Radiotherapy and Oncology最新文献

Background and purpose: Patients with head and neck cancer (HNC) are particularly vulnerable to mental health concerns. Radiotherapy (RT) remains a key treatment modality for these malignancies, offering high chances of cure. However, the effects on mental health are not well defined. We aim to characterize longitudinally the prevalence and risk of anxiety and depressive symptoms over the course of RT in patients with HNC.

Material and methods: A literature search was performed from database inception until November 1st, 2024. PROSPERO/MOOSE-compliant and pre-registered (PROSPERO:CRD42023441432) systematic review identified studies longitudinally reporting in patients with HNC undergoing curative intent RT. Pooled prevalence and odds ratio of clinically significant anxiety and depressive symptoms between different treatment timepoints were estimated using random-effects meta-analysis.

Results: 18 studies (total sample 1,920, mean age 59.9[SD = 3.17], 22.2 % female, 93.0 % white ethnicity) were included. Before RT, a pooled prevalence of depressive symptoms of 18.1 % (95 % confidence intervals [CI] = 13.1 %-24.4 %) was found. Short-term after completing RT (≤3 months), the prevalence of depressive symptoms peaked to 26.1 % (95 %CI = 18.9 %-35.0 %), decreasing in long-term (≥6 months) assessments to 16.4 % (95 %CI = 12.6 %-21.0 %). Anxiety symptoms continuously decreased from baseline (pooled prevalence 29.9 % [95 %CI = 27.3 %-32.7 %]) to 17.4 % (95 %CI = 12.1 %-24.5 %) in the long-term. Female and married patients showed higher prevalence of depressive symptoms. Those who had undergone surgery presented lower prevalence of anxiety symptoms.

Conclusions: High prevalence of clinically significant depressive and anxiety symptoms were found in patients with HNC undergoing RT, from baseline to long-term follow-up. The weeks following completion of RT are key, as depressive symptoms increase in this period. Screening and interventions prior to, during, and especially immediately post-RT would be beneficial.

Background: Data evaluating the impact of intensity-modulated proton therapy (IMPT) on survival among nasopharyngeal carcinoma (NPC) patients are limited. This study aims to elucidate the survival benefits and toxicity profiles of IMPT compared to modern photon therapy, volumetric-modulated arc therapy (VMAT), over an extended follow-up period.

Methods: We analyzed data from NPC patients recorded in the Chang Gung Research Database. This analysis focused on individuals who received definitive radiotherapy, either IMPT or VMAT therapy, from 2016 to 2021. Patients with distant metastasis or concurrent other malignancies were excluded. We performed 1:1 matching based on stage, year of diagnosis, and age (± 10 years). Oncological outcomes and toxicities were assessed using Cox proportional hazards modeling. For sensitivity analysis, we employed inverse probability of treatment weighting and additional 1:2 matching.

Results: Out of a 1,202 NPC patients' cohort, 276 were selected from a subset of 294 who received IMPT and matched with an equivalent number of patients receiving VMAT. IMPT was associated with improved oncological outcomes after matching, with an adjusted hazard ratio (aHR) of 0.31 (95% CI: 0.15-0.62) for all-cause mortality and an aHR of 0.58 (95% CI: 0.34-0.99) for disease recurrence. Additionally, IMPT was linked to a reduced incidence of feeding tube placement, with an aHR of 0.31 (95% CI: 0.18-0.55). Competing risk and sensitivity analyses corroborated these trends, though the significance for disease recurrence was not consistent.

Conclusion: IMPT was associated with significantly better overall survival outcomes and a lower incidence of dysphagia compared to VMAT in NPC patients. Further randomized trials are needed to confirm these findings.

Backgrounds: Intensity-modulated proton therapy (IMPT) is particularly susceptible to range and setup uncertainties, as well as anatomical changes.

Purpose: We present a framework for IMPT planning that employs a deep learning method for dose prediction based on multiple-CT (MCT). The extra CTs are created from cone-beam CT (CBCT) using deformable registration with the primary planning CT (PCT). Our method also includes a dose mimicking algorithm.

Methods: The MCT IMPT planning pipeline involves prediction of robust dose from input images using a deep learning model with a U-net architecture. Deliverable plans may then be created by solving a dose mimicking problem with the predictions as reference dose. Model training, dose prediction and plan generation are performed using a dataset of 55 patients with head and neck cancer in this retrospective study. Among them, 38 patients were used as training set, 7 patients were used as validation set, and 10 patients were reserved as test set for final evaluation.

Results: We demonstrated that the deliverable plans generated through subsequent MCT dose mimicking exhibited greater robustness than the robust plans produced by the PCT, as well as enhanced dose sparing for organs at risk. MCT plans had lower D_2% (76.1 Gy vs. 82.4 Gy), better homogeneity index (7.7 % vs. 16.4 %) of CTV1 and better conformity index (70.5 % vs. 61.5 %) of CTV2 than the robust plans produced by the primary planning CT for all test patients.

Conclusions: We demonstrated the feasibility and advantages of incorporating daily CBCT images into MCT optimization. This approach improves plan robustness against anatomical changes and may reduce the need for plan adaptations in head and neck cancer treatments.

Background: To investigate changes of objective instrumental measures and correlate with patient reported outcomes (PROs) of radiation-induced dysphagia (RID) after swallowing organs at risk (SWOARs)-sparing IMRT.

Methods: Patients (pts) underwent Fiberoptic Endoscopic Evaluation of Swallowing (FEES), Videofluoroscopy (VFS) and M.D. Anderson Dysphagia Inventory (MDADI) questionnaire at baseline, 6 and 12 months after treatment. They were categorized in two groups: MDADI-C ≥ 80 and MDADI-C < 80. Pharyngeal residue (PR) and penetration (P) or aspiration (A) were considered as surrogate of RID.

Results: Between 2016 and 2022 we enrolled 75 pts, 40 (53 %) MDADI-C ≥ 80 and 35 (47 %) MDADI-C < 80 at baseline. Among MDADI-C ≥ 80 the mean baseline PR score at FEES was 0,42 rising to 1,36 at 6 months (p = 0,001) and stabilizing to 1,15 at 12 months (p = 0,21); indeed, the mean baseline PR score at VFS was 0,55 rising to 1 at 6 months (p = 0,069) and slightly dropping to 0,7 at 12 months (p = 0,069). Among MDADI-C < 80 the mean baseline PR score at FEES was 0,56 rising to 1,07 at 6 months (p = 0,012) and stabilizing to 1,07 at 12 months (p = 0,99); indeed the mean baseline PR score at VFS was 0,67 rising to 1,19 at 6 months (p = 0,04) and dropping to 0,78 at 12 months (p = 0,04). No correlation was found between PROs and objective measures.

Conclusion: Our results show optimal acceptable deglutition preservation from major complications after SWOARs-sparing IMRT by means of low objective scores in both MDADI-C groups. Lack of correlation between PROs and objective measures suggest that referred RID is likely associated to persistence of SWOARs inflammation rather than to a real impairment of function.