Radiotherapy and Oncology最新文献

{"title":"Implementation of an automated contour quality assurance tool within the TROG 18.01 NINJA trial","authors":"Phillip Chlap ,&nbsp;Hang Min ,&nbsp;Jarad Martin ,&nbsp;Mark Sidhom ,&nbsp;Li Xiong Chan ,&nbsp;Angela Whitehead ,&nbsp;Alisha Moore ,&nbsp;Jason Dowling ,&nbsp;Matthew Field ,&nbsp;Annette Haworth ,&nbsp;Martin A. Ebert ,&nbsp;Shalini K. Vinod ,&nbsp;Lois Holloway","doi":"10.1016/j.radonc.2025.111269","DOIUrl":"10.1016/j.radonc.2025.111269","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Automated contour quality assurance (QA) has the potential to reduce resource and cost requirements for clinical trial QA. While several studies have developed such models, few have been translated for use in prospective real-world trials. This study aimed to implement a contour QA tool using a previously developed model and evaluate its performance during deployment within the TROG 18.01 NINJA prostate cancer trial.</div></div><div><h3>Materials and Methods</h3><div>A software tool was developed using an existing prostate clinical target volume (CTV) QA model and integrated into the trial QA workflow. A pilot study was conducted over an 18-month period, during which 56 CTVs were assessed. Reports generated by the tool flagged cases for review and were provided to radiation oncologists to support QA processes.</div></div><div><h3>Results</h3><div>All five protocol-violating CTVs were correctly identified during deployment, yielding a sensitivity of 1.0. However, a higher-than-expected false positive rate resulted in an accuracy of 0.46 and specificity of 0.41. Retrospective analysis showed that many cases submitted deviated from the model’s training distribution, primarily due to inconsistencies in MRI acquisition and variation in submitted CTV definitions. Incorporating out-of-distribution detection based on histogram correlation and model uncertainty improved accuracy to 0.69 for in-distribution cases. Radiation oncologists reported time savings of up to 60 min per case. However, preparation of data remained time intensive for QA coordinators, highlighting the need for further workflow automation.</div></div><div><h3>Conclusion</h3><div>These findings support the feasibility of automated contour QA in multicentre trials and offer guidance for future implementation at scale.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111269"},"PeriodicalIF":5.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model validation confirms variable relative biological effectiveness and elevated periventricular sensitivity after proton therapy of brain tumors","authors":"Martina Palkowitsch ,&nbsp;Larissa S. Kilian ,&nbsp;Fabian Hennings ,&nbsp;Armin Lühr ,&nbsp;Justus Thiem ,&nbsp;Arne Grey ,&nbsp;Rebecca Bütof ,&nbsp;Annekatrin Seidlitz ,&nbsp;Esther G.C. Troost ,&nbsp;Mechthild Krause ,&nbsp;Steffen Löck","doi":"10.1016/j.radonc.2025.111271","DOIUrl":"10.1016/j.radonc.2025.111271","url":null,"abstract":"<div><div>This study validates recently proposed voxel-wise and patient-wise predictive models for localization and occurrence of late radiation-induced contrast enhancements after proton therapy for brain tumors. Using an independent patient cohort, we confirmed the models’ accuracy and reliability, emphasizing an increased radiosensitivity in periventricular regions and a linear-energy-transfer-dependent relative biological effectiveness.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111271"},"PeriodicalIF":5.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac safety of ultra-hypofractionated whole breast irradiation: Results from the SAFE-FORWARD observational prospective cohort study","authors":"Viola Salvestrini ,&nbsp;Livia Marrazzo ,&nbsp;Giuseppe Barletta ,&nbsp;Carlotta Becherini ,&nbsp;Luca Visani ,&nbsp;Marianna Valzano ,&nbsp;Isacco Desideri ,&nbsp;Giulio Francolini ,&nbsp;Luisa Caprara ,&nbsp;Chiara Mattioli ,&nbsp;Niccolò Bertini ,&nbsp;Cecilia Petruccioli ,&nbsp;Gabriele Simontacchi ,&nbsp;Jacopo Nori Cucchiari ,&nbsp;Lorenzo Orzalesi ,&nbsp;Simonetta Bianchi ,&nbsp;Maria Riccarda Del Bene ,&nbsp;Stefania Pallotta ,&nbsp;Lorenzo Livi ,&nbsp;Icro Meattini","doi":"10.1016/j.radonc.2025.111267","DOIUrl":"10.1016/j.radonc.2025.111267","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Ultra-hypofractionated whole breast irradiation (WBI) following breast-conserving surgery (BCS) is increasingly adopted as standard of care. However, its potential impact on subclinical myocardial function remains poorly characterised. The SAFE-FORWARD study (NCT04842409) prospectively investigated early cardiac effects of the 26  Gy in five fractions regimen using advanced echocardiographic techniques.</div></div><div><h3>Materials and methods</h3><div>Fifty women with early-stage breast cancer (median age 67 years) were enrolled and received postoperative WBI to 26 Gy in five fractions. The primary endpoint was the detection of subclinical myocardial impairment at 12 months, defined as a ≥ 10 % decline from baseline in at least one of the following parameters: three-dimensional left or right ventricular ejection fraction (3D-LVEF, 3D-RVEF), left ventricular global longitudinal strain (LV-GLS), or right ventricular free wall longitudinal strain (RV-FWLS). Echocardiography was performed at baseline, and at 2, 6, and 12 months post-WBI. Cardiac substructures were delineated for dosimetric correlation. Adverse events were recorded using CTCAE v5.0.</div></div><div><h3>Results</h3><div>No patient met the predefined criteria for subclinical myocardial impairment. Mean baseline 3D-LVEF was 64.1 % (±3.1) and remained stable at 12 months (63.1 %, ±2.9; p = 0.97). LV-GLS showed no significant change from baseline (–20.5 % ± 1.8) to 12 months (–20.3 % ± 1.6; p = 0.34). 3D-RVEF and RV-FWLS remained unchanged throughout follow-up. A modest but statistically significant increase in LV end-diastolic volume index (LV-EDVI) was observed at 12 months in patients receiving left-sided WBI, without correlation to dosimetric parameters. Mean heart dose was 0.73 Gy (0.94 Gy for left-sided cases). No grade ≥ 3 adverse events occurred. The most common acute toxicities were grade 1 radiodermatitis (32 %) and fatigue (28 %). At 48 months’ median follow-up, all patients were alive, with one ipsilateral and three contralateral breast events reported.</div></div><div><h3>Conclusion</h3><div>Ultra-hypofractionated WBI using the FAST-Forward schedule was not associated with early subclinical myocardial dysfunction. These prospective findings support the cardiac safety of this regimen and may inform future cardio-oncology surveillance strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111267"},"PeriodicalIF":5.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying risk of radiation necrosis: Normal tissue complication probability modeling following stereotactic radiosurgery for small brain metastases in the modern era","authors":"Sreenija Yarlagadda ,&nbsp;Ranjini Tolakanahalli ,&nbsp;Yanjia Zhang ,&nbsp;DJay J. Wieczorek ,&nbsp;Tatiana Bejarano ,&nbsp;Yongsook C. Lee ,&nbsp;Eyub Akdemir ,&nbsp;Matthew D. Hall ,&nbsp;Robert H. Press ,&nbsp;Evan D. Bander ,&nbsp;Michael W. McDermott ,&nbsp;Alonso N. Gutierrez ,&nbsp;Minesh P. Mehta ,&nbsp;Rupesh Kotecha","doi":"10.1016/j.radonc.2025.111266","DOIUrl":"10.1016/j.radonc.2025.111266","url":null,"abstract":"<div><div>To estimate radiation necrosis (RN) risk, dose received by specific at-risk normal brain volumes (V8-22 Gy) was recorded for small brain metastases treated with single-fraction stereotactic radiosurgery. V15Gy was the best predictor with &lt;2.52 cc and &lt;4.65 cc associated with less than 5% risk of any grade RN and Grade 2+ RN, respectively.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111266"},"PeriodicalIF":5.3,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aims+Scope/Editorial Board/ Publication information","authors":"","doi":"10.1016/S0167-8140(25)05252-1","DOIUrl":"10.1016/S0167-8140(25)05252-1","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"213 ","pages":"Article 111248"},"PeriodicalIF":5.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-based lesion characterization and outcome prediction of prostate cancer on [18F]DCFPyL PSMA imaging","authors":"Linmei Zhao ,&nbsp;Maliha R. Imami ,&nbsp;Yuli Wang ,&nbsp;Yitao Mao ,&nbsp;Wen-Chi Hsu ,&nbsp;Ruohua Chen ,&nbsp;Esther Mena ,&nbsp;Yang Li ,&nbsp;Jingyi Tang ,&nbsp;Jing Wu ,&nbsp;Andrew F. Voter ,&nbsp;Alireza Amindarolzarbi ,&nbsp;Daniel Kargilis ,&nbsp;Shadi Afyouni ,&nbsp;Andrei Gafita ,&nbsp;Junyu Chen ,&nbsp;Bennett B. Chin ,&nbsp;Jeffrey P. Leal ,&nbsp;Yong Du ,&nbsp;Gigin Lin ,&nbsp;Harrison X. Bai","doi":"10.1016/j.radonc.2025.111265","DOIUrl":"10.1016/j.radonc.2025.111265","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Prostate cancer remains a significant clinical challenge, particularly in characterizing lesions and predicting patient outcomes. With the growing availability of advanced imaging techniques like [18F]DCFPyL PET/CT, there is an urgent need for intelligent tools that can facilitate clinical decision-making. This study aimed to develop artificial intelligence (AI) models for lesion characterization and outcome prediction in prostate cancer (PCa) patients.</div></div><div><h3>Materials and methods</h3><div>PCa patients who underwent [18F]DCFPyL PET/CT imaging were divided into training and internal test sets (n = 238) and a prospective test set (n = 36). Lesions were scored using the PSMA-Reporting and Data System (RADS) and assessed for malignancy, treatment response, and survival outcomes. Single- and multi-modality deep learning models were trained for four tasks: PSMA-RADS scoring, malignancy classification, treatment response prediction, and survival prediction.</div></div><div><h3>Results</h3><div>The input concatenation model, which combined PET and CT modalities, demonstrated superior performance across all tasks. For the internal test set, the area under the receiver operating characteristic curves (AUROCs) were 0.81 (95 % CI: 0.80–0.81) for PSMA-RADS scoring, 0.79 (95 % CI: 0.78–0.80) for malignancy classification, and 0.74 (95 % CI: 0.73–0.77) for treatment response prediction. In the prospective test set, the AUROCs were 0.72 (95 % CI: 0.69–0.75) for PSMA-RADS scoring, 0.70 (95 % CI: 0.68–0.71) for malignancy classification, and 0.70 (95 % CI: 0.67–0.72) for treatment response prediction. The C-indices for survival predictions were 0.58 (95 % CI: 0.57–0.59) and 0.60 (95 % CI: 0.60–0.63) for the internal and prospective test sets, respectively.</div></div><div><h3>Conclusion</h3><div>Our study highlights the potential of AI to improve lesion characterization and identify patients at high risk of disease progression.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111265"},"PeriodicalIF":5.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-based selection of treatment strategies in hepatocellular carcinoma with macrovascular invasion","authors":"Nalee Kim ,&nbsp;Hyunki Park ,&nbsp;Jeong Il Yu ,&nbsp;Hee Chul Park ,&nbsp;Byeong Geun Song ,&nbsp;Myung Ji Goh ,&nbsp;Wonseok Kang ,&nbsp;Geum-Youn Gwak ,&nbsp;Yong-Han Paik ,&nbsp;Joon Hyeok Lee ,&nbsp;Dong Hyun Sinn ,&nbsp;Moon Seok Choi ,&nbsp;Jung Yong Hong ,&nbsp;Minsuk Kwon ,&nbsp;Sung Wook Shin ,&nbsp;Sung Ki Cho ,&nbsp;Dongho Hyun","doi":"10.1016/j.radonc.2025.111260","DOIUrl":"10.1016/j.radonc.2025.111260","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The management of hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) remains challenging because of its heterogeneous clinical behavior. Various treatment strategies have been introduced, including transarterial chemoembolization (TACE), tyrosine kinase inhibitors (TKIs) combined with radiotherapy (RT), and atezolizumab/bevacizumab (AB) with or without RT. This study evaluated the efficacy and safety of these approaches by using a previously proposed MVI risk stratification model.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 526 treatment-naïve patients with HCC and MVI. Patients were categorized into very low/low-risk (n = 259) and intermediate/high-risk (n = 267) groups based on the MVI sub-classification. They were treated with TACE + RT (n = 417), TKI + RT (n = 67), AB alone (n = 25), or AB + RT (n = 17). Survival outcomes, including intrahepatic progression-free survival (IPFS), extrahepatic PFS (EPFS), PFS, and overall survival (OS), were assessed using Kaplan–Meier and multivariate Cox regression analyses.</div></div><div><h3>Results</h3><div>With a median follow-up of 11.6 months, the median IPFS, EPFS, PFS, and OS were 6.3, 7.4, 4.2, and 12.4 months, respectively. The MVI risk group subclassification was significantly correlated with all survival outcomes (p &lt; 0.05). In the very low/low-risk groups, TACE + RT showed superior outcomes compared with TKI + RT. In the intermediate/high-risk group, AB + RT revealed improved survival compared with TACE + RT or AB alone. Liver function deterioration was most frequent in the TKI + RT group.</div></div><div><h3>Conclusion</h3><div>The proposed MVI risk stratification effectively differentiated prognosis and may guide optimal treatment selection for HCC with MVI. Prospective validation is required to confirm the clinical utility.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111260"},"PeriodicalIF":5.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decrease in dose per fraction impairs the FLASH sparing effect in murine intestine model","authors":"A. Sesink ,&nbsp;R. Geyer ,&nbsp;P. Devanand ,&nbsp;T.T. Böhlen ,&nbsp;L. Soutter ,&nbsp;R. Moeckli ,&nbsp;C. Bailat ,&nbsp;F.G. Herrera ,&nbsp;V. Grilj","doi":"10.1016/j.radonc.2025.111262","DOIUrl":"10.1016/j.radonc.2025.111262","url":null,"abstract":"<div><h3>Purpose</h3><div>FLASH radiotherapy (FLASH) can ease radiation-induced normal tissue toxicities; however, its benefit in clinically relevant fractionation protocols remains insufficiently explored. This study investigated the FLASH sparing effect under two fractionated regimens using a murine model of acute gastrointestinal toxicity.</div></div><div><h3>Materials and methods</h3><div>Tumor-free C57BL/6 mice received abdominal irradiation with either conventional radiotherapy (CONV) or FLASH using a 9 MeV electron beam. Three dose delivery protocols were assessed: single-fraction delivery, two equal fractions over two consecutive days, and ten equal daily fractions over two weeks. Dose escalation was performed within each protocol, while overall survival was used to monitor normal tissue sparing. The FLASH dose modifying factor (DMF) was derived from normal tissue toxicity probability (NTCP) curves to quantify the relative protective effect of FLASH.</div></div><div><h3>Results</h3><div>The single-fraction irradiation demonstrated a significant FLASH sparing effect, with a mean DMF of 1.14. In contrast, this protective effect was diminished in the fractionated protocols, with the two-fraction regimen yielding a mean DMF value of 1.03, while the ten-fraction regimen showed no measurable sparing (mean DMF = 1.00).</div></div><div><h3>Conclusions</h3><div>In an acute responding model of radiation-induced abdominal toxicity, the FLASH sparing effect was substantially reduced with a two-fraction regimen and completely absent with a ten-fraction regimen. These findings suggest that the benefit of FLASH may be limited at lower doses per fraction and highlight the need for further studies in other clinically relevant models to better define the boundaries of its therapeutic applicability.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111262"},"PeriodicalIF":5.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient selection for proton therapy in lung cancer: Nationwide external validation and model update of a prognostic model for 2-year mortality including mean heart dose","authors":"Judith van Loon ,&nbsp;Robin Wijsman ,&nbsp;Liesbeth Boersma ,&nbsp;Hans Langendijk ,&nbsp;Stijn Krol ,&nbsp;Ewoud Schuit","doi":"10.1016/j.radonc.2025.111257","DOIUrl":"10.1016/j.radonc.2025.111257","url":null,"abstract":"<div><h3>Purpose</h3><div>To externally validate a prognostic model for the prediction of 2-year mortality in locally advanced non-small cell lung cancer (NSCLC) patients treated with (chemo)radiotherapy in multiple Dutch centers, to enable selection of patients for proton therapy.</div></div><div><h3>Materials and methods</h3><div>A published prognostic model for 2-year all-cause mortality after (chemo)radiotherapy for irresectable NSCLC, including mean heart dose, gross tumor volume, and smoking, was selected. External validation and model update was performed on cohorts from 5 centers. Model performance was assessed in terms of discrimination and calibration. In case the model performance differed substantially across centers, this was followed by an internal-external cross-validation (IECV) procedure. Ridge regression was used to fit the final set of predictors to the combined dataset and bootstrapping was applied to perform further internal validation.</div></div><div><h3>Results</h3><div>A total of 554/1094 (51 %) patients died within 2 years. Performance of the prognostic model differed substantially across centers. The IECV showed very low levels of heterogeneity in all three performance measures, indicating performance was consistent across centers. The final model, including the mean heart dose and gross tumor volume, showed moderate discrimination (AUC 0.64; 95 %CI 0.61–0.68) and good calibration (calibration-in-the-large 0.0; −0.12–0.12, calibration slope 1.04 [0.78–1.30]).</div></div><div><h3>Conclusion</h3><div>This nation-wide external validation study of a prognostic model for 2-year mortality resulted in a model that performs consistently in patient cohorts across the country. The model has been adopted by the national health authority for model-based selection and reimbursement of proton therapy for lung cancer.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111257"},"PeriodicalIF":5.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk modeling of imaging changes after proton beam therapy for childhood brain tumors.","authors":"Feline Heinzelmann, Sarah Peters, Annika Quenzer, Armin Lühr, Steffen Löck, Stefanie Schulze Schleithoff, Sabine Frisch, Christian Bäumer, Beate Timmermann","doi":"10.1016/j.radonc.2025.111261","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111261","url":null,"abstract":"<p><strong>Background and purpose: </strong>In childhood brain tumors, minimizing long-term side effects of cancer therapy is a critical objective. Radiation-related imaging changes (ICs), indicative of potential radionecrosis, remain an area of active investigation in proton beam therapy (PBT). This study aimed to identify and correlate post-therapeutic ICs and radio-biological and dosimetric factors, including linear energy transfer (LET) and variable relative biological effectiveness (RBE), as well as clinical factors.</p><p><strong>Materials and methods: </strong>A 3:1 matched-pair cohort of 93 pediatric PBT patients from a register study was retrospectively analyzed. The cohort comprised various brain tumor entities, with follow-up MRI data available up to 14 months post-treatment. Potential clinical risk factors for therapy-induced ICs in pediatric brains were analyzed using logistic regression at both patient and voxel levels. Dosimetric parameters were evaluated for the entire brain, periventricular region (PVR), and brainstem.</p><p><strong>Results: </strong>A total of 15 cases with post-therapeutic ICs from various childhood tumor entities were identified and localized in the brainstem, the PVR, and other brain regions. At the voxel level, the key parameter linked to increased IC probability was the product of dose D and proton dose-averaged LETd (D· LETd_proton)_{σ=6 mm}, excluding voxels below 5 Gy (RBE). The Gaussian filtering with a standard deviation σ of 6 mm served as a practical approach to account for spatial uncertainties. At the patient level, the median dose (D_50%) within the volume of the healthy brain receiving more than 20 Gy (RBE) was most significant.</p><p><strong>Conclusion: </strong>The identified univariate voxel- and patient-level risk factors provide a foundation for predicting post-therapeutic ICs in pediatric CNS tumor patients treated with PBT. Our findings contribute to refining risk prediction models and optimizing treatment planning strategies, ultimately aiming to minimize long-term radiation-induced effects in pediatric brain tumor patients.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111261"},"PeriodicalIF":5.3,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}