Pub Date : 2025-10-16DOI: 10.1016/j.clon.2025.103961
C. Udovicich , S. Siva , J. Palmer , M. Guckenberger , J. Kam , I. Sher , T. Tan , A. Sahgal
{"title":"Boosting the Evidence: Time to Integrate Simultaneous Integrated Boost in Spine Stereotactic Body Radiotherapy?","authors":"C. Udovicich , S. Siva , J. Palmer , M. Guckenberger , J. Kam , I. Sher , T. Tan , A. Sahgal","doi":"10.1016/j.clon.2025.103961","DOIUrl":"10.1016/j.clon.2025.103961","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"49 ","pages":"Article 103961"},"PeriodicalIF":3.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145523063","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 : 2025-10-14DOI: 10.1016/j.clon.2025.103954
K. Newbold , N. Armstrong , M. Beasley , K. Farnell , K. Garcez , F. Hassan , S. Iqbal , V. Paleri , N. Reed , M. Strachan , J. Wadsley , A. Hackshaw , U. Mallick
Aims
To develop a national consensus on how to implement findings of recent practice changing Iodine or Not (IoN) trial.
Materials and Methods
A multidisciplinary group of UK clinicians specialising in the management of thyroid cancer was convened to discuss the impact of the IoN trial on the management of early stage, low risk differentiated thyroid cancer in the UK. Virtual meetings were held to discuss the trial data and to develop a position statement on how to implement the findings ahead of changes in national guidelines.
Results
A position statement providing recommendations for the managemnet of early stage, low risk differentiated thyroid cancer based on the group consensus opinion and interpretation of the IoN trial data was defined.
Conclusion
The Iodine or Not (IoN) trial was a UK multicentre prospective randomised controlled trial that investigated the role of radioiodine ablation in early stage, low-risk differentiated thyroid cancer. The findings showed non-inferiority of omitting radioiodine in terms of recurrence-free survival. This provides level 1 evidence to support sparing many patients with low-risk thyroid cancer treatment with radioiodine and the possible associated treatment-related adverse events. Ahead of changes in national and international guidelines this multidisciplinary group of specialists involved in the management of thyroid cancer proposes a position statement on how to implement these findings into UK practice.
{"title":"Iodine or Not for Low-risk Differentiated Thyroid Cancer: How Should We Implement the Findings into UK Practice? An Expert Consensus Opinion","authors":"K. Newbold , N. Armstrong , M. Beasley , K. Farnell , K. Garcez , F. Hassan , S. Iqbal , V. Paleri , N. Reed , M. Strachan , J. Wadsley , A. Hackshaw , U. Mallick","doi":"10.1016/j.clon.2025.103954","DOIUrl":"10.1016/j.clon.2025.103954","url":null,"abstract":"<div><h3>Aims</h3><div>To develop a national consensus on how to implement findings of recent practice changing Iodine or Not (IoN) trial.</div></div><div><h3>Materials and Methods</h3><div>A multidisciplinary group of UK clinicians specialising in the management of thyroid cancer was convened to discuss the impact of the IoN trial on the management of early stage, low risk differentiated thyroid cancer in the UK. Virtual meetings were held to discuss the trial data and to develop a position statement on how to implement the findings ahead of changes in national guidelines.</div></div><div><h3>Results</h3><div>A position statement providing recommendations for the managemnet of early stage, low risk differentiated thyroid cancer based on the group consensus opinion and interpretation of the IoN trial data was defined.</div></div><div><h3>Conclusion</h3><div>The Iodine or Not (IoN) trial was a UK multicentre prospective randomised controlled trial that investigated the role of radioiodine ablation in early stage, low-risk differentiated thyroid cancer. The findings showed non-inferiority of omitting radioiodine in terms of recurrence-free survival. This provides level 1 evidence to support sparing many patients with low-risk thyroid cancer treatment with radioiodine and the possible associated treatment-related adverse events. Ahead of changes in national and international guidelines this multidisciplinary group of specialists involved in the management of thyroid cancer proposes a position statement on how to implement these findings into UK practice.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103954"},"PeriodicalIF":3.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457853","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 : 2025-10-14DOI: 10.1016/j.clon.2025.103959
M. Ebadi , X. Fan , G. Schoch , T. Gooley , A. Rashidi , S.D. Smith , M. Shadman , L. Holmberg , C. Ujjani , C. Poh , V. Raghunathan , N. Ali , P.T. Vo , S. Manjappa , M. Menon , M. Di , R. Lynch , C. Ho , B.G. Till , R. Ermoian , Y.D. Tseng
Aims
In the era of chimeric antigen receptor T-cell (CAR-T) therapy, there remains a role for autologous stem cell transplant (ASCT) for patients with large B-cell lymphoma (LBCL) without access to CAR T-cell therapy or who have late, chemosensitive relapse (>12 months). Typically, the ASCT conditioning regimen is chemotherapy only. Given the radioresponsiveness of LBCL, we retrospectively evaluated whether ASCT outcomes are improved with total body irradiation (TBI)–based conditioning compared to chemo-only conditioning.
Materials and Methods
We included patients with relapsed/refractory (r/r) LBCL who underwent ASCT at our centre (2012-2021). As TBI is generally offered only to younger patients, we excluded patients in the chemo-only group who were older than the oldest patient in the TBI group, leaving 56 patients in the final dataset (TBI: 19; chemo: 37).
Results
The TBI cohort had more adverse features including male sex (89.5% vs 62.2%), relapse ≤12 months (52.6% vs 32.4%), and shorter time between diagnosis and ASCT (median: 11.7 vs 21.8 months). Two-year progression-free survival (PFS) was 58% (95% confidence interval [CI]: 39%-85%) and 67% (53%-84%) in TBI and chemotherapy cohorts, respectively. Two-year overall survival (OS) was 79% (63%-100%) and 80% (68%-95%) in TBI and chemotherapy cohorts, respectively. Multivariable hazard ratio (HR) of PFS failure (TBI vs chemo) was 1.35 (95% CI: 0.59-3.12). The HR of death was 1.33 (95% CI: 0.49-3.58). While conditioning regimen was not associated with PFS, positron emission tomography (PET) positivity at time of ASCT (HR: 6.97, 95% CI: 2.98-16.27, P < 0.001) was associated with PFS failure.
Conclusion
Despite the presence of more adverse features among patients treated with TBI, there was no difference in PFS or OS among patients that underwent chemo-only vs TBI-based conditioning. Though hypothesis generating, this suggests that TBI may be able to partially compensate for adverse fatures.
目的在嵌合抗原受体t细胞（CAR- t）治疗的时代，自体干细胞移植（ASCT）对于无法获得CAR- t细胞治疗或晚期化疗敏感复发（12个月）的大b细胞淋巴瘤（LBCL）患者仍然有作用。通常，ASCT治疗方案仅为化疗。鉴于LBCL的放射反应性，我们回顾性评估了与单纯化疗相比，基于全身照射（TBI）的治疗是否能改善ASCT结果。材料和方法我们纳入了2012-2021年在我们中心接受ASCT治疗的复发/难治性（r/r） LBCL患者。由于TBI通常只提供给年轻患者，我们排除了仅化疗组中年龄大于TBI组中年龄最大患者的患者，在最终数据集中留下56例患者（TBI: 19；化疗：37）。结果TBI队列有更多的不良特征，包括男性（89.5% vs 62.2%），复发≤12个月（52.6% vs 32.4%），诊断和ASCT之间的时间较短（中位数：11.7 vs 21.8个月）。TBI组和化疗组的两年无进展生存率（PFS）分别为58%（95%可信区间[CI]: 39%-85%）和67%（53%-84%）。TBI组和化疗组的两年总生存率（OS）分别为79%（63%-100%）和80%（68%-95%）。PFS失败（TBI vs化疗）的多变量风险比（HR）为1.35 （95% CI: 0.59-3.12）。死亡风险比为1.33 （95% CI: 0.49-3.58）。虽然调理方案与PFS无关，但ASCT时正电子发射断层扫描（PET）阳性（HR: 6.97, 95% CI: 2.98-16.27, P < 0.001）与PFS失败相关。结论：尽管TBI患者存在更多的不良特征，但单纯化疗与基于TBI治疗的患者在PFS或OS方面没有差异。虽然是假设，但这表明TBI可能能够部分补偿不利的特征。
{"title":"Total Body Irradiation Versus Chemotherapy-Only Conditioning in Autologous Haematopoietic Stem Cell Transplantation for Relapsed/Refractory Large B-cell Lymphoma","authors":"M. Ebadi , X. Fan , G. Schoch , T. Gooley , A. Rashidi , S.D. Smith , M. Shadman , L. Holmberg , C. Ujjani , C. Poh , V. Raghunathan , N. Ali , P.T. Vo , S. Manjappa , M. Menon , M. Di , R. Lynch , C. Ho , B.G. Till , R. Ermoian , Y.D. Tseng","doi":"10.1016/j.clon.2025.103959","DOIUrl":"10.1016/j.clon.2025.103959","url":null,"abstract":"<div><h3>Aims</h3><div>In the era of chimeric antigen receptor T-cell (CAR-T) therapy, there remains a role for autologous stem cell transplant (ASCT) for patients with large B-cell lymphoma (LBCL) without access to CAR T-cell therapy or who have late, chemosensitive relapse (>12 months). Typically, the ASCT conditioning regimen is chemotherapy only. Given the radioresponsiveness of LBCL, we retrospectively evaluated whether ASCT outcomes are improved with total body irradiation (TBI)–based conditioning compared to chemo-only conditioning.</div></div><div><h3>Materials and Methods</h3><div>We included patients with relapsed/refractory (r/r) LBCL who underwent ASCT at our centre (2012-2021). As TBI is generally offered only to younger patients, we excluded patients in the chemo-only group who were older than the oldest patient in the TBI group, leaving 56 patients in the final dataset (TBI: 19; chemo: 37).</div></div><div><h3>Results</h3><div>The TBI cohort had more adverse features including male sex (89.5% vs 62.2%), relapse ≤12 months (52.6% vs 32.4%), and shorter time between diagnosis and ASCT (median: 11.7 vs 21.8 months). Two-year progression-free survival (PFS) was 58% (95% confidence interval [CI]: 39%-85%) and 67% (53%-84%) in TBI and chemotherapy cohorts, respectively. Two-year overall survival (OS) was 79% (63%-100%) and 80% (68%-95%) in TBI and chemotherapy cohorts, respectively. Multivariable hazard ratio (HR) of PFS failure (TBI vs chemo) was 1.35 (95% CI: 0.59-3.12). The HR of death was 1.33 (95% CI: 0.49-3.58). While conditioning regimen was not associated with PFS, positron emission tomography (PET) positivity at time of ASCT (HR: 6.97, 95% CI: 2.98-16.27, <em>P</em> < 0.001) was associated with PFS failure.</div></div><div><h3>Conclusion</h3><div>Despite the presence of more adverse features among patients treated with TBI, there was no difference in PFS or OS among patients that underwent chemo-only vs TBI-based conditioning. Though hypothesis generating, this suggests that TBI may be able to partially compensate for adverse fatures.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103959"},"PeriodicalIF":3.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413813","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 : 2025-10-14DOI: 10.1016/j.clon.2025.103960
A. Tahmasebzadeh , E. Yazdani , R. Mirshahi , M. Naseripour , M. Sadeghi
Aims
Uveal melanoma (UM) is the most common intraocular malignancy in adults, with local recurrence probability depending on treatment center strategies, radioisotopes, and follow-up period after conservative treatments such as plaque brachytherapy. This study is the first to assess the effectiveness of machine learning (ML) models in predicting UM local recurrence following Ruthenium-106 plaque brachytherapy by integrating demographic and clinical data.
Materials and methods
Data from 167 UM patients treated with Ru-106 plaque brachytherapy between 2011 and 2021 were analyzed in this retrospective, single-center study. The average follow-up duration for assessing local recurrence was approximately 93 months. Demographic and clinical variables were collected as features, with local recurrence status. Feature selection was achieved using recursive feature elimination (RFE), and principal component analysis (PCA) was applied for dimensionality reduction. Six classifiers—logistic regression, random forest (RF), support vector machine (SVM), gradient boosting, AdaBoost, and XGBoost–were trained and evaluated.
Results
The RF model demonstrated optimal performance, achieving an area under the curve (AUC) of 0.86, accuracy of 0.82, precision of 0.77, recall of 0.91, and an F1 score of 0.83. The final features, ranked by importance from SHapley Additive exPlanations (SHAP) analysis of the best-performing model, included the largest basal diameter (LBD), plaque size, thickness, apex dose, diabetes mellitus, and transpupillary thermotherapy.
Conclusion
ML models, particularly RF, effectively predict UM local recurrence using combined demographic and clinical data. These models can support personalized treatment strategies to improve patient outcomes. Future studies with larger, multicenter cohorts are needed to refine predictions further.
{"title":"Machine Learning-Based Prediction of Local Recurrence in Uveal Melanoma After Ruthenium-106 Plaque Brachytherapy Using Ultrasound Images and Clinical Data","authors":"A. Tahmasebzadeh , E. Yazdani , R. Mirshahi , M. Naseripour , M. Sadeghi","doi":"10.1016/j.clon.2025.103960","DOIUrl":"10.1016/j.clon.2025.103960","url":null,"abstract":"<div><h3>Aims</h3><div>Uveal melanoma (UM) is the most common intraocular malignancy in adults, with local recurrence probability depending on treatment center strategies, radioisotopes, and follow-up period after conservative treatments such as plaque brachytherapy. This study is the first to assess the effectiveness of machine learning (ML) models in predicting UM local recurrence following Ruthenium-106 plaque brachytherapy by integrating demographic and clinical data.</div></div><div><h3>Materials and methods</h3><div>Data from 167 UM patients treated with Ru-106 plaque brachytherapy between 2011 and 2021 were analyzed in this retrospective, single-center study. The average follow-up duration for assessing local recurrence was approximately 93 months. Demographic and clinical variables were collected as features, with local recurrence status. Feature selection was achieved using recursive feature elimination (RFE), and principal component analysis (PCA) was applied for dimensionality reduction. Six classifiers—logistic regression, random forest (RF), support vector machine (SVM), gradient boosting, AdaBoost, and XGBoost–were trained and evaluated.</div></div><div><h3>Results</h3><div>The RF model demonstrated optimal performance, achieving an area under the curve (AUC) of 0.86, accuracy of 0.82, precision of 0.77, recall of 0.91, and an F1 score of 0.83. The final features, ranked by importance from SHapley Additive exPlanations (SHAP) analysis of the best-performing model, included the largest basal diameter (LBD), plaque size, thickness, apex dose, diabetes mellitus, and transpupillary thermotherapy.</div></div><div><h3>Conclusion</h3><div>ML models, particularly RF, effectively predict UM local recurrence using combined demographic and clinical data. These models can support personalized treatment strategies to improve patient outcomes. Future studies with larger, multicenter cohorts are needed to refine predictions further.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103960"},"PeriodicalIF":3.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145413814","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 : 2025-10-13DOI: 10.1016/j.clon.2025.103948
M. Deshmukh, P. Kalbande , N.R. Datta
{"title":"Response to Letter Commenting on: ‘Evaluation of Gross Tumour Volume in Head and Neck Cancers on Contrast-Enhanced Computed Tomography Vs Magnetic Resonance Imaging and its Implications on Dice Similarity Coefficients and Dose-Volume Parameters’","authors":"M. Deshmukh, P. Kalbande , N.R. Datta","doi":"10.1016/j.clon.2025.103948","DOIUrl":"10.1016/j.clon.2025.103948","url":null,"abstract":"","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103948"},"PeriodicalIF":3.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353953","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 : 2025-10-11DOI: 10.1016/j.clon.2025.103956
C. Valentini , T. Perwein , B. Bison , G.H. Gielen , F. Knerlich-Lukoschus , H.C. Bock , C. Seidel , R.D. Kortmann , D. Sturm , M. Benesch , G. Nussbaumer , J.M. Krischer , A. v Bueren , M. Eyrich , L.L. Friker , M. Hoffmann , E. Gkika , A. Wittig-Sauerwein , J. Hörner-Rieber , R. Schwarz , M. Krause
Aims
Paediatric high-grade gliomas (pedHGGs) have a dismal prognosis, often characterised by early and diffuse disease progression. Novel treatment approaches are urgently needed to improve outcomes. The upcoming SIOPE-HGG (High Grade Glioma)-01 trial will investigate upfront craniospinal radiochemotherapy (CSI-RCT) for newly diagnosed, nonmetastatic diffuse midline glioma/diffuse intrinsic pontine glioma (DMG/DIPG). As CSI-RCT is frequently avoided due to concerns over haematotoxicity, real-world feasibility data are critically needed.
Materials and methods
We retrospectively assessed haematological toxicity in 19 patients (aged 3-21 years) with metastatic pedHGG treated with CSI-RCT within the hirn tumor glioblastoma trial (HIT-HGG) and hospital in trial-glioblastoma (HIT-GBM) trial programmes (2002–2024). All patients received craniospinal irradiation (median dose: 35.2 Gy) using photon- or proton-based techniques, with concurrent chemotherapy: temozolomide (TMZ; n = 14) or PEI (cisplatin, etoposide, ifosfamide; n = 5). Haematological toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0.
Results
Grade 3 to 4 haematotoxicity was observed in 7 of 19 patients (36.8%). Chemotherapy was discontinued in two cases—one due to TMZ-induced aplastic anaemia (TIAA) and another due to thrombocytopaenia. The remaining patients tolerated full-dose CSI-RCT with manageable side effects, and no unplanned radiotherapy interruptions occurred. The haematotoxicity rate was comparable to or lower than previous reports, indicating that CSI-RCT is feasible with appropriate monitoring and management.
Conclusion
This is the largest cohort to date assessing haematological toxicity of upfront CSI-RCT in metastatic pedHGG. Despite notable haematotoxicity, treatment was largely feasible and well-tolerated. These findings support the integration of CSI-RCT into future clinical trials for newly diagnosed DMG/DIPG and provide a foundation for the upcoming SIOPE HGG-01 trial. Proton therapy may further reduce toxicity and warrants prospective evaluation.
{"title":"Haematotoxicity of Craniospinal Radiochemotherapy for Metastatic Paediatric High-Grade Glioma","authors":"C. Valentini , T. Perwein , B. Bison , G.H. Gielen , F. Knerlich-Lukoschus , H.C. Bock , C. Seidel , R.D. Kortmann , D. Sturm , M. Benesch , G. Nussbaumer , J.M. Krischer , A. v Bueren , M. Eyrich , L.L. Friker , M. Hoffmann , E. Gkika , A. Wittig-Sauerwein , J. Hörner-Rieber , R. Schwarz , M. Krause","doi":"10.1016/j.clon.2025.103956","DOIUrl":"10.1016/j.clon.2025.103956","url":null,"abstract":"<div><h3>Aims</h3><div>Paediatric high-grade gliomas (pedHGGs) have a dismal prognosis, often characterised by early and diffuse disease progression. Novel treatment approaches are urgently needed to improve outcomes. The upcoming SIOPE-HGG (High Grade Glioma)-01 trial will investigate upfront craniospinal radiochemotherapy (CSI-RCT) for newly diagnosed, nonmetastatic diffuse midline glioma/diffuse intrinsic pontine glioma (DMG/DIPG). As CSI-RCT is frequently avoided due to concerns over haematotoxicity, real-world feasibility data are critically needed.</div></div><div><h3>Materials and methods</h3><div>We retrospectively assessed haematological toxicity in 19 patients (aged 3-21 years) with metastatic pedHGG treated with CSI-RCT within the hirn tumor glioblastoma trial (HIT-HGG) and hospital in trial-glioblastoma (HIT-GBM) trial programmes (2002–2024). All patients received craniospinal irradiation (median dose: 35.2 Gy) using photon- or proton-based techniques, with concurrent chemotherapy: temozolomide (TMZ; n = 14) or PEI (cisplatin, etoposide, ifosfamide; n = 5). Haematological toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0.</div></div><div><h3>Results</h3><div>Grade 3 to 4 haematotoxicity was observed in 7 of 19 patients (36.8%). Chemotherapy was discontinued in two cases—one due to TMZ-induced aplastic anaemia (TIAA) and another due to thrombocytopaenia. The remaining patients tolerated full-dose CSI-RCT with manageable side effects, and no unplanned radiotherapy interruptions occurred. The haematotoxicity rate was comparable to or lower than previous reports, indicating that CSI-RCT is feasible with appropriate monitoring and management.</div></div><div><h3>Conclusion</h3><div>This is the largest cohort to date assessing haematological toxicity of upfront CSI-RCT in metastatic pedHGG. Despite notable haematotoxicity, treatment was largely feasible and well-tolerated. These findings support the integration of CSI-RCT into future clinical trials for newly diagnosed DMG/DIPG and provide a foundation for the upcoming SIOPE HGG-01 trial. Proton therapy may further reduce toxicity and warrants prospective evaluation.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103956"},"PeriodicalIF":3.0,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145463425","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 : 2025-10-10DOI: 10.1016/j.clon.2025.103957
D. Kawahara , A.S. Koganezawa , H. Yamaguchi , T. Wada , Y. Murakami
Aims
To introduce a Biological Adaptive Radiotherapy (BART) framework that incorporates biological effects into adaptive planning, quantify the impact of a short intrafraction interruption on biologically effective dose (BED) in stage III non-small cell lung cancer treated with volumetric modulated arc therapy (VMAT), and evaluate a compensation strategy designed to restore target BED while respecting organs-at-risk (OAR) constraints.
Methods
We analysed lung non-small cell cancer patients with stage III treated using VMAT with two full arcs. A microdosimetric kinetic model (MKM) was used to calculate BED reductions caused by a 120-minute interruption after the first arc. Compensation plans were generated by converting deviations in biological dose into physical dose adjustments, which were optimised using a treatment planning system (TPS). Dose–volume histograms (DVHs) and other metrics were compared for plans with and without interruptions and after BART compensation.
Results
Interruption An interruption caused BED reductions in planning target volume, with the dose difference of the D98% and D2% differences of 15.7%-16.5% and 5.2%-14.5%, respectively. For a normal lung, volume differences at 5 Gy (V5Gy) and 20 Gy (V20Gy) ranged from 0.7% to 2.2% and 0.3% to 4.7%, respectively. With dose compensation, the dose differences reduced to 0.8%-1.4% for the D98% and 1.4%-8.3% for the D2%. The difference of the V5Gy and V20Gy also decreased to 1.0%-4.1% and 0.4%-2.6%, respectively. Spinal cord dose constraints were met across all plans.
Conclusion
The BART framework effectively compensates for BED reductions due to short-term treatment interruptions, preserving therapeutic efficacy and adhering to organ at risk (OAR) constraints. This innovative approach represents a transformative advancement in adaptive radiation therapy by integrating biological considerations, enhancing treatment precision and personalisation.
{"title":"Pioneering Change in Radiotherapy With Biological Adaptive Radiotherapy for Lung Volumetric Modulated Radiotherapy (VMAT) Patients","authors":"D. Kawahara , A.S. Koganezawa , H. Yamaguchi , T. Wada , Y. Murakami","doi":"10.1016/j.clon.2025.103957","DOIUrl":"10.1016/j.clon.2025.103957","url":null,"abstract":"<div><h3>Aims</h3><div>To introduce a Biological Adaptive Radiotherapy (BART) framework that incorporates biological effects into adaptive planning, quantify the impact of a short intrafraction interruption on biologically effective dose (BED) in stage III non-small cell lung cancer treated with volumetric modulated arc therapy (VMAT), and evaluate a compensation strategy designed to restore target BED while respecting organs-at-risk (OAR) constraints.</div></div><div><h3>Methods</h3><div>We analysed lung non-small cell cancer patients with stage III treated using VMAT with two full arcs. A microdosimetric kinetic model (MKM) was used to calculate BED reductions caused by a 120-minute interruption after the first arc. Compensation plans were generated by converting deviations in biological dose into physical dose adjustments, which were optimised using a treatment planning system (TPS). Dose–volume histograms (DVHs) and other metrics were compared for plans with and without interruptions and after BART compensation.</div></div><div><h3>Results</h3><div>Interruption An interruption caused BED reductions in planning target volume, with the dose difference of the D<sub>98%</sub> and D<sub>2%</sub> differences of 15.7%-16.5% and 5.2%-14.5%, respectively. For a normal lung, volume differences at 5 Gy (V<sub>5Gy</sub>) and 20 Gy (V<sub>20Gy</sub>) ranged from 0.7% to 2.2% and 0.3% to 4.7%, respectively. With dose compensation, the dose differences reduced to 0.8%-1.4% for the D<sub>98%</sub> and 1.4%-8.3% for the D<sub>2%</sub>. The difference of the V<sub>5Gy</sub> and V<sub>20Gy</sub> also decreased to 1.0%-4.1% and 0.4%-2.6%, respectively. Spinal cord dose constraints were met across all plans.</div></div><div><h3>Conclusion</h3><div>The BART framework effectively compensates for BED reductions due to short-term treatment interruptions, preserving therapeutic efficacy and adhering to organ at risk (OAR) constraints. This innovative approach represents a transformative advancement in adaptive radiation therapy by integrating biological considerations, enhancing treatment precision and personalisation.</div></div>","PeriodicalId":10403,"journal":{"name":"Clinical oncology","volume":"48 ","pages":"Article 103957"},"PeriodicalIF":3.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399975","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号