Pub Date : 2024-09-06DOI: 10.1016/j.radonc.2024.110526
{"title":"Concerns regarding the use of only phase 2 study to Justify palliative radiotherapy vs. Palliative chemo-radiotherapy in unresectable head and neck cancer","authors":"","doi":"10.1016/j.radonc.2024.110526","DOIUrl":"10.1016/j.radonc.2024.110526","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154897","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}
Pub Date : 2024-09-06DOI: 10.1016/j.radonc.2024.110507
Treatments at ultra-high dose rate (UHDR) have the potential to improve the therapeutic index of radiation therapy (RT) by sparing normal tissues compared to conventional dose rate irradiations. Insufficient and inconsistent reporting in physics and dosimetry of preclinical and translational studies may have contributed to a reproducibility crisis of radiobiological data in the field. Consequently, the development of a common terminology, as well as common recording, reporting, dosimetry, and metrology standards is required. In the context of UHDR irradiations, the temporal dose delivery parameters are of importance, and under-reporting of these parameters is also a concern.This work proposes a standardization of terminology, recording, and reporting to enhance comparability of both preclinical and clinical UHDR studies and and to allow retrospective analyses to aid the understanding of the conditions which give rise to the FLASH effect.
{"title":"Recording and reporting of ultra-high dose rate “FLASH” delivery for preclinical and clinical settings","authors":"","doi":"10.1016/j.radonc.2024.110507","DOIUrl":"10.1016/j.radonc.2024.110507","url":null,"abstract":"<div><p>Treatments at ultra-high dose rate (UHDR) have the potential to improve the therapeutic index of radiation therapy (RT) by sparing normal tissues compared to conventional dose rate irradiations. Insufficient and inconsistent reporting in physics and dosimetry of preclinical and translational studies may have contributed to a reproducibility crisis of radiobiological data in the field. Consequently, the development of a common terminology, as well as common recording, reporting, dosimetry, and metrology standards is required. In the context of UHDR irradiations, the temporal dose delivery parameters are of importance, and under-reporting of these parameters is also a concern.This work proposes a standardization of terminology, recording, and reporting to enhance comparability of both preclinical and clinical UHDR studies and and to allow retrospective analyses to aid the understanding of the conditions which give rise to the FLASH effect.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154907","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}
Pub Date : 2024-09-05DOI: 10.1016/j.radonc.2024.110520
Purpose
Substantiating data guiding clinical decision making in locally recurrent rectal cancer (LRRC) is lacking, specifically in target volume (TV) definition for chemoradiotherapy (CRT). A case-by-case review of local re-recurrences (re-LRRC) after multimodal treatment for LRRC was performed, to determine location of re-LRRC and assess whether treatment could have been improved.
Methods
All patients treated with curative intent for LRRC at the Catharina Hospital Eindhoven from October 2016 onwards, in whom complete imaging of (re-)LRRC and radiotherapy was available, were retrieved. Patients were discussed in plenary meetings with expert colorectal surgeons, radiation oncologists and radiologists. Each case was classified based on re-LRRC location, whether it was in accordance with the (current) radiotherapy protocol, and whether multimodal management would have been different in retrospect.
Results
Thirty-three cases were discussed. LRRC treatment was deemed suboptimal in 17/33 patients, due to different target volumes (13/17) and/or different surgery (9/17). 15/33 (46 %) of re-LRRC developed in-field of the prior radiotherapy TV, possibly showing RT-resistant disease. Other re-LRRCs developed out-field (n = 5, 15 %), marginally (n = 6, 18 %), or in a combined fashion (n = 7, 21 %). In retrospect, 48 % of cases were irradiated in line with current TV recommendations. TVs of 13/33 cases would have been altered if irradiated today.
Conclusion
This study highlights room for improvement within current standard-ofcare treatment for LRRC. Different surgical management or TVs may have improved outcome in up to half of discussed cases. Further delineation guideline development, incorporating the results from this study, may improve oncological outcome, specifically local control, for LRRC patients.
{"title":"Analysis of re-recurrent rectal cancer after curative treatment of locally recurrent rectal cancer","authors":"","doi":"10.1016/j.radonc.2024.110520","DOIUrl":"10.1016/j.radonc.2024.110520","url":null,"abstract":"<div><h3>Purpose</h3><p>Substantiating data guiding clinical decision making in locally recurrent rectal cancer (LRRC) is lacking, specifically in target volume (TV) definition for chemoradiotherapy (CRT). A case-by-case review of local re-recurrences (re-LRRC) after multimodal treatment for LRRC was performed, to determine location of re-LRRC and assess whether treatment could have been improved.</p></div><div><h3>Methods</h3><p>All patients treated with curative intent for LRRC at the Catharina Hospital Eindhoven from October 2016 onwards, in whom complete imaging of (re-)LRRC and radiotherapy was available, were retrieved. Patients were discussed in plenary meetings with expert colorectal surgeons, radiation oncologists and radiologists. Each case was classified based on re-LRRC location, whether it was in accordance with the (current) radiotherapy protocol, and whether multimodal management would have been different in retrospect.</p></div><div><h3>Results</h3><p>Thirty-three cases were discussed. LRRC treatment was deemed suboptimal in 17/33 patients, due to different target volumes (13/17) and/or different surgery (9/17). 15/33 (46 %) of re-LRRC developed in-field of the prior radiotherapy TV, possibly showing RT-resistant disease. Other re-LRRCs developed out-field (n = 5, 15 %), marginally (n = 6, 18 %), or in a combined fashion (n = 7, 21 %). In retrospect, 48 % of cases were irradiated in line with current TV recommendations. TVs of 13/33 cases would have been altered if irradiated today.</p></div><div><h3>Conclusion</h3><p>This study highlights room for improvement within current standard-ofcare treatment for LRRC. Different surgical management or TVs may have improved outcome in up to half of discussed cases. Further delineation guideline development, incorporating the results from this study, may improve oncological outcome, specifically local control, for LRRC patients.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146125","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}
Pub Date : 2024-09-05DOI: 10.1016/j.radonc.2024.110527
Background and purpose
Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR).
Materials and methods
Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows.
Results
All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min.
Conclusion
This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.
{"title":"Adapting outside the box: Simulation-free MR-guided stereotactic ablative radiotherapy for prostate cancer","authors":"","doi":"10.1016/j.radonc.2024.110527","DOIUrl":"10.1016/j.radonc.2024.110527","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR).</p></div><div><h3>Materials and methods</h3><p>Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows.</p></div><div><h3>Results</h3><p>All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min.</p></div><div><h3>Conclusion</h3><p>This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024035059/pdfft?md5=aec6cfd6f46613eaf3f01ef7120b1d00&pid=1-s2.0-S0167814024035059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146109","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}
Pub Date : 2024-09-05DOI: 10.1016/j.radonc.2024.110524
Purpose
We sought to determine the association between multidisciplinary team (MDT) quality and survival of patients with locally advanced rectal cancer.
Methods
In a post hoc analysis of the randomized phase III STELLAR trial, 464 patients with distal or middle-third, clinical tumor category cT3-4 and/or regional lymph node-positive rectal cancer who completed surgery were evaluated. Disease-free survival (DFS) and Overall survival (OS) were stratified by Multidisciplinary team (MDT) quality, which was also included in the univariable and multivariable analyses of DFS and OS.
Results
According to the univariable analyses, a significantly worse DFS was associated with a fewer specialized medical disciplines participating in MDT (<5 vs ≥ 5; P=0.049),a lower frequency of MDT meetings (<once a week vs ≥ once a week; P=0.021) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; P=0.039). In addition, a lower number of specialized medical disciplines participating in MDT (<5 vs ≥ 5; P<0.001), a lower frequency of MDT meetings (<once a week vs ≥ once a week; P<0.001) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; P=0.001) were the variables associated with OS. These 3 factors were considered when assessing MDT quality, which was classified into 2 categories: high quality or general quality. Patients treated in hospitals with high MDT quality had longer 3-year OS (90.5 % vs 78.1 %; P=0.001) and similar 3-year DFS (70.3 % vs 61.3 %; P=0.109) compared to those treated in hospitals of the general MDT quality group. Furthermore, multivariable analyses revealed a significance for DFS (HR, 1.648; 95 % CI, 1.143–2.375; P=0.007) and OS (HR, 2.771; 95 % CI, 1.575–4.877; P<0.001) in MDT quality.
Conclusions
The use of hospitals with optimized multidisciplinary infrastructure had a significant influence on survival of patients with locally advanced rectal cancer.
目的:我们试图确定多学科团队(MDT)质量与局部晚期直肠癌患者生存率之间的关系:在随机III期STELLAR试验的一项事后分析中,对464名完成手术的远端或中段、临床肿瘤分类为cT3-4和/或区域淋巴结阳性的直肠癌患者进行了评估。无病生存期(DFS)和总生存期(OS)根据多学科团队(MDT)质量进行分层,多学科团队质量也被纳入无病生存期和总生存期的单变量和多变量分析中:根据单变量分析,DFS明显较差与参与MDT的专业医疗学科较少有关(200;P=0.039)。此外,参与 MDT 的专业医疗学科较少(200 个;P=0.001)也是与 OS 相关的变量。在评估MDT质量时考虑了这3个因素,MDT质量分为两类:高质量和一般质量。与在一般MDT质量组医院接受治疗的患者相比,在高质量MDT医院接受治疗的患者的3年OS更长(90.5% vs 78.1%;P=0.001),3年DFS相似(70.3% vs 61.3%;P=0.109)。此外,多变量分析显示,DFS(HR,1.648;95 % CI,1.143-2.375;P=0.007)和OS(HR,2.771;95 % CI,1.575-4.877;PC结论:使用具有优化多学科基础设施的医院对局部晚期直肠癌患者的生存率有显著影响。
{"title":"Multidisciplinary team quality improves the survival outcomes of locally advanced rectal cancer patients: A post hoc analysis of the STELLAR trial","authors":"","doi":"10.1016/j.radonc.2024.110524","DOIUrl":"10.1016/j.radonc.2024.110524","url":null,"abstract":"<div><h3>Purpose</h3><p>We sought to determine the association between multidisciplinary team (MDT) quality and survival of patients with locally advanced rectal cancer.</p></div><div><h3>Methods</h3><p>In a post hoc analysis of the randomized phase III STELLAR trial, 464 patients with distal or middle-third, clinical tumor category cT3-4 and/or regional lymph node-positive rectal cancer who completed surgery were evaluated. Disease-free survival (DFS) and Overall survival (OS) were stratified by Multidisciplinary team (MDT) quality, which was also included in the univariable and multivariable analyses of DFS and OS.</p></div><div><h3>Results</h3><p>According to the univariable analyses, a significantly worse DFS was associated with a fewer specialized medical disciplines participating in MDT (<5 vs ≥ 5; <em>P</em>=0.049),a lower frequency of MDT meetings (<once a week vs ≥ once a week; <em>P</em>=0.021) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; <em>P</em>=0.039). In addition, a lower number of specialized medical disciplines participating in MDT (<5 vs ≥ 5; <em>P</em><0.001), a lower frequency of MDT meetings (<once a week vs ≥ once a week; <em>P</em><0.001) and a smaller MDT annual discussion volume of rectal cancer (≤200 vs > 200; <em>P</em>=0.001) were the variables associated with OS. These 3 factors were considered when assessing MDT quality, which was classified into 2 categories: high quality or general quality. Patients treated in hospitals with high MDT quality had longer 3-year OS (90.5 % vs 78.1 %; <em>P</em>=0.001) and similar 3-year DFS (70.3 % vs 61.3 %; <em>P</em>=0.109) compared to those treated in hospitals of the general MDT quality group. Furthermore, multivariable analys<strong>e</strong>s revealed a significance for DFS (HR, 1.648; 95 % CI, 1.143–2.375; <em>P</em>=0.007) and OS (HR, 2.771; 95 % CI, 1.575–4.877; <em>P</em><0.001) in MDT quality.</p></div><div><h3>Conclusions</h3><p>The use of hospitals with optimized multidisciplinary infrastructure had a significant influence on survival of patients with locally advanced rectal cancer.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024035023/pdfft?md5=3bbecd73ece600c6eaef87da35c7960c&pid=1-s2.0-S0167814024035023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146127","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}
Pub Date : 2024-09-04DOI: 10.1016/j.radonc.2024.110499
Background
Stereotactic arrhythmia radioablation (STAR) is a therapeutic option for ventricular tachycardia (VT) where catheter-based ablation is not feasible or has previously failed. Target definition and its transfer from electro-anatomic maps (EAM) to radiotherapy treatment planning systems (TPS) is challenging and operator-dependent. Software solutions have been developed to register EAM with cardiac CT and semi-automatically transfer 2D target surface data into 3D CT volume coordinates. Results of a cross-validation study of two conceptually different software solutions using data from the RAVENTA trial (NCT03867747) are reported.
Methods
Clinical Target Volumes (CTVs) were created from target regions delineated on EAM using two conceptually different approaches by separate investigators on data of 10 patients, blinded to each other’s results. Targets were transferred using 3D-3D registration and 2D-3D registration, respectively. The resulting CTVs were compared in a core-lab using two complementary analysis software packages for structure similarity and geometric characteristics.
Results
Volumes and surface areas of the CTVs created by both methods were comparable: 14.88 ± 11.72 ml versus 15.15 ± 11.35 ml and 44.29 ± 33.63 cm2 versus 46.43 ± 35.13 cm2. The Dice-coefficient was 0.84 ± 0.04; median surface-distance and Hausdorff-distance were 0.53 ± 0.37 mm and 6.91 ± 2.26 mm, respectively. The 3D-center-of-mass difference was 3.62 ± 0.99 mm. Geometrical volume similarity was 0.94 ± 0.05 %.
Conclusion
The STAR targets transferred from EAM to TPS using both software solutions resulted in nearly identical 3D structures. Both solutions can be used for QA (quality assurance) and EAM-to-TPS transfer of STAR-targets. Semi-automated methods could potentially help to avoid mistargeting in STAR and offer standardized workflows for methodically harmonized treatments.
背景:立体定向心律失常射频消融术(STAR)是一种治疗室性心动过速(VT)的方法,适用于导管消融术不可行或曾经失败的情况。靶点定义及其从电子解剖图(EAM)到放疗治疗计划系统(TPS)的转移具有挑战性,且取决于操作者。目前已开发出软件解决方案,用于将 EAM 与心脏 CT 进行配准,并半自动地将二维靶面数据传输到三维 CT 容积坐标中。本文报告了利用 RAVENTA 试验(NCT03867747)数据对两种概念不同的开源软件解决方案进行交叉验证研究的结果:方法:临床靶区(CTV)是由不同的研究人员使用两种概念不同的方法从 EAM 上划定的靶区创建的,研究人员对 10 名患者的数据进行了研究,他们对彼此的研究结果互不知情。分别使用三维-三维配准和二维-三维配准转移目标。在一个核心实验室中,使用两个互补的分析软件包对所得 CTV 的结构相似性和几何特征进行比较:结果:两种方法生成的 CTV 的体积和表面积相当:14.88 ± 11.72 毫升对 15.15 ± 11.35 毫升,44.29 ± 33.63 平方厘米对 46.43 ± 35.13 平方厘米。Dice 系数为 0.84 ± 0.04;中位表面距离和 Hausdorff 距离分别为 0.53 ± 0.37 毫米和 6.91 ± 2.26 毫米。三维质量中心差为 3.62 ± 0.99 毫米。几何体积相似度为 0.94 ± 0.05 %:使用这两种软件解决方案将 STAR 靶件从 EAM 转移到 TPS 后,其三维结构几乎完全相同。这两种解决方案都可用于 STAR 靶件的 QA(质量保证)和 EAM 到 TPS 传输。半自动化方法可能有助于避免 STAR 靶件的错误定位,并为方法统一的治疗提供标准化的工作流程。
{"title":"Semi-automated reproducible target transfer for cardiac radioablation – A multi-center cross-validation study within the RAVENTA trial","authors":"","doi":"10.1016/j.radonc.2024.110499","DOIUrl":"10.1016/j.radonc.2024.110499","url":null,"abstract":"<div><h3>Background</h3><p>Stereotactic arrhythmia radioablation (STAR) is a therapeutic option for ventricular tachycardia (VT) where catheter-based ablation is not feasible or has previously failed. Target definition and its transfer from electro-anatomic maps (EAM) to radiotherapy treatment planning systems (TPS) is challenging and operator-dependent. Software solutions have been developed to register EAM with cardiac CT and semi-automatically transfer 2D target surface data into 3D CT volume coordinates. Results of a cross-validation study of two conceptually different software solutions using data from the RAVENTA trial (NCT03867747) are reported.</p></div><div><h3>Methods</h3><p>Clinical Target Volumes (CTVs) were created from target regions delineated on EAM using two conceptually different approaches by separate investigators on data of 10 patients, blinded to each other’s results. Targets were transferred using 3D-3D registration and 2D-3D registration, respectively. The resulting CTVs were compared in a core-lab using two complementary analysis software packages for structure similarity and geometric characteristics.</p></div><div><h3>Results</h3><p>Volumes and surface areas of the CTVs created by both methods were comparable: 14.88 ± 11.72 ml versus 15.15 ± 11.35 ml and 44.29 ± 33.63 cm<sup>2</sup> versus 46.43 ± 35.13 cm<sup>2</sup>. The <span>Dice-</span>coefficient was 0.84 ± 0.04; median surface-distance and <span>Hausdorff</span>-distance were 0.53 ± 0.37 mm and 6.91 ± 2.26 mm, respectively. The 3D-center-of-mass difference was 3.62 ± 0.99 mm. Geometrical volume similarity was 0.94 ± 0.05 %.</p></div><div><h3>Conclusion</h3><p>The STAR targets transferred from EAM to TPS using both software solutions resulted in nearly identical 3D structures. Both solutions can be used for QA (quality assurance) and EAM-to-TPS transfer of STAR-targets. Semi-automated methods could potentially help to avoid mistargeting in STAR and offer standardized workflows for methodically harmonized treatments.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024007692/pdfft?md5=7caf28a8639411db03430f07ae26df2e&pid=1-s2.0-S0167814024007692-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146128","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}
Pub Date : 2024-09-03DOI: 10.1016/j.radonc.2024.110500
Background and Purpose
To evaluate the impact of a deep learning (DL)-assisted interactive contouring tool on inter-observer variability and the time taken to complete tumour contouring.
Materials and Methods
Nine clinicians contoured the gross tumour volume (GTV) using the PET-CT scans of 10 non-small cell lung cancer (NSCLC) patients, either using DL-assisted or manual contouring tools. After contouring a case using one contouring method, the same case was contoured one week later using the other method. The contours and time taken were compared.
Results
Use of the DL-assisted tool led to a statistically significant decrease in active contouring time of 23 % relative to the standard manual segmentation method (p < 0.01). The mean observation time for all clinicians and cases made up nearly 60 % of interaction time for both contouring approaches. On average the time spent contouring per case was reduced from 22 min to 19 min when using the DL-assisted tool. Additionally, the DL-assisted tool reduced contour variability in the parts of tumour where clinicians tended to disagree the most, while the consensus contour was similar whichever of the two contouring approaches was used.
Conclusions
A DL-assisted interactive contouring approach decreased active contouring time and local inter-observer variability when used to delineate lung cancer GTVs compared to a standard manual method. Integration of this tool into the clinical workflow could assist clinicians in contouring tasks and improve contouring efficiency.
{"title":"Deep learning-assisted interactive contouring of lung cancer: Impact on contouring time and consistency","authors":"","doi":"10.1016/j.radonc.2024.110500","DOIUrl":"10.1016/j.radonc.2024.110500","url":null,"abstract":"<div><h3>Background and Purpose</h3><p>To evaluate the impact of a deep learning (DL)-assisted interactive contouring tool on inter-observer variability and the time taken to complete tumour contouring.</p></div><div><h3>Materials and Methods</h3><p>Nine clinicians contoured the gross tumour volume (GTV) using the PET-CT scans of 10 non-small cell lung cancer (NSCLC) patients, either using DL-assisted or manual contouring tools. After contouring a case using one contouring method, the same case was contoured one week later using the other method. The contours and time taken were compared.</p></div><div><h3>Results</h3><p>Use of the DL-assisted tool led to a statistically significant decrease in active contouring time of 23 % relative to the standard manual segmentation method (p < 0.01). The mean observation time for all clinicians and cases made up nearly 60 % of interaction time for both contouring approaches. On average the time spent contouring per case was reduced from 22 min to 19 min when using the DL-assisted tool. Additionally, the DL-assisted tool reduced contour variability in the parts of tumour where clinicians tended to disagree the most, while the consensus contour was similar whichever of the two contouring approaches was used.</p></div><div><h3>Conclusions</h3><p>A DL-assisted interactive contouring approach decreased active contouring time and local inter-observer variability when used to delineate lung cancer GTVs compared to a standard manual method. Integration of this tool into the clinical workflow could assist clinicians in contouring tasks and improve contouring efficiency.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024007709/pdfft?md5=8fc6323e4fa571961ec2a84da65d7a36&pid=1-s2.0-S0167814024007709-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140910","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}
Pub Date : 2024-09-03DOI: 10.1016/j.radonc.2024.110521
Purpose
The aim of this secondary analysis of the prospective randomized phase 2 PET-Plan trial (ARO-2009-09; NCT00697333) was to evaluate the impact of mediastinal tumor burden and lymphatic spread in patients with locally advanced non-small-cell lung cancer (NSCLC).
Methods
All patients treated per protocol (n = 172) were included. Patients received isotoxically dose-escalated chemoradiotherapy up to a total dose of 60–74 Gy in 30–37 fractions, aiming as high as possible while adhering to normal tissue constraints. Radiation treatment (RT) planning was based on an 18F-FDG PET/CT targeting all lymph node (LN) stations containing CT positive LNs (i.e. short axis diameter > 10 mm), even if PET-negative (arm A) or targeting only LN stations containing PET-positive nodes (arm B). LN stations were classified into echelon 1 (ipsilateral hilum), 2 (ipsilateral station 4 and 7), and 3 (rest of the mediastinum, contralateral hilum). The endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local progression (FFLP).
Results
The median follow-up time (95 % confidence interval [CI]) was 41.1 (33.8 − 50.4) months. Patients with a high absolute number of PET-positive LN stations had worse OS (hazard ratio [HR] = 1.09; 95 % CI 0.99 − 1.18; p = 0.05) and PFS (HR = 1.12; 95 % CI 1.04 − 1.20; p = 0.003), irrespective of treatment arm allocation. The prescribed RT dose to the LNs did not correlate with any of the endpoints when considering all patients. However, in patients in arm B (i.e., PET-based selective nodal irradiation), prescribed RT dose to each LN station correlated significantly with FFLP (HR=0.45; 95 % CI 0.24–0.85; p = 0.01). Furthermore, patients with involvement of echelon 3 LN stations had worse PFS (HR = 2.22; 95 % CI 1.16–4.28; p = 0.02), also irrespective of allocation.
Conclusion
Mediastinal tumor burden and lymphatic involvement patterns influence outcome in patients treated with definitive chemoradiotherapy for locally advanced NSCLC. Higher dose to LNs did not improve OS, but did improve FFLP in patients treated with PET-based dose-escalated RT.
目的:这项对前瞻性随机 2 期 PET-Plan 试验(ARO-2009-09;NCT00697333)的二次分析旨在评估纵隔肿瘤负荷和淋巴扩散对局部晚期非小细胞肺癌(NSCLC)患者的影响:方法:纳入所有按方案接受治疗的患者(n = 172)。患者接受等毒性剂量递增的化放疗,总剂量为60-74 Gy,分30-37次进行,在遵守正常组织限制的前提下尽量提高剂量。放射治疗(RT)计划以18F-FDG PET/CT为基础,靶向所有含有CT阳性淋巴结(即短轴直径大于10毫米)的淋巴结站,即使PET阴性(A组)或仅靶向含有PET阳性淋巴结的淋巴结站(B组)。LN站被分为第1梯队(同侧腹股沟)、第2梯队(同侧第4和第7站)和第3梯队(纵隔其余部分、对侧腹股沟)。终点为总生存期(OS)、无进展生存期(PFS)和无局部进展(FFLP):中位随访时间(95% 置信区间 [CI])为 41.1 (33.8 - 50.4) 个月。PET阳性LN站绝对数量较多的患者的OS(危险比[HR] = 1.09; 95 % CI 0.99 - 1.18; p = 0.05)和PFS(HR = 1.12; 95 % CI 1.04 - 1.20; p = 0.003)较差,与治疗臂的分配无关。考虑到所有患者,对淋巴结的规定 RT 剂量与任何终点均无相关性。但是,在B组(即基于PET的选择性结节照射)患者中,每个LN站的处方RT剂量与FFLP显著相关(HR=0.45;95 % CI 0.24-0.85;p = 0.01)。此外,第3梯队LN站受累的患者PFS较差(HR = 2.22; 95 % CI 1.16-4.28; p = 0.02),这也与分配无关:结论:纵隔肿瘤负荷和淋巴受累模式会影响局部晚期NSCLC明确化放疗患者的预后。在接受基于 PET 的剂量递增 RT 治疗的患者中,增加淋巴结的剂量并不能改善 OS,但却能改善 FFLP。
{"title":"Impact of mediastinal tumor burden and lymphatic spread in locally advanced non-small-cell lung cancer: A secondary analysis of the multicenter randomized PET-Plan trial","authors":"","doi":"10.1016/j.radonc.2024.110521","DOIUrl":"10.1016/j.radonc.2024.110521","url":null,"abstract":"<div><h3>Purpose</h3><p>The aim of this secondary analysis of the prospective randomized phase 2 PET-Plan trial (ARO-2009-09; NCT00697333) was to evaluate the impact of mediastinal tumor burden and lymphatic spread in patients with locally advanced non-small-cell lung cancer (NSCLC).</p></div><div><h3>Methods</h3><p>All patients treated per protocol (<em>n</em> = 172) were included. Patients received isotoxically dose-escalated chemoradiotherapy up to a total dose of 60–74 Gy in 30–37 fractions, aiming as high as possible while adhering to normal tissue constraints. Radiation treatment (RT) planning was based on an <sup>18</sup>F-FDG PET/CT targeting all lymph node (LN) stations containing CT positive LNs (i.e. short axis diameter > 10 mm), even if PET-negative (arm A) or targeting only LN stations containing PET-positive nodes (arm B). LN stations were classified into echelon 1 (ipsilateral hilum), 2 (ipsilateral station 4 and 7), and 3 (rest of the mediastinum, contralateral hilum). The endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local progression (FFLP).</p></div><div><h3>Results</h3><p>The median follow-up time (95 % confidence interval [CI]) was 41.1 (33.8 − 50.4) months. Patients with a high absolute number of PET-positive LN stations had worse OS (hazard ratio [HR] = 1.09; 95 % CI 0.99 − 1.18; <em>p</em> = 0.05) and PFS (HR = 1.12; 95 % CI 1.04 − 1.20; <em>p</em> = 0.003), irrespective of treatment arm allocation. The prescribed RT dose to the LNs did not correlate with any of the endpoints when considering all patients. However, in patients in arm B (i.e., PET-based selective nodal irradiation), prescribed RT dose to each LN station correlated significantly with FFLP (HR=0.45; 95 % CI 0.24–0.85; <em>p</em> = 0.01). Furthermore, patients with involvement of echelon 3 LN stations had worse PFS (HR = 2.22; 95 % CI 1.16–4.28; <em>p</em> = 0.02), also irrespective of allocation.</p></div><div><h3>Conclusion</h3><p>Mediastinal tumor burden and lymphatic involvement patterns influence outcome in patients treated with definitive chemoradiotherapy for locally advanced NSCLC. Higher dose to LNs did not improve OS, but did improve FFLP in patients treated with PET-based dose-escalated RT.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140911","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}
Pub Date : 2024-09-02DOI: 10.1016/j.radonc.2024.110504
Pierre Blanchard, David Collingridge
{"title":"Call For Papers: Radiotherapy & Oncology and The Lancet Oncology collaboration.","authors":"Pierre Blanchard, David Collingridge","doi":"10.1016/j.radonc.2024.110504","DOIUrl":"https://doi.org/10.1016/j.radonc.2024.110504","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126493","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}