Clinical oncology最新文献

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Population-Based Outcomes of Single-Fraction Stereotactic Ablative Radiotherapy for Early Stage Non-small Cell Lung Cancer 以人群为基础的早期非小细胞肺癌单次立体定向消融放疗的疗效

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-12-06 DOI: 10.1016/j.clon.2025.103997

J.M. Callueng , S. Baker , N. Chng , J.P. Abrina , D. Hoegler , D. Petrik , E.M. Dunne , I. Mohamed , R. Halperin , S. Atrchian , A. Lin , A. Ye , F. Hsu , D. Schellenberg , M. Liu , B. Mou

Aims

Single-fraction stereotactic ablative radiotherapy (SF-SABR) was introduced in British Columbia (BC), Canada, during the COVID-19 pandemic. It persists as a standard treatment owing to its comparable outcomes with fractionated regimens in two randomised phase II trials and advantages in resource utilisation and patient convenience. This study evaluated the clinical outcomes and toxicities in patients treated with SF-SABR for early stage non-small lung cancer (NSCLC) in BC.

Materials and methods

This multi-institution population-based retrospective study included all patients treated with SF-SABR for early stage NSCLC between March 2020 and August 2023 in BC. All lesions were peripheral T1-T2 tumours, less than 5 cm in diameter. All patients were medically inoperable or declined surgery. Prescription doses were either 30 Gy or 34 Gy in one fraction. Assessed clinical outcomes included 2-year local failure (LF), distant failure (DF), and overall survival (OS). Toxicity endpoints were graded according to Common Terminology Criteria for Adverse Events version 5.0.

RESULTS

A total of 179 lesions in 166 patients were included. The median follow-up was 23.0 months. The median age was 75 years. The majority (95%) of tumours were T1. The median tumour diameter was 1.5 cm. Prescription doses of 30 Gy and 34 Gy were delivered to 103 (57.5%) and 76 (42.5%) lesions, respectively. The 2-year LF, DF, and OS rates were 7.1%, 14.1%, and 81.5%, respectively. No grade 4 or 5 toxicities were reported. Crude rates of grade 2 and 3 toxicities were 17.3% and 2.2%, respectively. Grade 2 and 3 chest wall toxicity (CWT) rates were 5.6% and 0.6%, respectively. Chest wall abutment, diabetes, and prior thoracic radiation were significant predictors for CWT on univariate analysis.

CONCLUSIONS

This multi-institution population-based study demonstrated that SF-SABR for early stage NSCLC had favourable early clinical outcomes and low toxicity rates comparable to data from other SF-SABR and multi-fraction lung SABR studies. Long-term follow-up of outcomes and toxicity for SF-SABR are warranted.

目的：在2019冠状病毒病大流行期间，加拿大不列颠哥伦比亚省引入了单片段立体定向消融放疗（SF-SABR）。由于其在两个随机II期试验中与分级方案的可比较结果以及在资源利用和患者便利性方面的优势，它一直作为标准治疗方法存在。本研究评估了SF-SABR治疗不列颠哥伦比亚省早期非小肺癌（NSCLC）患者的临床结果和毒性。材料和方法这项基于多机构人群的回顾性研究纳入了BC省2020年3月至2023年8月期间接受SF-SABR治疗的所有早期NSCLC患者。所有病变均为周围T1-T2肿瘤，直径小于5cm。所有患者均因医学原因无法手术或拒绝手术。处方剂量为30 Gy或34 Gy。评估的临床结果包括2年局部失败（LF）、远处失败（DF）和总生存期（OS）。根据不良事件通用术语标准5.0版对毒性终点进行分级。结果共纳入166例患者的179个病变。中位随访时间为23.0个月。中位年龄为75岁。大多数肿瘤（95%）为T1。中位肿瘤直径1.5 cm。处方剂量为30 Gy和34 Gy，分别对103个（57.5%）和76个（42.5%）病变进行治疗。2年生存率为7.1%，DF为14.1%，OS为81.5%。未见4级或5级毒性报告。2级和3级的粗毒性率分别为17.3%和2.2%。2级和3级胸壁毒性（CWT）率分别为5.6%和0.6%。单因素分析显示，胸壁基台、糖尿病和既往胸椎放疗是CWT的重要预测因素。结论：这项基于多机构人群的研究表明，与其他SF-SABR和多部分肺SABR研究的数据相比，SF-SABR治疗早期NSCLC具有良好的早期临床结果和低毒性率。需要对SF-SABR的结果和毒性进行长期随访。

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引用次数: 0

Radiotherapy Plan Quality Assurance in the ABC-07 Trial of Stereotactic Body Radiotherapy for Locally Advanced Biliary Tract Cancer ABC-07型立体定向体放射治疗局部晚期胆道癌的放疗计划质量保证

IF 3 3区医学 Q2 ONCOLOGY

Clinical oncology

Pub Date : 2025-12-04 DOI: 10.1016/j.clon.2025.103993

D.J. Eaton , D.H. Brand , N. Hava , M. Harrison , A. Lopes , P. Manoharan , G. Radhakrishna , S. Shelly , M.A. Hawkins

Aims

The ABC-07 phase II randomised controlled trial (ISRCTN: 10639376) investigated the addition of stereotactic body radiotherapy (SBRT) to systemic chemotherapy in locally advanced biliary tract cancers (BTCs). We report the radiotherapy quality assurance (RTQA) of SBRT treatment plans in the trial.

Materials and methods

RTQA was performed before and during accrual, including benchmark contouring and planning cases, along with prospective independent case review (ICR) of the first three patients from each centre randomised to SBRT. Prescription doses were up to 50 Gy in 5 fractions or up to 67.5 Gy in 15 fractions. Cases were reviewed for segmentation accuracy and plan quality, including target coverage and organ-at-risk (OAR) constraints being met.

Results

Benchmark cases: Six of seventeen contouring submissions required revision (35%), and 6/17 planning submissions were revised after feedback on what was achievable by other centres. Prospective ICR: Thirty-one of forty-one cases from all 12 recruiting centres that were randomised to SBRT underwent review in real-time, and the others were reviewed retrospectively. Eight of these prospectively reviewed cases required revisions during the review process (26%, including 7 contouring and 2 planning revisions). Nineteen of forty-one plans overall (46%) had deviations from trial protocol objectives (even after any revisions), mostly unavoidable target coverage compromise (D95% < 90%) because of proximal OARs such as duodenum (17/41) and stomach (6/41).

Conclusion

Despite rigorous plan QA, we encountered variability in segmentation and plan coverage. The revision rate was reduced between pre-trial and on-trial cases. Radiotherapy doses in the protocol were achievable in many cases; however, target coverage was frequently compromised to maintain OAR dose constraints. Such compromises should be prespecified in future studies.

ABC-07期随机对照试验（ISRCTN: 10639376）研究了在局部晚期胆道癌（btc）全身化疗的基础上增加立体定向体放疗（SBRT）。我们在试验中报告了SBRT治疗方案的放疗质量保证（RTQA）。材料和方法在试验前和试验期间进行srtqa，包括基准轮廓和计划病例，以及随机分配到SBRT的每个中心的前三名患者的前瞻性独立病例回顾（ICR）。处方剂量为5份50戈瑞或15份67.5戈瑞。对病例进行了分割准确性和计划质量的审查，包括目标覆盖率和器官风险（OAR）约束是否得到满足。结果基准案例：17份等高线意见书中有6份需要修改（35%），6/17份规划意见书在反馈了其他中心的可实现性后进行了修改。前瞻性ICR：来自所有12个随机分配到SBRT的招募中心的41例患者中，有31例进行了实时评估，其余的进行了回顾性评估。这些前瞻性审查的案例中有8个在审查过程中需要修订（26%，包括7个轮廓和2个规划修订）。总体而言，41个计划中有19个（46%）偏离试验方案目标（即使经过任何修订），大多数不可避免的目标覆盖率妥协（D95% < 90%），因为近端OARs如十二指肠（17/41）和胃（6/41）。结论：尽管严格的计划QA，我们在分割和计划覆盖方面遇到了可变性。审前和审中案件之间的修改率降低。在许多情况下，方案中的放疗剂量是可以达到的；然而，为了维持桨叶剂量限制，经常损害目标覆盖范围。在今后的研究中应预先规定这种折衷办法。

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