Radiotherapy and Oncology最新文献

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.

Introduction: The observation in preclinical studies that FLASH radiotherapy (FLASH-RT) can spare normal tissues while maintaining its anti-tumoral effect provided the rational for its clinical translation. In this context, this clinical trial presents the first-in-human dose-escalation trial of FLASH-RT.

Materials and methods: This phase I clinical trial enrolled patients presenting progressive melanoma with cutaneous metastases refractory to systemic treatment. A 3 + 3 dose-escalation design was used to determine the maximum tolerated dose (MTD), starting at 22 Gy and escalating in 2 Gy increments up to 28 Gy. Dose-limiting toxicity (DLT) was defined as any Grade ≥ 3 adverse event occurring in the irradiated field within 4 weeks post-RT. FLASH-RT was delivered using a 9 MeV Mobetron (IntraOp, USA) at a dose rate exceeding 200 Gy/s, delivered in 10 pulses over 90 ms. For all patients, dosimetry was performed using alanine, thermoluminescent dosimeters (TLD), and films.

Results: Between June 2021 and September 2024, 11 patients were enrolled, with 15 lesions treated in 10 out of these patients. One patient was enrolled at two different dose levels for distinct lesions. The trial initially aimed to dose escalation up to 34 Gy but was discontinued after completing of dose level 28 Gy due to slow accrual. No DLTs were observed at any of the administered dose levels (22-28 Gy), and the MTD was not reached.

Conclusion: Dose escalation of FLASH-RT delivered in a single fraction up to 28 Gy did not induce DLTs in the irradiation field, indicating a favorable tolerance of human tissue to the acute effects of FLASH-RT.

Purpose: The international PORTEC-4a trial demonstrated that individualised adjuvant-treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant-treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes.

Patients and methods: Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant-treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data.

Results: All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile-arm and 197 in standard-arm. QALYs were comparable (p = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile-arm compared to standard-arm (€11,898 vs €13,047, p = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile-arm (€9,995 vs €11,926, p < 0.01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, p = 0.17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective.

Conclusion: Individualised adjuvant-treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.

Purpose: Treatment for locally advanced cervical cancer (LACC), and especially brachytherapy, can be physically and psychologically demanding for patients. The IMPRaCC study (Impact of primary Radiotherapy on the psychosocial well-being of patients with LACC) aimed to investigate risk factors, peak moments of distress, and unmet needs.

Material and methods: Analyses of EORTC-C30 questionnaires in a cohort of LACC patients (2019-2024) were combined with semi-structured interviews 4-16 weeks post-treatment. Questionnaires were collected at baseline, during treatment, and regularly throughout follow-up up to two years. Linear-mixed models evaluated changes in scores from baseline. Scores were also compared to a healthy reference population. Logistic regression identified factors associated with deteriorations in emotional (EF) and social functioning (SF) and fatigue during treatment and follow-ups. Interviews were evaluated using thematic analyses.

Results: Among 142 LACC patients, baseline EF and SF were impaired compared to the reference population during treatment, but improved in follow-up. Deteriorations in EF, SF and fatigue were more frequent during treatment (18.6%, 48.8%, 62.8%) than follow-up (10.4%, 25%, 34.4%). Psychiatric history was associated with worse SF during treatment, while being in a relationship and psychological support were protective factors. Brachytherapy delivered in four vs. three fractions seemed to be associated with worse EF, SF and fatigue. Interviews with 13 patients revealed emotional distress, especially before brachytherapy, and need for clear and consistent communication across multiple healthcare professionals.

Conclusion: Psychiatric history assessments, psychological support, and consistent communication support tailored care for LACC patients. Brachytherapy regimens of three fractions may further reduce psychosocial distress.

Climate change, pollution, and resource depletion pose significant challenges to modern society, including the healthcare sector. While the delivery of health services inherently entails energy and resource utilization, the health care sector has a relevant role to play for sustainable development, since it is estimated to account for approximately 4.7% of total greenhouse gas emissions in the EU whilst also contributing to natural resource depletion, toxic chemical release, and the generation of non-compostable waste. In response, the European Society for Radiotherapy and Oncology (ESTRO) established the Green Task Force in 2022 to support the development of a strategic framework, which integrates environmental sustainability into ESTRO's activities. This position paper presents ESTRO's principles for environmental sustainability, which focus on four key areas: (1) raising awareness and sharing best practices, (2) monitoring the environmental impact of ESTRO's activities, (3) evaluating interventions to reduce carbon emissions and improve the environmental sustainability of ESTRO activities, and (4) embedding sustainability into governance and professional activities. Examples of strategies which can reduce climate impact of ESTRO activities include advocating for environmentally conscious radiotherapy practices, considering venues that facilitate shorter travelling for participants in ESTRO conferences and educational activities, promoting digital participation, facilitating sustainable travel options and promoting healthy lifestyle. By emphasizing sustainability, ESTRO aims to lead the radiation oncology community toward a more environmentally responsible future, balancing scientific progress with climate-conscious practices. This initiative aligns with global sustainability goals and underscores the role of oncology professionals in addressing the climate crisis.

Background and purpose: Proton therapy offers potentially improved normal tissue sparing compared to photon-based whole-pelvic radiotherapy (WPRT) for high-risk prostate cancer, but its sensitivity to anatomical and setup variations raises concerns about robustness. The aim of this study was - within the setting of a multicentre randomised clinical trial - to explore whether the dose-volume advantages of proton therapy persisted when subject to inter-fractional variation.

Materials and methods: Five patients treated with WPRT at a national proton centre were included. Comparative photon plans were created independently by five photon therapy centres. Nominal proton and photon plans were evaluated alongside recalculated plans on two repeat computed tomography scans per patient and with robustness scenarios simulating geometric uncertainties. Dose-volume metrics for target volumes and normal tissues were compared between the two modalities using linear mixed effects models accounting for patient and centre variability.

Results: Target coverage was consistently robust for both modalities across all plan types. Proton therapy resulted in significantly reduced bowel V_35Gy by 11.2 percentage points (95% CI [4.1:18.4], p = 0.01) and bowel mean dose by 13.9  Gy (95% CI [9.5:18.4], p < 0.001). Bladder mean dose was also lower with proton therapy (reduced by 18.4  Gy, p = 0.02). These advantages remained consistent across nominal, recalculated, and uncertainty scenario plans. No consistent modality-related differences were observed for high-dose normal tissue metrics.

Conclusion: Within this robustness-inclusive multicentre comparison study, proton-based WPRT maintained target coverage comparable to photon therapy and consistently reduced low- and intermediate-dose exposure to normal tissues, while demonstrating preserved robustness under the influence of inter-fractional variation.

Background and purpose: Patients with renal cell carcinoma (RCC) in a solitary kidney have limited treatment options. Stereotactic MRI-guided adaptive radiotherapy (SMART) offers a non-invasive alternative that preserves healthy kidney tissue. This study evaluated the clinical outcomes of SMART in patients with renal tumors in a solitary kidney. Oncological outcomes, renal function preservation, and treatment-related toxicity were assessed.

Materials and methods: All consecutive patients with RCC in a solitary kidney treated with SMART between 2018 and 2024 in a single center were analyzed. Local control was defined as any response or stable disease using RECIST criteria. Kaplan-Meier analysis was used for survival outcomes and paired t-tests assessed renal function changes.

Results: Thirty-two patients with a median age of 70 years were included. Most patients had WHO status 0-1 (93.8%) and had prior nephrectomy for RCC (78.1%). Median tumor size was 4.2 cm, and median pre-treatment eGFR was 45.8 ml/min. Seven patients were treated for multiple lesions, in simultaneous or separate sessions. Most patients were treated in a single (22.8%) or five (74.3%) fractions. After a median follow-up of 21.3 months, the local control rates at 1 and 2 years were 96.2% and 90.1%, respectively. Mean eGFR change was -6.6 ml/min, none required dialysis. No grade ≥ 3 toxicity was observed. The overall survival rate at 2 years was 80.9%.

Conclusion: SMART provides high local control with minimal impact on renal function, offering a non-invasive, kidney-sparing treatment option that also enables repeated treatments within the solitary kidney.