Radiotherapy and Oncology最新文献

{"title":"Quality assurance of internal mammary node irradiation in the DBCG IMN2 study","authors":"Lasse Refsgaard ,&nbsp;Emma S. Buhl ,&nbsp;Anders W. Mølby Nielsen ,&nbsp;Mette S. Thomsen ,&nbsp;Karen Andersen ,&nbsp;Ingelise Jensen ,&nbsp;Martin Berg ,&nbsp;Ebbe L. Lorenzen ,&nbsp;Lise B.J. Thorsen ,&nbsp;Jens Overgaard ,&nbsp;Stine S. Korreman ,&nbsp;Birgitte V. Offersen ,&nbsp;on behalf of the DBCG RT Committee","doi":"10.1016/j.radonc.2024.110600","DOIUrl":"10.1016/j.radonc.2024.110600","url":null,"abstract":"<div><h3>Purpose/objective</h3><div>The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.</div></div><div><h3>Material/methods</h3><div>Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.</div></div><div><h3>Results</h3><div>Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p &lt; 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8–100.0) in right-sided patients and 20.4 % (IQR 0.9–55.8) in left-sided patients, p &lt; 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p &lt; 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p &lt; 0.001.</div></div><div><h3>Conclusion</h3><div>For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110600"},"PeriodicalIF":4.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk and survival outcomes of secondary pelvic neoplasm after radiotherapy in female patients with genital neoplasms: A large Population-Based cohort study","authors":"Yan-hong Lyu ,&nbsp;Jia-qi Liu ,&nbsp;Fa-han Wang ,&nbsp;Wen-jingchi Yan ,&nbsp;An-hong Ming ,&nbsp;Geng-sheng Li ,&nbsp;Jun-li Ge ,&nbsp;Ru Jing ,&nbsp;Shu-juan Liu ,&nbsp;Hong-Yang ,&nbsp;Yuan-yuan He ,&nbsp;Jia-Li","doi":"10.1016/j.radonc.2024.110595","DOIUrl":"10.1016/j.radonc.2024.110595","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To investigate the impact of radiotherapy (RT) on the risk of secondary pelvic neoplasms (SPN) and the survival outcomes of patients following a diagnosis of female patients with genital neoplasm(FGN).</div></div><div><h3>Materials and Methods</h3><div>Utilizing SEER databases, this study involved 102,895 patients from nine oncology centers, spanning 1990 to 2015. We employed the Fine-Gray competing risks regression methodology to chart the trajectory of SPN development and used the Kaplan–Meier method to calculate the 10-year overall survival rates.</div></div><div><h3>Results</h3><div>This study included 25,774 patients in the RT group and 77,121 in the non-radiotherapy (NRT) group. The cumulative incidence rate of SPN was 5.10 % in the RT group and 3.42 % in the NRT group. The RT group showed a significantly higher incidence of bladder cancer (adjusted hazard ratio [HR]: 1.75; 95 % confidence interval [CI]: 1.43–2.14; P &lt; 0.05), colon cancer (adjusted HR: 1.32; 95 % CI: 1.16–1.49; P &lt; 0.05), and rectal cancer (adjusted HR: 1.34; 95 % CI: 1.10–1.65; P &lt; 0.05) compared to the NRT group. After propensity score matching, patients in the RT group who developed bladder cancer had significantly reduced 10-year survival rates compared to patients with primary pelvic tumors (P = 0.01).</div></div><div><h3>Conclusion</h3><div>RT is identified as an independent risk factor for the development of SPN in patients with FGN. Patients with FGN who undergo RT demonstrate a significant increase in the risk of developing secondary neoplasms, specifically bladder cancers, and experience a reduction in 10-year survival rates.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110595"},"PeriodicalIF":4.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the incidence and non-union rate of radiation-associated fractures? – A systematic review of the literature","authors":"Argen Omurzakov,&nbsp;Sanjeev Rampam,&nbsp;Marcos R. Gonzalez,&nbsp;Santiago A. Lozano-Calderon","doi":"10.1016/j.radonc.2024.110617","DOIUrl":"10.1016/j.radonc.2024.110617","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-associated fractures (RAFs) are a challenging complication in oncologic patients, yet their incidence remains unknown and optimal management lacks consensus.</div></div><div><h3>Aim</h3><div>This review aimed to evaluate the incidence of RAFs in the trunk, pelvis, and extremities as well as non-union rates of surgical and non-surgical treatment.</div></div><div><h3>Materials and methods</h3><div>A systematic review of PubMed and Embase databases was conducted. The study was registered on PROSPERO (ID: CRD42024513017). Studies were included if they reported RAFs in oncologic populations, had a sample size of at least five patients, and provided extractable data on RAF incidence or number. The STROBE checklist was utilized for evaluation of study quality. For eligible studies, quantitative analyses were conducted to determine weighted incidence of RAF and fracture non-union.</div></div><div><h3>Results</h3><div>Thirty-five studies comprising 9,980 patients treated with radiation therapy were included. The weighted incidence of RAFs was calculated to be 6.5% across 8,061 patients. The weighted incidence of femoral RAF was 5.2%, while pelvic RAF incidence was 17.1%. Non-union rates after initial treatment varied from 4% to 100%, with an overall weighted incidence of 48%. Treatments included intramedullary nailing, fixation with screws/plate, prosthetic replacement, conservative treatment, and amputation, with varying success rates.</div></div><div><h3>Conclusion</h3><div>This review highlights RAFs as a significant complication of radiation therapy, with a weighted incidence of 6.5% and a non-union rate of 48%. Advanced radiation techniques have reduced RAF occurrences, but non-union remains a challenge, necessitating tailored treatment strategies. Further research is needed to optimize RAF management and improve patient outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110617"},"PeriodicalIF":4.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606186","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":"Comparison of stereotactic body radiotherapy and transcatheter arterial chemoembolization for hepatocellular carcinoma: Systematic review and meta‐analysis","authors":"Satoshi Komiyama ,&nbsp;Atsuya Takeda ,&nbsp;Yudai Tateishi ,&nbsp;Yuichiro Tsurugai ,&nbsp;Takahisa Eriguchi ,&nbsp;Nobuyuki Horita","doi":"10.1016/j.radonc.2024.110614","DOIUrl":"10.1016/j.radonc.2024.110614","url":null,"abstract":"<div><div>Stereotactic body radiation therapy (SBRT) is an emerging treatment for hepatocellular carcinoma (HCC), which provides excellent local control (LC) and prolongs overall survival (OS). However, in current guidelines, transcatheter arterial chemoembolization (TACE) has been proposed as a key treatment option for patients with early- and intermediate-stage HCC, whereas SBRT is not. Therefore, we performed a systematic review and <em>meta</em>-analysis of randomized controlled trials and retrospective studies using the propensity score (PS) to compare the outcomes of SBRT and TACE for HCC in a balanced manner. We systematically searched the PubMed, Cochrane, EMBASE, and Web of Science databases to identify randomized controlled trials and studies comparing SBRT and TACE using PS analysis. The hazard ratios (HRs) for OS and LC were pooled. The heterogeneity between the data collected from these studies was also assessed. SBRT led to a comparable OS (HR: 0.83; 95 % confidence interval (CI): 0.52–1.34; p = 0.44) to TACE, and significantly improved LC (HR: 0.25; 95 % CI: 0.09–0.67; p = 0.006). Considerable heterogeneity was observed in the HR of OS and LC. Although there was no significant difference in the rate of grade 3 or higher toxicities between TACE and SBRT, or between studies, liver toxicity was identified as a common adverse event associated with both SBRT and TACE. Compared to TACE, SBRT showed a comparable OS and improved LC without serious toxicity. Therefore, SBRT should be considered an effective treatment option for various stages of HCC, depending on the tumor factors and pretreatment liver function.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110614"},"PeriodicalIF":4.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606183","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":"Validation of an artificial intelligence-based prognostic biomarker in patients with oligometastatic Castration-Sensitive prostate cancer","authors":"Jarey H. Wang ,&nbsp;Matthew P. Deek ,&nbsp;Adrianna A. Mendes ,&nbsp;Yang Song ,&nbsp;Amol Shetty ,&nbsp;Soha Bazyar ,&nbsp;Kim Van der Eecken ,&nbsp;Emmalyn Chen ,&nbsp;Timothy N. Showalter ,&nbsp;Trevor J. Royce ,&nbsp;Tamara Todorovic ,&nbsp;Huei-Chung Huang ,&nbsp;Scott A. Houck ,&nbsp;Rikiya Yamashita ,&nbsp;Ana P. Kiess ,&nbsp;Daniel Y. Song ,&nbsp;Tamara Lotan ,&nbsp;Theodore DeWeese ,&nbsp;Luigi Marchionni ,&nbsp;Lei Ren ,&nbsp;Piet Ost","doi":"10.1016/j.radonc.2024.110618","DOIUrl":"10.1016/j.radonc.2024.110618","url":null,"abstract":"<div><h3>Background</h3><div>There is a need for clinically actionable prognostic and predictive tools to guide the management of oligometastatic castration-sensitive prostate cancer (omCSPC).</div></div><div><h3>Methods</h3><div>This is a multicenter retrospective study to assess the prognostic and predictive performance of a multimodal artificial intelligence biomarker (MMAI; the ArteraAI Prostate Test) in men with omCSPC (n = 222). The cohort also included 51 patients from the STOMP and ORIOLE phase 2 clinical trials which randomized patients to observation versus metastasis-directed therapy (MDT). MMAI scores were computed from digitized histopathology slides and clinical variables. Overall survival (OS) and time to castration-resistant prostate cancer (TTCRPC) were assessed for the entire cohort from time of diagnosis. Metastasis free survival (MFS) was assessed for the trial cohort from time of randomization.</div></div><div><h3>Results</h3><div>In the overall cohort, patients with a high MMAI score had significantly worse OS (HR = 6.46, 95 % CI = 1.44–28.9; p = 0.01) and shorter TTCRPC (HR = 2.07, 95 % CI = 1.15–3.72; p = 0.015). In a multivariable Cox model, MMAI score remained the only variable significantly associated with OS (HR = 6.51, 95 % CI = 1.32–32.2; p = 0.02). In the subset of patients randomized in the STOMP and ORIOLE trials, high MMAI score corresponded to improved MFS with MDT (p = 0.039) compared to patients with a low score, with p_interaction = 0.04.</div></div><div><h3>Conclusion</h3><div>The ArteraAI MMAI biomarker is prognostic for OS and TTCRPC among patients with omCSPC and may predict for response to MDT. Further work is needed to validate the MMAI biomarker in a broader mCSPC cohort.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110618"},"PeriodicalIF":4.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on FET PET-based target volume delineation for the radiotherapy of glioblastoma: A pictorial guide to help overcome methodological pitfalls","authors":"Nicolas Martz ,&nbsp;Mario Levis ,&nbsp;Timothée Zaragori ,&nbsp;Silvia Morbelli ,&nbsp;Antoine Verger","doi":"10.1016/j.radonc.2024.110616","DOIUrl":"10.1016/j.radonc.2024.110616","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110616"},"PeriodicalIF":4.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606184","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":"Long-term trends in the burden of nasopharyngeal carcinoma in China: A comprehensive analysis from 1990 to 2021 and projections to 2030 based on the global burden of disease study 2021","authors":"Bijuan Chen ,&nbsp;Zhouwei Zhan ,&nbsp;Yun Xu ,&nbsp;Sisi Yu ,&nbsp;Jiali Huang ,&nbsp;Yunxiang Fang ,&nbsp;Yifei Liu ,&nbsp;Ruyu Lin ,&nbsp;Jianji Pan ,&nbsp;Shaojun Lin ,&nbsp;Qiaojuan Guo ,&nbsp;Jinsheng Hong","doi":"10.1016/j.radonc.2024.110613","DOIUrl":"10.1016/j.radonc.2024.110613","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Nasopharyngeal carcinoma (NPC) is a significant public health issue in China, with distinctive epidemiological characteristics and evolving trends. This study aims to analyze long-term trends in NPC burden from 1990 to 2021 and provide projections.</div></div><div><h3>Materials and Methods</h3><div>Data from the Global Burden of Disease (GBD) database (1990–2021) was utilized to evaluate NPC metrics, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression identified significant changes over time. Age-period-cohort (APC) analyses assessed the effects of age, period, and cohort. A decomposition analysis identified factors influencing changes in NPC incidence, prevalence, and DALYs. Projections were made for future trends up to 2030.</div></div><div><h3>Results</h3><div>In 2021, NPC significantly impacted China, with males experiencing higher incidence (5.16 per 100,000) and mortality rates (2.32 per 100,000) than females. NPC prevalence was 342,477 cases, with males accounting for 260,164. DALYs totaled 982,657, predominantly affecting males. From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 4.64 to 3.42 per 100,000, while globally it declined from 1.74 to 1.38 per 100,000. Between 1990 and 2021, trends showed an initial decline in ASIR and age-standardized prevalence rate (ASPR), followed by a steady increase from 2006 onwards, with males experiencing more significant rises. Mortality rates showed a general downward trend, yet males remained disproportionately affected. Comparative global data indicated that while NPC metrics are declining worldwide, the burden remains higher in China. Decomposition analysis highlighted aging and population growth as major contributors to the NPC burden. Bayesian age-period-cohort (BAPC) projections indicated a continuing rise in age-standardized incidence and prevalence rates for both males and females up to 2030.</div></div><div><h3>Conclusions</h3><div>The burden of NPC in China remains significant, particularly among the male population. Despite declining mortality rates, the increasing prevalence suggests that more people are living with NPC. Targeted public health interventions are urgently needed to address these gender-specific trends and reduce the disease burden.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110613"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569412","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":"Boron neutron capture therapy for cutaneous angiosarcoma and malignant melanoma: First in-human phase I clinical trial","authors":"Tairo Kashihara ,&nbsp;Satoshi Nakamura ,&nbsp;Naoya Yamazaki ,&nbsp;Akira Takahashi ,&nbsp;Kenjiro Namikawa ,&nbsp;Dai Ogata ,&nbsp;Eiji Nakano ,&nbsp;Kae Okuma ,&nbsp;Tomoya Kaneda ,&nbsp;Taisuke Mori ,&nbsp;Kimiteru Ito ,&nbsp;Jun Itami ,&nbsp;Kazuaki Shimada ,&nbsp;Hitoshi Nakagama ,&nbsp;Hiroshi Igaki","doi":"10.1016/j.radonc.2024.110607","DOIUrl":"10.1016/j.radonc.2024.110607","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Definitive radiotherapy for patients with scalp angiosarcoma has a poor prognosis, often resulting in severe skin adverse events. Additionally, malignant melanoma is known for its radioresistant nature. Boron neutron capture therapy (BNCT) may address these challenges due to the high uptake capacity of boron drugs in these cancer types. We aimed to determine the treatment dose for BNCT and evaluate the incidence of acute adverse events AEs following BNCT in patients with primary or recurrent angiosarcoma/malignant melanoma of the skin.</div></div><div><h3>Materials and methods</h3><div>This was a single-center, non-randomized clinical trial with a three-step dose escalation plan, involving maximum skin doses of 12, 15, and 18 Gy-Eq following a 3 + 3 design. The patients underwent BNCT between November 2019 and April 2022. The primary endpoint was to evaluate the incidence of acute adverse events.</div></div><div><h3>Results</h3><div>Ten patients (scalp angiosarcomanine, forefinger malignant melanoma: one) were included. The median target lesion size was 46.5 (range: 20–145) mm. A transient asymptomatic increase in serum amylase level was the only grade 3 adverse event. The best overall response rate within 180 days was 70 % (median tumor shrinkage rate: 77.5 % [4.9–100 %]).</div></div><div><h3>Conclusions</h3><div>BNCT with a dose of 18 Gy-Eq is a feasible treatment option, demonstrating a favorable safety profile and a high response rate in patients with primary or recurrent angiosarcoma or malignant melanoma of the skin.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110607"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of loco-regional progression and patient outcomes after definitive-dose radiation therapy for anaplastic thyroid cancer","authors":"Julianna K. Bronk ,&nbsp;Alexander Augustyn ,&nbsp;Abdallah S.R. Mohamed ,&nbsp;C. David Fuller ,&nbsp;Adam S. Garden ,&nbsp;Amy C. Moreno ,&nbsp;Anna Lee ,&nbsp;William H. Morrison ,&nbsp;Jack Phan ,&nbsp;Jay P. Reddy ,&nbsp;David I. Rosenthal ,&nbsp;Michael T. Spiotto ,&nbsp;Steven J. Frank ,&nbsp;Ramona Dadu ,&nbsp;Naifa Busaidy ,&nbsp;Mark Zafereo ,&nbsp;Jennifer R. Wang ,&nbsp;Anastasios Maniakas ,&nbsp;Renata Ferrarotto ,&nbsp;Priyanka C. Iyer ,&nbsp;G. Brandon Gunn","doi":"10.1016/j.radonc.2024.110602","DOIUrl":"10.1016/j.radonc.2024.110602","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study is to characterize the patterns of loco-regional progression (LRP) and outcomes after definitive-dose intensity modulated radiation therapy (IMRT) for anaplastic thyroid cancer (ATC) with macroscopic neck disease at the time of IMRT.</div></div><div><h3>Methods</h3><div>Disease/treatment characteristics and outcomes for patients with unresected or incompletely resected ATC who received IMRT (≥45 Gy) were retrospectively reviewed. For those with LRP after IMRT, progressive/recurrent gross tumor volumes (rGTV) were contoured on diagnostic CTs and co-registered with initial planning CTs using deformable image registration. rGTVs were classified based on established spatial/dosimetric criteria.</div></div><div><h3>Results</h3><div>Forty patients treated between 2010–2020 formed the cohort. Median IMRT dose was 66 Gy (45–70 Gy); altered fractionation (AF) was used in 24 (60 %). All received concurrent chemotherapy. In addition to areas of gross disease, target volumes (TVs) commonly included: central compartment/upper mediastinum (levels VI/VII), neck levels II-V in an involved, and levels III-IV in an uninvolved lateral neck. Median overall survival was 7.1 m. Median progression free survival was 7.4 m for patients with locoregional disease and 1.8 m for patients with distant metastasis at the time of IMRT. Twenty-one patients (53 %) developed LRP at median of 10.9 m; freedom from LRP at 3 m and 12 m was 71 % (95 %CI 58–87 %) and 47 % (95 %CI 32–68 %). Forty-one individual rGTVs were identified and most occurred within the high dose (HD) TVs: Type A/central HD (n = 29, 71 %) and B/peripheral HD (n = 3, 7 %).</div></div><div><h3>Conclusions</h3><div>Despite an intensive treatment schedule, including AF and concurrent chemotherapy, classic radio-resistant and rapid Type A failures predominated; isolated extraneous dose failures were rare. While these findings support the IMRT and TV delineation strategies described herein, they highlight the importance of identifying novel strategies to further improve LRC for patients with unresectable disease without targetable mutations for contemporary neo-adjuvant strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110602"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auto-contouring of cardiac substructures for Stereotactic arrhythmia radioablation (STAR): A STOPSTORM.eu consortium study","authors":"Luuk H.G. van der Pol ,&nbsp;Oliver Blanck ,&nbsp;Melanie Grehn ,&nbsp;Tomáš Blazek ,&nbsp;Lukáš Knybel ,&nbsp;Brian V. Balgobind ,&nbsp;Joost J.C. Verhoeff ,&nbsp;Marcin Miszczyk ,&nbsp;Slawomir Blamek ,&nbsp;Sabrina Reichl ,&nbsp;Nicolaus Andratschke ,&nbsp;Felix Mehrhof ,&nbsp;Judit Boda-Heggemann ,&nbsp;Bartłomiej Tomasik ,&nbsp;Stefano Mandija ,&nbsp;Martin F. Fast","doi":"10.1016/j.radonc.2024.110610","DOIUrl":"10.1016/j.radonc.2024.110610","url":null,"abstract":"<div><h3>Background/Purpose</h3><div>High doses to healthy cardiac substructures (CS) in stereotactic arrhythmia radioablation (STAR) raise concerns regarding potential treatment-induced cardio-toxicity. However, CS contours are not routinely created, hindering the understanding of the CS dose–effect relationships. To address this issue, the alignment of CS contouring was initiated within the STOPSTORM consortium. In this study, we developed and evaluated auto-contouring models trained to delineate CS and major vessels in ventricular tachycardia (VT) patients.</div></div><div><h3>Methods</h3><div>Eight centres provided standard treatment planning computed tomography (CT) and/or contrast-enhanced CT datasets of 55 VT patients, each including 16 CS. Auto-contouring models were trained to contour either large structures or small structures. Dice Similarity Coefficient (DSC), 95 % Hausdorff distance (HD95) and volume ratio (VR) were used to evaluate model performance versus inter-observer variation (IOV) on seven VT patient test cases. Significant differences were tested using the Mann-Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>The performance on the four chambers and the major vessels (median DSC: 0.88; HD95: 5.8–19.4 mm; VR: 1.09) was similar to the IOV (median DSC: 0.89; HD95: 4.8–14.0 mm; VR: 1.20).</div><div>For the valves, model performance (median DSC: 0.37; HD95: 11.6 mm; VR: 1.63) was similar to the IOV (median DSC: 0.41; HD95: 12.4 mm; VR: 3.42), but slightly worse for the coronary arteries (median DSC: 0.33 vs 0.42; HD95: 24.4 mm vs 16.9 mm; VR: 1.93 vs 3.30). The IOV for these small structures remains large despite using contouring guidelines.</div></div><div><h3>Conclusion</h3><div>CS auto-contouring models trained on VT patient data perform similarly to IOV. This allows for time-efficient evaluation of CS as possible organs-at-risk.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110610"},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}