Radiotherapy and Oncology最新文献

Background and purpose: We evaluated whether using the tracer [¹⁸F] AlF-NOTA-FAPI-04. in positron emission tomography/computed tomography (PET/CT) could predict pathologic complete response (pCR) rates in patients receiving neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC).

Materials and methods: We prospectively evaluated 60 patients with histopathologically confirmed primary rectal cancer (20 referred for surgery and 40 for nCRT) who provided pretreatment [¹⁸F] AlF-NOTA-FAPI-04 PET/CT scans to detect FAP on tumor surfaces. Among those 40 patients, 26 provided a second [¹⁸F] AlF-NOTA-FAPI-04 PET/CT scan after the 10th radiotherapy fraction to assess changes in FAPI uptake variables. Correlations between baseline PET variables and markers of cancer-associated fibroblasts (CAFs) were assessed with Spearman's rank test. Relationships between pathologic remission and potential predictors were assessed with logistic regression.

Results: The FAPI PET variables maximum and mean standardized uptake values (SUVmax, SUVmean) were positive correlated with FAP expression (p < 0.05). Receiver operating characteristic curve analysis identified SUV_mean (area under the curve [AUC] = 0.869, p < 0.001; cutoff value 6.02; sensitivity 100%; specificity 74.2%) and SUV_max (AUC = 0.810, p = 0.005; cutoff value 11.46; sensitivity 77.8%; specificity 80.6%), both for the primary tumor, as predicting pCR. Multivariate logistic regression showed that SUV_mean was an independent predictor of good response (odds ratio = 0.295, 95% confidence interval [CI] 0.113-0.772, p = 0.013). Changes in FAPI uptake variables were not correlated with radiotherapy response.

Conclusions: [¹⁸F] AlF-NOTA-FAPI-04 PET/CT uptake variables reflected the expression of CAF-related biomarkers. Higher baseline SUV_mean on [¹⁸F] AlF-NOTA-FAPI-04 PET/CT scans was associated with poor response to nCRT for LARC.

As cancer care evolves toward more individualized, survivorship-focused models, there is growing interest in the role of non-biological factors that shape outcomes after diagnosis. Environmental exposures, ranging from air pollution to urban infrastructure, are increasingly recognized as modifiable contributors not only to cancer incidence but also to outcomes after diagnosis. Yet, evidence on cancer outcomes remains fragmented. We conducted a scoping review to map existing literature on the relationship between environmental factors and cancer outcomes, including mortality, treatment-related toxicity, and health-related quality of life. Air pollution was extensively studied, with consistent associations with poorer lung cancer outcomes and emerging evidence for other cancers. Radon was another common exposure investigated, largely in relation to lung cancer. Other factors such as proximity to industrial sites, chemical pollutants, green space access, noise, and meteorological conditions were less frequently examined. Most studies focused on mortality, with limited attention to quality of life or treatment-related complications. Moreover, because many studies were ecological and/or did not model exposure timing relative to diagnosis and treatment, the literature often cannot separate increased cancer mortality driven by higher incidence from worse prognosis after diagnosis. Evidence directly addressing peri-treatment exposures, treatment tolerance/toxicity, and survivorship-specific outcomes remains sparse. Research was concentrated in high-income countries, while evidence from low- and middle-income regions was limited. This review highlights emerging mechanisms, data challenges, and opportunities for translational research and policy intervention, while underscoring the need for interdisciplinary, equity-focused approaches to strengthen causal inference and guide public health strategies.

Background and purpose: As cancer survival rates continue to improve, optimising the provision of quality cancer survivorship care is paramount. Radiation therapists (RTTs) play a pivotal role in the delivery of cancer treatment, but their involvement in providing cancer survivorship care has yet to be explored or understood. This systematic review aimed to examine the role of the RTT within the Quality of Cancer Survivorship Framework across the cancer care continuum.

Methods: Five databases were searched from inception until August 2025. Studies were included if they described or evaluated survivorship care interventions delivered by RTTs, whether within formal roles (e.g. advanced practice) or as part of routine clinical practice. Studies were also included if they reported on RTTs knowledge, attitudes or skills related to survivorship care, defined as care and support provided from diagnosis onwards across the cancer care continuum.

Results: Thirty-eight articles met the inclusion criteria. Sixteen articles reported RTT-delivered survivorship care interventions, and twenty-two articles reported RTT knowledge, attitudes and skills related to survivorship care. Most studies fit within three domains: surveillance and management of psychosocial effects (n = 23), surveillance and management of physical effects (n = 7), and health promotion and disease prevention (n = 7). RTTs expressed willingness to be involved in survivorship care, however highlighted barriers, including limited time and lack of knowledge and training that restricted their involvement.

Conclusions: RTT survivorship specific roles are lacking, however RTTs can play a valuable role in the provision of survivorship care for patients during and after treatment. Barriers to RTTs providing this care include lack of knowledge, training, and time.

Purpose: Assess consistency of end-to-end dosimetry audits used by six Global Quality Assurance of Radiation Therapy Clinical Trials Harmonization Group (GHG) member organizations to harmonise audits and reduce audit overlap in multinational trials while maintaining quality.

Methods: Prior work developed and validated 16 head and neck reference plans, based on established international dosimetry audits for intensity modulated radiotherapy treatments. Realistic modifications, developed from reported variations in clinical practice, were introduced into nine copies of each plan, generating 144 modified plans. These plans were grouped as acceptable (should pass) and unacceptable (should fail) using plan assessment metrics and action limits on CTV_mean, CTV_D95, and OAR_D0.03cc. In the current work, each GHG audit system measured the error-free reference plans on its own phantom using its standard workflow. The measured error-free plans were then compared to the dose calculations of the modified plans. Outcomes were expressed as pass/fail, which were then compared to the "should pass/should fail" benchmark to determine the sensitivity and specificity of each system. An optimal action limit was determined for each audit system to achieve a common sensitivity across all audit systems.

Results: All audit systems reliably identified failing plans (sensitivity 0.92-1.0; specificity 0.40-0.91) with 5% ΔCTV_mean assessment action thresholds. Adjusting the action limit revealed that each audit system was tuned to detect different error thresholds (3.3% - 5.7%). Changing audit system action limits specificity, while preserving system sensitivity.

Conclusion: The comparably high sensitivity across all audit systems could allow harmonising of dosimetry audits for clinical trials on an international scale based on sensitivity alone. Future work harmonising specificity would help streamline credentialing for international clinical trials.

Background and purpose: Anatomical landmarks are often used to assess the quality of a deformable image registration (DIR) between two scans. However, such landmarks are manually placed on both scans, which is prone to observer variability. We analysed the interobserver variability of the placement of corresponding landmarks on pelvic scans, to provide context for DIR validation studies that use landmarks as a reference.

Material and methods: Pelvic CT and MRI scans of nine cervical cancer patients were distributed to 17 observers. Three annotation settings were considered, each including scan pairs of five patients: CT-CT (13 observers), MRI-CT (eight observers), and MRI-MRI (eight observers). The observer group consisted of 15 RTTs professionally trained in working with scans of the given modality, and two fourth-year Ph.D. students in the domain. During annotation, observers received the same reference scan of each patient with 23 anatomically relevant, pre-annotated landmarks, and were asked to annotate the corresponding location of each reference landmark on a second scan of the same patient. To quantify the interobserver variability between different landmark placements on the same patient scan, their geometric median was used to approximate the true corresponding landmark location.

Results: Placements of landmarks on soft tissue for all patients deviated from their geometric median by a median 3D Euclidean distance of 3.0 mm (CT-CT), 5.6 mm (MRI-CT), and 2.6 mm (MRI-MRI). On bony anatomy, variability was significantly lower. Overall, variability was positively correlated with the deformation magnitude in the region.

Conclusions: There is large interobserver variability in anatomical landmark placements on pelvic CT and MRI scans. Variability frequently exceeds voxel size, challenging the AAPM guideline recommending landmark-based DIR quality assessment.

Online adaptive proton therapy (OAPT) requires a fast plan optimization. Different optimization parameters of a commercial treatment planning system were investigated for OAPT of locally advanced non-small cell lung-cancer patients. With the selected parameters, clinical-quality plans were optimized within a median time of 4 min, currently deemed acceptable for OAPT.

The recently published 10-year results of the SUPREMO trial offer valuable insights into the role of postmastectomy radiotherapy (PMRT) to the chest wall alone in low- to intermediate-risk breast cancer patients. However, the trial s design and evolving standards in surgery, radiation therapy (RT), and systemic therapy necessitate careful interpretation. Main findings. SUPREMO enrolled 1,600 patients, primarily with pT1-2N1M0 and pT3N0M0 disease, and reported no significant overall survival (OS) benefit at 10 years. Major protocol modifications-including reduced sample size, extended accrual, and broadened eligibility criteria-were required to ensure trial completion but compromised statistical power and generalizability. The trial s limited use of regional nodal irradiation (RNI), including internal mammary node (IMN) coverage, further limits its applicability in the context of modern evidence demonstrating clear survival benefits from comprehensive RNI. Moreover, pathology quality assurance discrepancies, evolving surgical practices (from modified radical mastectomy to more conservative approaches), and advances in systemic therapy have fundamentally altered risk profiles and treatment paradigms. CONCLUSION: While SUPREMO contributes to understanding PMRT's historical role, its relevance to contemporary multimodal breast cancer management is limited. The restriction to chest wall irradiation, omission of RNI, and the predominance oflower-end intermediate-risk disease(including many patients withnode-negative or limited nodal involvement) diminish its clinical impact. Future trials must integrate biology-driven risk stratification, contemporary surgical and systemic standards, and precise RT definitions, requiring pragmatic designs, robust QA, and accelerated accrual to remain relevant and avoid undertreatment in selected patients who may still benefit from PMRT.