International Journal of Radiation Oncology Biology Physics最新文献

Purpose and objectives: A combination of metastasis-directed ablative therapy and curative intent treatment for OMBC is an active area of research. We designed this prospective study to explore this approach in a homogenous population of oligometastatic breast cancer patients with bone-only metastases.

Materials and methods: Patients with 1-5 bone-only metastases were included and received Stereotactic Body Radiation Therapy (SBRT) to the metastatic site, followed by curative intent anthracycline and taxane-based chemotherapy and surgical excision of the primary tumor. Patients with vertebral metastases received SBRT as 30 Gy in three fractions over three days, and those with non-vertebral metastases received 24 Gy in two fractions over two days. Response assessment was done using PERCIST criteria. The study was designed to evaluate the progression-free survival (PFS), overall survival (OS), local control rate at the mestastatic site of SBRT, and impact of SBRT on pain control.

Results: Between June 2021 and April 2024, a total of 49 patients with a total of 84 metastatic sites were enrolled. After a median follow-up of 19.4 months (1.1-44.4 months), median PFS was 18.8 months (1.1-44.4 months;95% CI 26.512-36.349), while the 1 and 2-year PFS were 81.63% and 71.43%, respectively. Multivariate analysis for PFS revealed that patients who completed neoadjuvant chemotherapy (NACT) (p-value: 0.05) and underwent surgical excision of the primary tumour (p-value: 0.02) experienced significantly improved PFS, and hormone receptor positivity approached significance (p-value: 0.07). The median OS for the entire cohort was 19.4 months (1.56-44.4 months), while the 1 and 2-year OS were 89% and 74%, respectively. Multivariate Analysis for OS revealed significantly improved survival for patients completing NACT (p-value:0.01), receiving LRRT (p-value:0.038), and presence of vertebral metastasis (p-value: 0.038). With SBRT, a high proportion of patients (96.4%) experienced a reduction in their analgesic medication requirements. The median time to achieve a pain response was 2.3 months (interquartile range: 1.0-4.7 months). The treatment was well-tolerated, with no documented Grade 3-4 toxicities reported throughout the follow-up period. The most frequently observed adverse event was a temporary exacerbation of pain, known as a pain flare, which occurred in 10.7% of the patient cohort.

Conclusion: Oligometastatic breast cancer is a very heterogeneous group of patients. This study demonstrates excellent outcomes in treatment-naïve, bone-only metastatic patients, emphasizing the need for patient selection. This finding underscores the critical importance of careful patient stratification and selection to achieve optimal therapeutic efficacy.

Purpose: This study aimed to evaluate survival outcomes of transarterial chemoembolization (TACE) alone versus TACE plus radiation therapy (RT) as first-line treatment in patients with single hepatocellular carcinoma (HCC) within Barcelona Clinic Liver Cancer (BCLC) stage 0-A.

Methods and materials: We retrospectively analyzed 1243 treatment-naïve patients with BCLC stage 0-A single HCC who received TACE alone (n = 986) or TACE plus RT (n = 257) between January 2008 and December 2018. Propensity score matching and subgroup analyses were performed to compare overall survival (OS) and progression-free survival (PFS) between the treatment groups, and to identify patient subsets most likely to benefit from combined therapy.

Results: The median age was 61 years (IQR, 55-69); 38% of the patients had BCLC stage 0 disease, whereas 62% had stage A disease. Baseline characteristics were comparable between groups, except for a higher rate of noncomplete response to TACE in the TACE plus RT group. At a median follow-up of 54.7 months, TACE plus RT demonstrated significantly higher 5-year OS (76.4% vs 62.5%; P < .001) and PFS (41.9% vs 22.3%; P < .001) compared with TACE alone. In the propensity score-matched cohort, TACE plus RT maintained superior 5-year OS (76.4% vs 54.0%; P < .001) and PFS (41.9% vs 12.3%; P < .001). These survival benefits were consistent across subgroups, with significant interactions identified for tumor size (> 4 cm), alpha-fetoprotein levels (> 100 ng/mL), and TACE response (noncomplete response). Incorporating these factors, the TACE-RT stratification model categorized patients into distinct groups with differential treatment effects: groups B (1 factor) and C (2-3 factors) derived significant survival benefits from combined therapy, whereas group A (no factors) showed no differences. Early RT integration yielded superior OS and PFS compared with delayed integration.

Conclusions: TACE combined with RT as first-line treatment was associated with improved OS and PFS compared with TACE alone in selected patients with BCLC stage 0-A single HCC. Our TACE-RT stratification model may help identify appropriate candidates for combined therapy.

Outcomes for patients with nasopharyngeal carcinoma (NPC) have improved significantly due to advances in radiotherapy technology such as precision image-guided intensity-modulated radiotherapy (IG-IMRT), the emergence of novel systemic agents, and a growing understanding of disease biology and clinical behavior. Minimising treatment-related toxicities while maintaining effective disease control is increasingly important in NPC, especially given its predilection for younger middle-aged patients with a long life expectancy after cure of their disease. Over the past five years, multiple clinical trials and large contemporary series have offered valuable insights into optimizing treatment strategies that balance oncologic efficacy with functional preservation, positioning NPC as one of the most rapidly evolving head and neck cancer sites in the pursuit of precision oncology. This critical review summarizes data from randomized clinical trials, with a particular emphasis on studies published in the past six years, across five key areas: (1) trials investigating treatment deintensification in low-risk disease; (2) strategies to improve treatment tolerability during the concurrent phase; (3) intensified treatment approaches for LANPC; (4) utility of plasma EBV DNA for treatment personalisation; (5) tailored radiotherapy target volume delineation and organ-at-risk (OAR) sparing; and (6) treatment strategies for recurrent and metastatic (R/M) NPC. Together, these developments reflect a paradigm shift toward increasingly personalised, risk-adapted management of NPC that prioritizes both survival and quality of life.

Purpose: Radiation-induced heart damage is a significant concern in the treatment of non-small cell lung cancer (NSCLC) that can have debilitating or life-threatening consequences. Current strategies focus on minimizing heart exposure, but individual susceptibility varies. Existing evidence also suggests that a uniform "one-size-fits-all" dosimetric constraint for the heart may not be optimal for all patients.

Methods: We developed a prospective study using Bayesian continuous learning and adaptation to develop a framework for personalized adaptive radiation treatment (PART) to reduce cardiovascular adverse events (CAEs) among patients with locally advanced NSCLC. The trial includes a Bayesian personalized risk prediction model to guide heart dose constraints; sequential learning to refine the model and the PART; continuous adaptation of the target risk level; and go/no-go monitoring of PART effectiveness in clinical implementation. Elevation of high-sensitivity cardiac troponin T (hs-cTnT) after radiation was used as a surrogate biomarker for grade ≥2 CAEs to allow real-time decision-making.

Results: As of July 31, 2025, 100 patients have been enrolled and completed radiation treatment. Standard radiation plans were implemented for cohort 1 (50 patients), and PART for cohort 2 (50 patients). The first model incorporated patient- and disease-related factors and mean heart dose (MHD) as risk factors. The average treated MHDs were 7.84 ± 6.30 Gy in cohort 1 and 6.36 ± 6.01 Gy in cohort 2 (p = 0.20). The incidence of hs-cTnT elevation was 20.5% in cohort 2 compared to 31.9% in cohort 1. Within cohort 2, patients who satisfied the PART dose constraint had a markedly lower incidence of hs-cTnT elevation (9.7%) compared with those who exceeded the PART dose constraint (46.2%, p = 0.012).

Conclusion: Clinical implementation of PART model to guide treatment decision within a prospective trial is feasible. The recommended mean heart dose constraints generated by the first version of PART appear reasonable and clinically relevant. PART was associated with lower incidence of hs-cTnT elevation.

Purpose: The challenges of postoperative accelerated partial breast irradiation (APBI) include targeting inaccuracies and inability to measure tumor response. We hypothesized that the tumor could be targeted with preoperative APBI (pAPBI) using magnetic resonance imaging (MRI) in prone position with our established prone breast technique. This feasibility study aimed to assess the accuracy and tumor response of pAPBI using our MRI/computed tomography (CT)-guided prone technology.

Methods and materials: This prospective study enrolled patients aged >50 years with clinical stage IA ER+ breast cancer intending lumpectomy. Axillary ultrasound and MRI confirmed clinically negative nodes. Planning CT, MRI, and pAPBI (3850 cGy in 10 fractions twice a day) used the same prone immobilization platform. Another MRI was obtained 4 weeks after APBI to quantitatively measure tumor response. Lumpectomy was performed 4 to 6 weeks after pAPBI. Simon's 2-stage design required assessment after accrual of the first 19 patients for feasibility.

Results: Nineteen patients with clinical stage IA ER+/PR+/HER2- breast cancer with median age of 65 years (range, 51-78 years) completed pAPBI followed by lumpectomy and endocrine therapy. Median follow-up was 73.8 months (IQR, 58.6-82.5 months). Median clinical tumor size was 0.9 cm (IQR, 0.8-1.6 cm). There was complete pathologic response in 10.5% (2) patients and another 36.8% (7) were downstaged after pAPBI. MRI-detected tumor response significantly correlated with tumor response on pathology (P = .03). Cosmesis was rated as excellent/good in 89.5% (17) patients. Although 3 patients had macrometastases in nodes on final pathology despite a negative axillary ultrasound, local control was 95% and disease-free survival was 89.5% at a median follow-up of 73.8 months.

Conclusions: Using the same prone platform, patients successfully underwent CT simulation, MRI acquisition, and pAPBI followed by lumpectomy. Nearly half of patients demonstrated tumor response to pAPBI on imaging and pathology. Further utilization of this technology can be highly applicable to the delivery of pAPBI, stereotactic body radiation therapy, or tumor bed boost radiation in the prone position.

Purpose: Stereotactic radiosurgery (SRS) is a standard treatment for brain metastases; however, it may lead to radiation necrosis (RN). RN can be virtually indistinguishable from tumor progression (TP), which can have significant clinical implications on appropriate, time-sensitive treatment. This study investigated the effectiveness of multimodal chemical exchange saturation transfer magnetic resonance imaging (MRI), combined with T1/T2 mapping and/or conventional structural MRI, in addressing this diagnostic challenge, when analyzed through attention-guided deep learning.

Methods and materials: MRI data (3-dimensional amide proton transfer magnetization transfer ratio [Amide_MTR], relayed nuclear Overhauser effect magnetization transfer ratio [rNOE_MTR], T1 and T2 parametric maps, and postcontrast T1-weighted [T1c] and T2-weighted fluid-attenuated inversion recovery [T2-FLAIR] images) were acquired from 93 patients (230 brain metastases lesions) treated with SRS a few months prior. Lesion outcomes (TP/RN) were confirmed via histopathology and/or serial clinical imaging, including the use of perfusion imaging, over a follow-up period of at least 6 months. Data were split into training (47 patients; 184 lesions) and independent testing (46 patients; 46 lesions) sets. A 3-dimensional transformer model with 2 new attention mechanisms was developed to classify lesions using various combinations of multimodal MRI inputs.

Results: Among dual-channel models, T1c and T2-FLAIR yielded an area under the receiver operating characteristic curve (AUC) of 0.78 ± 0.01, whereas Amide_MTR and rNOE_MTR maps achieved 0.76 ± 0.01. Integrating Amide_MTR and rNOE_MTR with either T1/T2 maps or T1c/T2-FLAIR substantially improved performance (AUC = 0.84 ± 0.02 and 0.85 ± 0.02, respectively). The highest performance (AUC = 0.87 ± 0.01) was achieved using all 6 modalities.

Conclusions: Attention-guided deep-learning analysis of chemical exchange saturation transfer MRI shows strong potential for accurately distinguishing RN from TP, underscoring the significance of multimodal MRI inputs for post-SRS lesion evaluation.