DOI: 10.1016/j.ctro.2025.101023

Shaïma El Chammah , Mickael Bendahman , Sarah Ghandour , Loris Fuchs , Rémy Kinj , Gian Guyer , Mahmut Ozsahin

We report the case of exceptional response of massive liver metastases of a patient with synchronous lung adenocarcinoma and small cell lung cancer following lattice radiotherapy (L-RT). After a single irradiation of 16 Gy to 1 % of the metastatic liver burden, the patient reported improved abdominal symptoms within a week. Within two weeks liver volume decreased by 50 %, and liver enzyme levels stabilized or improved. This case highlights L-RT as a novel and effective approach to treat symptomatic liver metastases.

我们报告了一例同步肺腺癌和小细胞肺癌患者在晶格放射治疗（L-RT）后出现大量肝转移的特殊反应。在16 Gy的单次照射至转移性肝脏负荷的1%后，患者在一周内报告腹部症状改善。在两周内，肝脏体积减少了50%，肝酶水平稳定或改善。这个病例强调了L-RT是治疗有症状的肝转移的一种新颖有效的方法。

引用次数: 0

PSMA response evaluation in follow-up PSMA-PET/CT after stereotactic ablative body radiotherapy (SABR) for oligometastases in prostate cancer 立体定向消融体放疗（SABR）治疗前列腺癌寡转移灶后随访PSMA pet /CT反应评价

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-23 DOI: 10.1016/j.ctro.2025.101021

Anna-Lena Zang , Timo Maier , Sandra Freitag-Wolf , Alexander Fabian , Severin Rodler , Jürgen Dunst , David Krug , Ulf Lützen , Olaf Wittenstein

Purpose

PSMA-PET/CT is frequently used for staging patients with de-novo or recurrent prostate cancer (PCa). In patients with oligometastatic PCa PSMA-PET/CT guided stereotactic ablative body radiotherapy (SABR) is a common treatment option. Follow-up is regularly performed via measurement of prostate-specific-antigen (PSA) level. Response assessment based on follow-up PSMA-PET/CTs is poorly studied. Therefore, we report on long-term local tumor response using repeated PSMA-PET/CTs of patients with oligometastatic PCa after PSMA-PET/CT guided SABR.

Methods/Patients

Patients with de-novo oligometastatic or oligoprogressive PCa who received PSMA-PET/CT-directed SABR with 5 × 7 Gy of at least one bone or lymph node lesion between 2015 and 2019 and had one or more follow-up PSMA-PET/CT were included in this retrospective single center analysis. PSMA response was evaluated by visual and quantitative assessment of local PSMA uptake pre- and post-SABR.

Results

Overall, 48 patients with 97 irradiated lesions and a total of 145 PSMA-PET/CT-scans were analyzed. 26 patients received androgen-deprivation-therapy (ADT) at any time. Median SUV_max per lesion was 10.88 (range 1.59–122.11) before SABR with a median CTV of 4.75 cm³ (Range 0.68–60.4 cm³). In the first follow-up PET/CT after a median of 13 months (range 3–42) after SABR, median SUV_max per lesion declined to 2.2 (range 0.13–26.09). Complete remission (CR) was observed in 49 lesions, partial remission in 32 and stable disease in 12 lesions. Four lesions were non-responders. Over the course of up to five follow-up PSMA-PET/CTs a maximum of 90 % of the lesions showed CR. Median time to SUV_min was 19 months (range 3–50). 5-year local control was 86 %. No short-term or long-term toxicities were reported.

Conclusion

PSMA-PET/CT directed SABR provides excellent long-term local tumor control of 90% in bone and lymph node metastasis of oligometastatic PCa and is well tolerated. PSMA activity may further decrease after initial re-imaging with PSMA-PET/CT.

目的：sepsma - pet /CT常用于前列腺癌复发患者的分期。在少转移性前列腺癌患者中，PSMA-PET/CT引导立体定向消融体放疗（SABR）是一种常见的治疗选择。定期随访，检测前列腺特异性抗原（PSA）水平。基于PSMA-PET/ ct随访的疗效评估研究甚少。因此，我们报告了在PSMA-PET/CT引导的SABR后，使用重复PSMA-PET/CT对低转移性PCa患者的长期局部肿瘤反应。2015年至2019年期间接受PSMA-PET/CT定向SABR （5 × 7 Gy，至少有一个骨或淋巴结病变）并进行一次或多次PSMA-PET/CT随访的低转移性或低进展性PCa患者纳入本回顾性单中心分析。通过sabr前后局部PSMA摄取的视觉和定量评估来评估PSMA的反应。结果共分析了48例患者的97个放射病灶和145个PSMA-PET/ ct扫描。26例患者在任何时间接受雄激素剥夺治疗（ADT）。SABR前每个病灶的中位SUVmax为10.88（范围1.59-122.11），中位CTV为4.75 cm3（范围0.68-60.4 cm3）。在SABR后的第一次随访PET/CT中位数为13个月（范围3-42），每个病变的中位SUVmax下降到2.2（范围0.13-26.09）。49例完全缓解，32例部分缓解，12例病情稳定。4个病灶无反应。在长达5次的PSMA-PET/ ct随访过程中，最多90%的病变显示CR，中位SUVmin时间为19个月（范围3-50）。5年局部控制率为86%。无短期或长期毒性报告。结论psma - pet /CT定向SABR对低转移性前列腺癌的骨和淋巴结转移具有良好的长期局部肿瘤控制性，可达90%，且耐受性良好。PSMA活性在PSMA- pet /CT首次重新成像后可能进一步降低。

{"title":"PSMA response evaluation in follow-up PSMA-PET/CT after stereotactic ablative body radiotherapy (SABR) for oligometastases in prostate cancer","authors":"Anna-Lena Zang , Timo Maier , Sandra Freitag-Wolf , Alexander Fabian , Severin Rodler , Jürgen Dunst , David Krug , Ulf Lützen , Olaf Wittenstein","doi":"10.1016/j.ctro.2025.101021","DOIUrl":"10.1016/j.ctro.2025.101021","url":null,"abstract":"<div><h3>Purpose</h3><div>PSMA-PET/CT is frequently used for staging patients with de-novo or recurrent prostate cancer (PCa). In patients with oligometastatic PCa PSMA-PET/CT guided stereotactic ablative body radiotherapy (SABR) is a common treatment option. Follow-up is regularly performed via measurement of prostate-specific-antigen (PSA) level. Response assessment based on follow-up PSMA-PET/CTs is poorly studied. Therefore, we report on long-term local tumor response using repeated PSMA-PET/CTs of patients with oligometastatic PCa after PSMA-PET/CT guided SABR.</div></div><div><h3>Methods/Patients</h3><div>Patients with de-novo oligometastatic or oligoprogressive PCa who received PSMA-PET/CT-directed SABR with 5 × 7 Gy of at least one bone or lymph node lesion between 2015 and 2019 and had one or more follow-up PSMA-PET/CT were included in this retrospective single center analysis. PSMA response was evaluated by visual and quantitative assessment of local PSMA uptake pre- and post-SABR.</div></div><div><h3>Results</h3><div>Overall, 48 patients with 97 irradiated lesions and a total of 145 PSMA-PET/CT-scans were analyzed. 26 patients received androgen-deprivation-therapy (ADT) at any time. Median SUV<sub>max</sub> per lesion was 10.88 (range 1.59–122.11) before SABR with a median CTV of 4.75 cm<sup>3</sup> (Range 0.68–60.4 cm<sup>3</sup>). In the first follow-up PET/CT after a median of 13 months (range 3–42) after SABR, median SUV<sub>max</sub> per lesion declined to 2.2 (range 0.13–26.09). Complete remission (CR) was observed in 49 lesions, partial remission in 32 and stable disease in 12 lesions. Four lesions were non-responders. Over the course of up to five follow-up PSMA-PET/CTs a maximum of 90 % of the lesions showed CR. Median time to SUV<sub>min</sub> was 19 months (range 3–50). 5-year local control was 86 %. No short-term or long-term toxicities were reported.</div></div><div><h3>Conclusion</h3><div>PSMA-PET/CT directed SABR provides excellent long-term local tumor control of 90% in bone and lymph node metastasis of oligometastatic PCa and is well tolerated. PSMA activity may further decrease after initial re-imaging with PSMA-PET/CT.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101021"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721944","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}

引用次数: 0

Normal tissue outlining guidelines development for soft tissue sarcoma of the extremities 正常组织概述四肢软组织肉瘤的发展指南

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-19 DOI: 10.1016/j.ctro.2025.101020

Rita Simões , Sarah Gulliford , Punita Shah , Eve McAtavey , Elizabeth Richardson , Umme Chowdhury , Laura Fray , Roeum Butt , Yolanda Augustin , Ruqayyah Sarang , Refia Kilinc , Maryam Iqbal , Hakim Moulay-Dehbi , Elizabeth Miles , Peter Hoskin , Shane Zaidi , Kevin J Harrington , Aisha B. Miah

Introduction

Radiotherapy (RT) plans for soft tissue sarcoma of the extremities (STSE) are optimised to achieve maximum target coverage whilst avoiding high doses to weight-bearing bones and intermediate doses to the normal tissue (NT) limb corridor. Within this study, novel lower extremity NT outlining guidelines and atlas were developed based on the hypothesis that using these for RT planning may reduce RT toxicity. Usability and applicability of the guidance were also investigated.

Methods

Guidelines for NT outlining were developed. Two STSE cases were selected and a set of reference volumes was outlined on each case by one Therapeutic Radiographer/Radiation Therapist (RTT) and peer-reviewed by a consultant radiation oncologist (RO). NTs were then outlined following the guidelines by 11 (8 RTT and 3 RO) and 12 (9 RTT and 3 RO) additional observers, respectively for cases 1 and 2. Dice coefficient (DICE), Maximum Hausdorff distance (maxHD) and mean surface distance (MSD) were calculated for individual NT volumes against the reference volumes. The Kruskal-Wallis test was performed. Analysis of interobserver variability was then used to inform guidance improvement.

Results

Good agreement and reproducibility were observed in DICE, MSD and maxHD for the anterior, posterior, adductor and gluteal muscle compartments, femur and femoral head and neck, knee and hip joints. Moderate agreement was observed for the lateral rotator and iliopsoas muscle compartments, and the femoral and inguinofemoral neurovascular bundle. Poor agreement was observed for the deep thigh neurovascular bundle.

Conclusion

Our results identify that the new NT outlining guidance for STSE is reproducible between observers and within a multi-professional environment, with consistent RTT and RO scores. This reproducibility is attributed to the use of guidelines. This study has also identified areas for refinement of the guidelines, particularly for the deep thigh neurovascular bundle.

针对肢体软组织肉瘤（STSE）的放射治疗（RT）计划进行了优化，以实现最大的目标覆盖，同时避免高剂量对负重骨骼和中等剂量对正常组织（NT）肢体走廊的影响。在这项研究中，基于使用这些指南和图谱进行放射治疗计划可能降低放射治疗毒性的假设，开发了新的下肢放射治疗指南和图谱。对指南的可用性和适用性进行了研究。方法制定NT概述指南。选择了两个STSE病例，并由一名放射治疗技师/放射治疗师（RTT）为每个病例概述了一套参考书，并由放射肿瘤学顾问（RO）进行了同行评审。然后分别由11名（8名RTT和3名RO）和12名（9名RTT和3名RO）额外观察员根据指南对病例1和2进行了nt概述。根据参考体积计算单个NT体积的骰子系数（Dice）、最大豪斯多夫距离（maxHD）和平均表面距离（MSD）。进行Kruskal-Wallis检验。然后使用观察者间可变性分析来告知指导改进。结果DICE、MSD和maxHD对前、后、内收肌室、臀肌室、股骨、股骨头、颈部、膝关节和髋关节的测量结果一致性好，重复性好。外旋肌室和髂腰肌室、股神经血管束和腹股沟股神经血管束观察到中度一致。大腿深层神经维管束的一致性较差。结论：我们的研究结果表明，新NT概述了STSE的指导方针，在观察者和多专业环境中具有可重复性，RTT和RO评分一致。这种可重复性归功于指南的使用。本研究还确定了指南需要改进的领域，特别是大腿深部神经血管束。

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引用次数: 0

Decision regret after reirradiation of the primary site in patients with prostate cancer 前列腺癌患者原发部位再照射后的决定后悔

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-19 DOI: 10.1016/j.ctro.2025.101019

Alexander Fabian , Bilgesu Sahin Öztürk , Lars Haack , Severin Rodler , Christof van der Horst , Christian Schulz , Claudia Schmalz , Stefan Huttenlocher , Olaf Wittenstein , Oliver Blanck , Frank-André Siebert , David Krug

Purpose

A subset of prostate cancer patients develops local relapse at the primary site after radiotherapy. The optimal local salvage strategy is unknown. Therefore, we aimed to explore prevalence and determinants of decision regret among patients after reirradiation of the primary site.

Materials and methods

We surveyed 31 patients in a cross-sectional bi-centre exploratory study. Reirradiation was high dose-rate brachytherapy (HDR-BT) in 21 and stereotactic body radiotherapy (SBRT) in 10 patients. Decision regret (DR) was measured using the Decision Regret Scale (DRS) (range: 0–100; higher values higher regret). Further patient-reported outcomes (PRO) included the EPIC-26, EORTC QLQ-C30, PRO-CTCAE, and PSCC questionnaires. Univariable associations of decision regret and potential determinants were assessed by one-way ANOVA or Pearson’s correlation.

Results

Median age at reirradiation was 75 years. Median time intervals from initial radiotherapy to reirradiation was 8 years and 4 years from reirradiation to survey. The mean DRS score was 10 (SD: 14). No (0 points), mild (1–25 points), or strong regret (>25 points) was reported by 45 % (14/31), 48 % (15/31), and 7 % (2/31) of the patients, respectively. DR was significantly associated with PRO of urinary symptom burden and toxicity as well as levels of shared-decision making and patient satisfaction. HDR-BT vs. SBRT, further local relapse, and progression-free survival were not associated with DR.

Conclusions

DR was mild among prostate cancer patients after reirradiation to the primary site. PRO on symptom burden and shared decision making may be associated with DR. These findings should be validated and may inform treatment decisions on local salvage therapy.

目的：部分前列腺癌患者放疗后发生原发部位局部复发。最优的局部救助策略是未知的。因此，我们旨在探讨原发部位再照射后患者决策后悔的患病率和决定因素。材料和方法我们在一项横断面双中心探索性研究中调查了31例患者。21例为高剂量率近距离放疗（HDR-BT）， 10例为立体定向放射治疗（SBRT）。决策后悔（DR）采用决策后悔量表（DRS）测量(范围：0-100；价值越高，后悔越深)。进一步的患者报告结果（PRO）包括EPIC-26、EORTC QLQ-C30、PRO- ctcae和PSCC问卷调查。决策后悔和潜在决定因素的单变量关联通过单因素方差分析或Pearson相关进行评估。结果再照射时的中位年龄为75岁。从首次放疗到再照射的中位时间间隔为8年，从再照射到调查的中位时间间隔为4年。DRS平均评分为10分（SD: 14）。45%（14/31）、48%（15/31）和7%（2/31）的患者报告无后悔（0分）、轻度后悔（1-25分）和强烈后悔（25分）。DR与泌尿症状负担、毒性、共同决策水平和患者满意度的PRO显著相关。HDR-BT vs. SBRT、进一步局部复发和无进展生存期与dr无关。结论前列腺癌患者原发部位再照射后dr为轻度。关于症状负担和共同决策的PRO可能与dr有关，这些发现应该得到验证，并可能为局部挽救性治疗的治疗决策提供信息。

{"title":"Decision regret after reirradiation of the primary site in patients with prostate cancer","authors":"Alexander Fabian , Bilgesu Sahin Öztürk , Lars Haack , Severin Rodler , Christof van der Horst , Christian Schulz , Claudia Schmalz , Stefan Huttenlocher , Olaf Wittenstein , Oliver Blanck , Frank-André Siebert , David Krug","doi":"10.1016/j.ctro.2025.101019","DOIUrl":"10.1016/j.ctro.2025.101019","url":null,"abstract":"<div><h3>Purpose</h3><div>A subset of prostate cancer patients develops local relapse at the primary site after radiotherapy. The optimal local salvage strategy is unknown. Therefore, we aimed to explore prevalence and determinants of decision regret among patients after reirradiation of the primary site.</div></div><div><h3>Materials and methods</h3><div>We surveyed 31 patients in a cross-sectional bi-centre exploratory study. Reirradiation was high dose-rate brachytherapy (HDR-BT) in 21 and stereotactic body radiotherapy (SBRT) in 10 patients. Decision regret (DR) was measured using the Decision Regret Scale (DRS) (range: 0–100; higher values higher regret). Further patient-reported outcomes (PRO) included the EPIC-26, EORTC QLQ-C30, PRO-CTCAE, and PSCC questionnaires. Univariable associations of decision regret and potential determinants were assessed by one-way ANOVA or Pearson’s correlation.</div></div><div><h3>Results</h3><div>Median age at reirradiation was 75 years. Median time intervals from initial radiotherapy to reirradiation was 8 years and 4 years from reirradiation to survey. The mean DRS score was 10 (SD: 14). No (0 points), mild (1–25 points), or strong regret (>25 points) was reported by 45 % (14/31), 48 % (15/31), and 7 % (2/31) of the patients, respectively. DR was significantly associated with PRO of urinary symptom burden and toxicity as well as levels of shared-decision making and patient satisfaction. HDR-BT vs. SBRT, further local relapse, and progression-free survival were not associated with DR.</div></div><div><h3>Conclusions</h3><div>DR was mild among prostate cancer patients after reirradiation to the primary site. PRO on symptom burden and shared decision making may be associated with DR. These findings should be validated and may inform treatment decisions on local salvage therapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101019"},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704412","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}

引用次数: 0

CD8-positive lymphocyte infiltration as a marker of anti-tumor immune response in rectal cancer: pre- and post-neoadjuvant radiotherapy comparison cd8阳性淋巴细胞浸润作为直肠癌抗肿瘤免疫反应的标志物：新辅助放疗前后的比较

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-16 DOI: 10.1016/j.ctro.2025.101018

Samaneh Salarvand , Romina Abyaneh , Abdorreza Raee , Mahdieh Yaghooti-Khorasani , Fariba Mohammadjani , Fatemeh Nili , Mahdi Aghili , Reza Ghalehtaki

Background

Antitumor immunity, exerted by CD8+ cytotoxic T lymphocytes, plays a vital role in tumor control. Therefore, the present study was conducted to compare the amount of CD8+ tumor-infiltrating lymphocytes (TILs) before and after either long- (LCRT) or short-course radiotherapy (SCRT) in rectal cancer.

Methods

This study retrospectively assessed rectal cancer patients treated by neoadjuvant radiotherapy between 2019 and 2021. Biopsy and surgical samples were subjected to immunohistochemical staining to count CD8+ TILs. The association between the post-to-pre-treatment CD8+ count ratio and treatment groups, histopathological factors, and response to treatment was assessed.

Results

A total of 34 patients were included, with 23 (67.6 %) receiving LCRT and 11 (32.4 %) receiving SCRT. The mean age was 58.56 ± 13.59 years. The number and percentage of CD8+ TILs increased significantly after radiotherapy in all patients (P < 0.001). An increase in CD8+ TILs was observed in both groups, with LCRT showing a median post-to-pre-treatment count ratio of 2.77 and SCRT showing 3.1 (P = 0.127). A generalized linear multivariate model adjusting for mucinous histology, surgical grade, and pathological stages revealed that SCRT was associated with a significantly higher post-to-pre-treatment CD8+ count ratio compared to LCRT (P = 0.03).

Conclusion

Our study highlights that both SCRT and LCRT significantly increase CD8+ TIL count and percentage, reflecting robust immune activation after radiotherapy in rectal cancer, with SCRT showing a higher relative increase, though not statistically significant in unadjusted analyses. After adjusting for histopathological variables, SCRT was independently associated with a greater increase in CD8+ T cells.

CD8+细胞毒性T淋巴细胞的抗肿瘤免疫在肿瘤控制中起着至关重要的作用。因此，本研究旨在比较直肠癌长期放疗（LCRT）和短期放疗（SCRT）前后CD8+肿瘤浸润淋巴细胞（TILs）的数量。方法回顾性分析2019 ~ 2021年接受新辅助放疗的直肠癌患者。活检和手术标本经免疫组化染色计数CD8+ TILs。评估治疗前后CD8+计数比与治疗组、组织病理因素和治疗反应之间的关系。结果共纳入34例患者，其中LCRT 23例（67.6%），SCRT 11例（32.4%）。平均年龄58.56±13.59岁。所有患者放疗后CD8+ TILs的数量和百分比均显著增加(P <；0.001)。两组患者CD8+ TILs均升高，LCRT治疗后与治疗前计数比中位数为2.77，SCRT治疗后与治疗前计数比中位数为3.1 （P = 0.127）。调整黏液组织学、手术分级和病理分期的广义线性多变量模型显示，与LCRT相比，SCRT与治疗前后CD8+计数比显著升高（P = 0.03）。我们的研究强调，SCRT和LCRT均显著增加了直肠癌放疗后CD8+ TIL计数和百分比，反映了强大的免疫激活，SCRT的相对增加更高，但在未经调整的分析中无统计学意义。在调整组织病理学变量后，SCRT与CD8+ T细胞的增加独立相关。

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引用次数: 0

Increasing patient comfort in palliative radiotherapy with a newly developed mattress: a nonrandomized clinical trial 使用新开发的床垫增加姑息性放疗患者舒适度：一项非随机临床试验

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology

Pub Date : 2025-07-16 DOI: 10.1016/j.ctro.2025.101017

Nienke Hoffmans-Holtzer, Britt Kunnen, Olijn Tims, Ilse de Pree, Cleo Slagter, Manouk Olofsen-van Acht, Mischa Hoogeman, Steven Petit

Background

In palliative radiotherapy, many patients experience discomfort and pain during treatment, particularly while lying on flat, hard treatment couches that are considered essential for accurate treatment delivery. Thin foam matts, often used for palliative treatments, can somewhat reduce discomfort, but they are frequently insufficient.

Aim

In this study a mattress was developed and investigated, with the aim to reduce pain during radiotherapy treatments without affecting treatment quality.

Methods

A nonrandomized clinical trial compared the newly designed RTComfort mattress with a standard thin foam matt. The primary endpoint was mattress preference, while secondary endpoints included experienced pain, positioning stability, and dosimetric effects. Included patients tested both the mat and mattress for one minute each in the treatment position before planning-CT acquisition, scoring their preference and pain on a Numerical Rating Scale (NRS, 0–10). Subsequently, patients were scanned and treated on their preferred option. Positioning stability during treatment was evaluated using optical surface scanning and dosimetric effects were evaluated through dose calculations with the treatment planning system.

Results

Out of 45 patients, 44 (98 %) preferred the RTComfort mattress, with 35 patients showing a strong preference (p < 0.0001). The median pain score on the RTComfort mattress decreased from 4.8 (IQR: 2.0–6.1) to 2.0 (IQR: 0.4 to 4.0 NRS) (p < 0.0001). Both options showed negligible patient sagging, with marginally less on the RTComfort mattress (p < 0.0001). No relevant dosimetric effects were observed.

Conclusions

This prospective clinical trial highlights the need for more comfortable radiotherapy treatments. Compared to the standard thin foam matt, 98% of patients preferred the RTComfort mattress. The RTComfort mattress provided clinically significant reduction in pain associated with lying on flat, hard treatment couches. The mattress is safe for clinical use and shows potential beyond palliative radiotherapy settings.

在姑息性放疗中，许多患者在治疗期间感到不适和疼痛，特别是躺在平坦、坚硬的治疗沙发上时，这被认为是准确提供治疗所必需的。薄泡沫垫，通常用于姑息治疗，可以在一定程度上减轻不适，但往往是不够的。目的：在不影响放疗质量的前提下，开发和研究一种床垫，以减轻放疗期间的疼痛。方法采用非随机临床试验将新设计的RTComfort床垫与标准的薄泡沫哑光床垫进行比较。主要终点是床垫偏好，次要终点包括疼痛经历、体位稳定性和剂量效应。纳入的患者在计划- ct采集前分别在垫子和床垫的治疗位置上测试一分钟，用数值评定量表（NRS, 0-10）对他们的偏好和疼痛进行评分。随后，对患者进行扫描并按其首选方案进行治疗。使用光学表面扫描评估治疗期间的定位稳定性，并通过使用治疗计划系统计算剂量来评估剂量学效应。结果45例患者中，44例（98%）偏爱RTComfort床垫，其中35例表现出强烈的偏好(p <；0.0001)。RTComfort床垫的中位疼痛评分从4.8 （IQR: 2.0 - 6.1）降至2.0 (IQR: 0.4 - 4.0) (p <；0.0001)。两种选择都显示患者的松弛可以忽略不计，RTComfort床垫的松弛程度略低(p <；0.0001)。未观察到相关的剂量学效应。结论：该前瞻性临床试验强调了更舒适的放射治疗的必要性。与标准的薄泡沫床垫相比，98%的患者更喜欢RTComfort床垫。RTComfort床垫在临床上显著减少了与躺在平坦坚硬的治疗沙发上相关的疼痛。该床垫对临床使用是安全的，并显示出超出姑息性放疗设置的潜力。

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