Pub Date : 2024-11-19DOI: 10.1016/j.radonc.2024.110639
Marcin Kubeczko , Dorota Gabryś , Justyna Rembak-Szynkiewicz , Donata Gräupner , Anna Polakiewicz-Gilowska , Michał Jarząb
Background
In patients diagnosed with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, bone metastases emerge as the primary site of significant tumor burden. Cyclin-dependent kinase 4/6 (CDK4/6i) inhibitors are the gold standard in this clinical scenario, while radiotherapy (RT) represents a valuable addition. However, data on the efficacy of this combination remain scarce. We aimed to evaluate efficacy of RT in bone metastatic breast cancer patients treated with CDK4/6 inhibitors.
Materials and methods
398 patients (pts) with ER-positive HER2-negative breast cancer with bone metastases treated with CDK4/6i between 2018–2024 were analyzed. A total of 114 pts received 177 bone RT concurrently with CDK4/6i or within 6 months before CDK4/6i initiation, including 34 courses of stereotactic-body RT and 143 courses of conventional RT.
Results
The median progression-free survival (PFS) in pts who received bone RT was 31.0 months, compared to 26.3 months in pts without bone RT. The 2-y PFS for pts with bone RT was 57.1 % [95 % CI: 46.3–66.6 %] vs. 53.2 % [95 % CI: 46.3–59.6 %] for patients without bone RT (p = 0.51). The median overall survival (OS) for pts who received bone RT was 49.1 months, compared to 40.5 months for pts without bone RT. The 3-y OS for pts with bone RT was 63.7 % [95 % CI: 51.5–73.5 %] vs. 55.0 % [95 % CI 46.6–62.6 %] for pts without bone RT (p = 0.50). The 3-y local control for irradiated patients was 86.9 % [95 % CI 72.2–94.1 %].
Conclusions
In this study, we present the largest cohort published to date of breast cancer patients who received CDK4/6i alongside bone-directed RT. Although the observed differences in survival were not statistically significant, RT remains a viable treatment modality in metastatic breast cancer in some patients.
{"title":"Efficacy of radiotherapy for bone metastasis in breast cancer patients treated with cyclin-dependent kinase 4/6 inhibitors","authors":"Marcin Kubeczko , Dorota Gabryś , Justyna Rembak-Szynkiewicz , Donata Gräupner , Anna Polakiewicz-Gilowska , Michał Jarząb","doi":"10.1016/j.radonc.2024.110639","DOIUrl":"10.1016/j.radonc.2024.110639","url":null,"abstract":"<div><h3>Background</h3><div>In patients diagnosed with<!--> <!-->estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, bone metastases<!--> <!-->emerge as the<!--> <!-->primary site<!--> <!-->of<!--> <!-->significant tumor burden. Cyclin-dependent kinase 4/6 (CDK4/6i) inhibitors<!--> <!-->are the<!--> <!-->gold standard in this clinical scenario, while radiotherapy (RT) represents a valuable addition. However, data on the efficacy of this combination remain scarce. We aimed to evaluate efficacy of RT in bone metastatic breast cancer patients treated with CDK4/6 inhibitors.</div></div><div><h3>Materials and methods</h3><div>398 patients (pts) with ER-positive HER2-negative breast cancer with bone metastases treated with CDK4/6i between 2018–2024 were analyzed. A total of 114 pts received 177 bone RT concurrently with CDK4/6i or within 6 months before CDK4/6i initiation, including 34 courses of stereotactic-body RT and 143 courses of conventional RT.</div></div><div><h3>Results</h3><div>The median progression-free survival (PFS) in pts who received bone RT was 31.0 months, compared to 26.3 months in pts without bone RT. The 2-y PFS for pts with bone RT was 57.1 % [95 % CI: 46.3–66.6 %] vs. 53.2 % [95 % CI: 46.3–59.6 %] for patients without bone RT (p = 0.51). The median overall survival (OS) for pts who received bone RT was 49.1 months, compared to 40.5 months for pts without bone RT. The 3-y OS for pts with bone RT was 63.7 % [95 % CI: 51.5–73.5 %] vs. 55.0 % [95 % CI 46.6–62.6 %] for pts without bone RT (p = 0.50). The 3-y local control for irradiated patients was 86.9 % [95 % CI 72.2–94.1 %].</div></div><div><h3>Conclusions</h3><div>In this study, we present the largest cohort published to date of breast cancer patients who received CDK4/6i alongside bone-directed RT. Although the observed differences in survival were not statistically significant, RT remains a viable treatment modality in metastatic breast cancer in some patients.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110639"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682315","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 : 2024-11-16DOI: 10.1016/j.radonc.2024.110642
Cas Stefaan Dejonckheere , Lara Caglayan , Andrea Renate Glasmacher , Shari Wiegreffe , Julian Philipp Layer , Younèss Nour , Davide Scafa , Gustavo Renato Sarria , Simon Spohn , Markus Essler , Stefan Hauser , Manuel Ritter , Marit Bernhardt , Glen Kristiansen , Anca-Ligia Grosu , Constantinos Zamboglou , Eleni Gkika
Purpose
Stereotactic body radiotherapy (SBRT) is emerging as a valuable treatment modality for localized prostate cancer, with promising biochemical progression-free survival rates. Longitudinal assessment of prostate-specific antigen (PSA) is the mainstay of follow-up after treatment. PSA kinetics and dynamics are well-established in the context of brachytherapy and conventionally fractionated radiotherapy, yet little is known in the context of prostate SBRT.
Methods
A review of available literature in MEDLINE, Scopus, and Embase was performed, focusing on studies reporting PSA slope, nadir, bounce, and biochemical failure after prostate SBRT.
Results
Thirty-three records (45 % prospective) encompassing 9949 patients were included. SBRT dose ranged from 32–50 Gy in 4–5 fractions and overall median follow-up time (range) was 41 (15–74) months. Use of androgen deprivation therapy ranged from 0–38 %. SBRT was characterized by a steep initial decline of PSA, slowing down over time and ultimately yielding a lower nadir in comparison with conventional radiotherapy, with a median value (range) of 0.24 (0.1–0.6) ng/mL after a median time (range) of 33.1 (6–54) months. There was an inverse correlation between the highest SBRT dose in a trial and PSA nadir (r = − 0.59; p < 0.001). Benign PSA bounce occurred in 30 % of patients across all studies, after a median time (range) of 14.8 (9–36) months and with a median size (range) of 0.5 (0.3–1.1) ng/mL. There was no significant correlation between bounce and dose, nadir nor biochemical failure. There was, however, a significant inverse correlation between ADT use and PSA bounce frequency (r = −0.49; p = 0.046).
Conclusion
PSA kinetics and dynamics after SBRT for localized prostate cancer are different from those in other established radiotherapy modalities. Benign PSA bounce is very common. Clinicians should be aware of these factors and patients should be counseled accordingly, preventing unnecessary distress or salvage treatment.
{"title":"Prostate-specific antigen kinetics after stereotactic body radiotherapy for localized prostate cancer: A scoping review and meta-analysis","authors":"Cas Stefaan Dejonckheere , Lara Caglayan , Andrea Renate Glasmacher , Shari Wiegreffe , Julian Philipp Layer , Younèss Nour , Davide Scafa , Gustavo Renato Sarria , Simon Spohn , Markus Essler , Stefan Hauser , Manuel Ritter , Marit Bernhardt , Glen Kristiansen , Anca-Ligia Grosu , Constantinos Zamboglou , Eleni Gkika","doi":"10.1016/j.radonc.2024.110642","DOIUrl":"10.1016/j.radonc.2024.110642","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic body radiotherapy (SBRT) is emerging as a valuable treatment modality for localized prostate cancer, with promising biochemical progression-free survival rates. Longitudinal assessment of prostate-specific antigen (PSA) is the mainstay of follow-up after treatment. PSA kinetics and dynamics are well-established in the context of brachytherapy and conventionally fractionated radiotherapy, yet little is known in the context of prostate SBRT.</div></div><div><h3>Methods</h3><div>A review of available literature in MEDLINE, Scopus, and Embase was performed, focusing on studies reporting PSA slope, nadir, bounce, and biochemical failure after prostate SBRT.</div></div><div><h3>Results</h3><div>Thirty-three records (45 % prospective) encompassing 9949 patients were included. SBRT dose ranged from 32–50 Gy in 4–5 fractions and overall median follow-up time (range) was 41 (15–74) months. Use of androgen deprivation therapy ranged from 0–38 %. SBRT was characterized by a steep initial decline of PSA, slowing down over time and ultimately yielding a lower nadir in comparison with conventional radiotherapy, with a median value (range) of 0.24 (0.1–0.6) ng/mL after a median time (range) of 33.1 (6–54) months. There was an inverse correlation between the highest SBRT dose in a trial and PSA nadir (<em>r</em> = − 0.59; <em>p</em> < 0.001). Benign PSA bounce occurred in 30 % of patients across all studies, after a median time (range) of 14.8 (9–36) months and with a median size (range) of 0.5 (0.3–1.1) ng/mL. There was no significant correlation between bounce and dose, nadir nor biochemical failure. There was, however, a significant inverse correlation between ADT use and PSA bounce frequency (<em>r</em> = −0.49; <em>p</em> = 0.046).</div></div><div><h3>Conclusion</h3><div>PSA kinetics and dynamics after SBRT for localized prostate cancer are different from those in other established radiotherapy modalities. Benign PSA bounce is very common. Clinicians should be aware of these factors and patients should be counseled accordingly, preventing unnecessary distress or salvage treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110642"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668798","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 : 2024-11-16DOI: 10.1016/j.radonc.2024.110643
Emma Skarsø Buhl , Lasse Hindhede Refsgaard , Sami Aziz-Jowad Al-Rawi , Karen Andersen , Martin Berg , Kristian Boye , Ingelise Jensen , Ebbe Laugaard Lorenzen , Else Maae , Maja Vestmø Maraldo , Louise Wichmann Matthiessen , Marie Louise Milo , Mette Holck Nielsen , Abhilasha Saini , Esben Yates , Birgitte Vrou Offersen , Stine Sofia Korreman
Background and purpose
In this study, we conducted a population-based retrospective audit of heart doses for high-risk breast cancer (BC) over a nine-year period in patients treated with adjuvant CT-based radiotherapy in a comprehensive and homogenized national BC cohort. Additionally, this serves as a demonstration of performing large scale audits with consistent delineations created by an auto-segmentation tool.
Materials and methods
High-risk BC patients treated with adjuvant radiotherapy in the period 2008–2016 from all seven radiotherapy centres in Denmark were included. A homogenized cohort was created using an inhouse developed auto-segmentation tool. The homogenized cohort volume and planned doses (mean heart dose (MHD), V20Gy and V40Gy) were evaluated. Volumes and dose metrics were compared for clinical and homogenized heart volumes.
Results
Among 6925 patients, 5589(81 %) had a clinical heart delineation. The median delineated heart volume increased from 531.9 ml (2008) to 638.5 ml (2016) (p < 0.01). The median MHD for the homogenized cohort was 1.58 Gy (2008–2016) with an overall decreasing trend, 2.14 Gy in left- and 1.08 Gy in right-sided patients. The median MHD in the clinically delineated hearts was 0.01 Gy lower than the planned median MHD in the homogenized cohort.
Conclusion
During 2008–2016 the planned heart dose has been low across the population. A volume increase was observed in the clinically delineated hearts, however the median MHD in the homogenized cohort was low, with 1.58 Gy. The study demonstrated the possibilities for full population-based and consistent dose audit by using auto-segmentation tools.
{"title":"Population based audit of heart radiation doses in 6925 high-risk breast cancer patients from the Danish breast cancer group RT Nation study","authors":"Emma Skarsø Buhl , Lasse Hindhede Refsgaard , Sami Aziz-Jowad Al-Rawi , Karen Andersen , Martin Berg , Kristian Boye , Ingelise Jensen , Ebbe Laugaard Lorenzen , Else Maae , Maja Vestmø Maraldo , Louise Wichmann Matthiessen , Marie Louise Milo , Mette Holck Nielsen , Abhilasha Saini , Esben Yates , Birgitte Vrou Offersen , Stine Sofia Korreman","doi":"10.1016/j.radonc.2024.110643","DOIUrl":"10.1016/j.radonc.2024.110643","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In this study, we conducted a population-based retrospective audit of heart doses for high-risk breast cancer (BC) over a nine-year period in patients treated with adjuvant CT-based radiotherapy in a comprehensive and homogenized national BC cohort. Additionally, this serves as a demonstration of performing large scale audits with consistent delineations created by an auto-segmentation tool.</div></div><div><h3>Materials and methods</h3><div>High-risk BC patients treated with adjuvant radiotherapy in the period 2008–2016 from all seven radiotherapy centres in Denmark were included. A homogenized cohort was created using an inhouse developed auto-segmentation tool. The homogenized cohort volume and planned doses (mean heart dose (MHD), V20Gy and V40Gy) were evaluated. Volumes and dose metrics were compared for clinical and homogenized heart volumes.</div></div><div><h3>Results</h3><div>Among 6925 patients, 5589(81 %) had a clinical heart delineation. The median delineated heart volume increased from 531.9 ml (2008) to 638.5 ml (2016) (p < 0.01). The median MHD for the homogenized cohort was 1.58 Gy (2008–2016) with an overall decreasing trend, 2.14 Gy in left- and 1.08 Gy in right-sided patients. The median MHD in the clinically delineated hearts was 0.01 Gy lower than the planned median MHD in the homogenized cohort.</div></div><div><h3>Conclusion</h3><div>During 2008–2016 the planned heart dose has been low across the population. A volume increase was observed in the clinically delineated hearts, however the median MHD in the homogenized cohort was low, with 1.58 Gy. The study demonstrated the possibilities for full population-based and consistent dose audit by using auto-segmentation tools.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110643"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668789","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 : 2024-11-16DOI: 10.1016/j.radonc.2024.110640
Martin C. Tom , Seema Nagpal , Joshua D. Palmer , William G. Breen , Erqi L. Pollom , Eric J. Lehrer , Tresa M. McGranahan , Kevin Shiue , Anupama Chundury , Shearwood McClelland III , Hina Saeed , Eric L. Chang , Veronica L.S. Chiang , Tony J.C. Wang , Jonathan P.S. Knisely , Samuel T. Chao , Michael T. Milano
The ARS brain committee recommends that vorasidenib may be appropriate for recurrent or residual IDH-mutant grade 2 oligodendroglioma or astrocytoma. Vorasidenib is usually not appropriate for completely resected grade 2 oligodendroglioma or astrocytoma, any grade 3 oligodendroglioma or astrocytoma, or combined with radiotherapy and/or chemotherapy for any grade 2–3 glioma.
{"title":"An update to the American Radium Society’s appropriate use criteria of lower grade gliomas: Integration of IDH inhibitors","authors":"Martin C. Tom , Seema Nagpal , Joshua D. Palmer , William G. Breen , Erqi L. Pollom , Eric J. Lehrer , Tresa M. McGranahan , Kevin Shiue , Anupama Chundury , Shearwood McClelland III , Hina Saeed , Eric L. Chang , Veronica L.S. Chiang , Tony J.C. Wang , Jonathan P.S. Knisely , Samuel T. Chao , Michael T. Milano","doi":"10.1016/j.radonc.2024.110640","DOIUrl":"10.1016/j.radonc.2024.110640","url":null,"abstract":"<div><div>The ARS brain committee recommends that vorasidenib <em>may be appropriate</em> for recurrent or residual IDH-mutant grade 2 oligodendroglioma or astrocytoma. Vorasidenib is <em>usually not appropriate</em> for completely resected grade 2 oligodendroglioma or astrocytoma, any grade 3 oligodendroglioma or astrocytoma, or combined with radiotherapy and/or chemotherapy for any grade 2–3 glioma.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110640"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668786","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 : 2024-11-16DOI: 10.1016/j.radonc.2024.110626
Jennifer Le Guévelou , Luca Nicosia , Pierre Blanchard , Flavien Ralite , Xavier Durand , Vincent Marchesi , Guilhem Roubaud , Paul Sargos
Seminoma is a highly curable disease; therefore, long-term morbidity of oncological treatment represents a crucial stake. In view of the considerable advances made in radiotherapy in the past decade, we aim to shed light on current and future strategies that hold promises for the management of stage II seminoma.
精原细胞瘤是一种高度可治愈的疾病；因此，肿瘤治疗的长期发病率关系重大。鉴于放射治疗在过去十年中取得了长足的进步，我们旨在阐明目前和未来有望治疗 II 期精索瘤的策略。
{"title":"Radiation therapy for stage IIA/IIB seminomas: Back to the future?","authors":"Jennifer Le Guévelou , Luca Nicosia , Pierre Blanchard , Flavien Ralite , Xavier Durand , Vincent Marchesi , Guilhem Roubaud , Paul Sargos","doi":"10.1016/j.radonc.2024.110626","DOIUrl":"10.1016/j.radonc.2024.110626","url":null,"abstract":"<div><div>Seminoma is a highly curable disease; therefore, long-term morbidity of oncological treatment represents a crucial stake. In view of the considerable advances made in radiotherapy in the past decade, we aim to shed light on current and future strategies that hold promises for the management of stage II seminoma.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110626"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668800","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 : 2024-11-14DOI: 10.1016/j.radonc.2024.110625
Chong-jie Zhang
{"title":"Comment on “Analysis of re-recurrent rectal cancer after curative treatment of locally recurrent rectal cancer”","authors":"Chong-jie Zhang","doi":"10.1016/j.radonc.2024.110625","DOIUrl":"10.1016/j.radonc.2024.110625","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110625"},"PeriodicalIF":4.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639670","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 : 2024-11-14DOI: 10.1016/j.radonc.2024.110622
Jane Jomy , Rachel Lu , Radha Sharma , Ke Xin Lin , David C. Chen , Jeff Winter , Srinivas Raman
Background
Radiotherapy peer review is recognized as a key component of institutional quality assurance, though the impact is ill-defined. We conducted the first systematic review and meta-analysis to date to quantify the impact of institutional peer review on the treatment planning workflow including radiotherapy contours, prescription and dosimetry.
Methods
We searched several medical and healthcare databases from January 1, 2000, to May 25, 2024, for papers that report on the impact of institutional radiotherapy peer review on treatment plans. We conducted random-effects meta-analyses of proportions to summarize the rates of any change recommendation and major change recommendation (suggesting re-planning or re-simulation due to safety concerns) following peer review processes. To explore differences in change recommendations dependent on location, radiotherapy intent, technique, and peer review structure characteristics, we conducted analyses of variance.
Results
Of 9,487 citations, we identified 55 studies that report on 96,444 case audits in 10 countries across various disease sites. The pooled proportion of any change recommendation was 28 % (95 %CI = 21–35) and major change recommendation was 12 % (95 %CI = 7–18). Proportions of change recommendation were not impacted by any treatment characteristics. The most common reasons for change recommendation include target volume delineation (25/55; 45 %), target dose prescription (18/55; 33 %), organ at risk dose prescription (5/55; 9 %), and organ at risk volume delineation (3/55; 5 %).
Conclusions
Our review provides evidence that peer review results in treatment plan change recommendations in over one in four patients. The results suggest that some form of real-time, early peer review may be beneficial for all cases, irrespective of treatment intent or RT technique.
{"title":"A systematic review and meta-analysis on the impact of institutional peer review in radiation oncology","authors":"Jane Jomy , Rachel Lu , Radha Sharma , Ke Xin Lin , David C. Chen , Jeff Winter , Srinivas Raman","doi":"10.1016/j.radonc.2024.110622","DOIUrl":"10.1016/j.radonc.2024.110622","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy peer review is recognized as a key component of institutional quality assurance, though the impact is ill-defined. We conducted the first systematic review and <em>meta</em>-analysis to date to quantify the impact of institutional peer review on the treatment planning workflow including radiotherapy contours, prescription and dosimetry.</div></div><div><h3>Methods</h3><div>We searched several medical and healthcare databases from January 1, 2000, to May 25, 2024, for papers that report on the impact of institutional radiotherapy peer review on treatment plans. We conducted random-effects <em>meta</em>-analyses of proportions to summarize the rates of any change recommendation and major change recommendation (suggesting re-planning or re-simulation due to safety concerns) following peer review processes. To explore differences in change recommendations dependent on location, radiotherapy intent, technique, and peer review structure characteristics, we conducted analyses of variance.</div></div><div><h3>Results</h3><div>Of 9,487 citations, we identified 55 studies that report on 96,444 case audits in 10 countries across various disease sites. The pooled proportion of any change recommendation was 28 % (95 %CI = 21–35) and major change recommendation was 12 % (95 %CI = 7–18). Proportions of change recommendation were not impacted by any treatment characteristics. The most common reasons for change recommendation include target volume delineation (25/55; 45 %), target dose prescription (18/55; 33 %), organ at risk dose prescription (5/55; 9 %), and organ at risk volume delineation (3/55; 5 %).</div></div><div><h3>Conclusions</h3><div>Our review provides evidence that peer review results in treatment plan change recommendations in over one in four patients. The results suggest that some form of real-time, early peer review may be beneficial for all cases, irrespective of treatment intent or RT technique.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110622"},"PeriodicalIF":4.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639669","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 : 2024-11-12DOI: 10.1016/j.radonc.2024.110619
J. Varlotto , R. Voland , M. DeCamp , J. Khatri , Y. Shweihat , K. Nwanwene , M. Tirona , T. Wright , T. Pacioles , M. Jamil , K. Anwar , J. Bastidas , N. Chowdhury , D. Zander , D. Silbermins , M. Abdallah , J. Flickinger
Introduction
The role of consolidative thoracic and prophylactic brain radiation for extensive stage small cell lung cancer patients is controversial. We investigated the factors associated with the use of any radiation therapy (RT) and whether RT has a benefit to overall survival (OS) in patients receiving any systemic therapy and whether this benefit is the same if Chemotherapy (CT) or chemo-immunotherapy (CT-IO) is used.
Material/Methods
The NCDB database was queried from years 2017–2019. Patients receiving systemic therapy- STX (CT or CT-IO) had to have at least 6 months of follow-up and have no brain metastases at diagnosis. All RT patients had to receive upfront systemic therapy, be treated 2–6 months from diagnosis, and if treated to the brain received 25 Gy in 10 fractions only. Multi-variable analyses (MVA) were used to determine factors associated with OS and selection for any radiation. Propensity matching for factors affecting OS were used to generate Kaplan-Meier OS curves. Log-rank tests were used to determine differences in Kaplan Meier survival curves for the effects of RT on OS.
Results
The total number of patients receiving RT/STX or STX alone as well as their median follow-up (months) were (890, 17.0 mn) and (6898, 14.0mn). The median time to the start of STX and RT were 22.9 days and 152 days, respectively. MVA noted that RT had a greater effect on OS (Thorax, Brain, Both Brain/Thorax – HRs = 0.80, 0.77, 0.70) than other interventions including IO (HR 0.87) and palliative care without RT (HR 1.06). Selection for radiation depended significantly upon factors affecting OS (HR) including lack of liver metastases, females, age and Charlson co-morbidity index, but did not depend upon insurance status, race, or county income/high school graduation rates. Propensity-score matched OS curves noted the same significant effects of RT on OS in those receiving CT +/- IO, CT-IO, and CT alone with HRs of 0.68/0.68/0.68 for thoracic RT, 0.72/0.72/0.70 for brain RT, and 0.60/0.60/0.60 for brain/thoracic RT, respectively.
Conclusions
The patient with extensive stage small cell lung cancer who reach candidacy and receive RT may have a significant improvement in OS compared to the patients treated only with CT or CT-IO. Combined thoracic and prophylactic brain RT seems to be better than either one alone. The impact of radiation whether given to one or two sites may be more beneficial than immunotherapy added to chemotherapy.
{"title":"Role of consolidative thoracic and prophylactic cranial radiation in extensive stage small cell lung cancer in chemo-immunotherapy era","authors":"J. Varlotto , R. Voland , M. DeCamp , J. Khatri , Y. Shweihat , K. Nwanwene , M. Tirona , T. Wright , T. Pacioles , M. Jamil , K. Anwar , J. Bastidas , N. Chowdhury , D. Zander , D. Silbermins , M. Abdallah , J. Flickinger","doi":"10.1016/j.radonc.2024.110619","DOIUrl":"10.1016/j.radonc.2024.110619","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of consolidative thoracic and prophylactic brain radiation for extensive stage small cell lung cancer patients is controversial. We investigated the factors associated with the use of any radiation therapy (RT) and whether RT has a benefit to overall survival (OS) in patients receiving any systemic therapy and whether this benefit is the same if Chemotherapy (CT) or chemo-immunotherapy (CT-IO) is used.</div></div><div><h3>Material/Methods</h3><div>The NCDB database was queried from years 2017–2019. Patients receiving systemic therapy- STX (CT or CT-IO) had to have at least 6 months of follow-up and have no brain metastases at diagnosis. All RT patients had to receive upfront systemic therapy, be treated 2–6 months from diagnosis, and if treated to the brain received 25 Gy in 10 fractions only. Multi-variable analyses (MVA) were used to determine factors associated with OS and selection for any radiation. Propensity matching for factors affecting OS were used to generate Kaplan-Meier OS curves. Log-rank tests were used to determine differences in Kaplan Meier survival curves for the effects of RT on OS.</div></div><div><h3>Results</h3><div>The total number of patients receiving RT/STX or STX alone as well as their median follow-up (months) were (890, 17.0 mn) and (6898, 14.0mn). The median time to the start of STX and RT were 22.9 days and 152 days, respectively. MVA noted that RT had a greater effect on OS (Thorax, Brain, Both Brain/Thorax – HRs = 0.80, 0.77, 0.70) than other interventions including IO (HR 0.87) and palliative care without RT (HR 1.06). Selection for radiation depended significantly upon factors affecting OS (HR) including lack of liver metastases, females, age and Charlson co-morbidity index, but did not depend upon insurance status, race, or county income/high school graduation rates. Propensity-score matched OS curves noted the same significant effects of RT on OS in those receiving CT +/- IO, CT-IO, and CT alone with HRs of 0.68/0.68/0.68 for thoracic RT, 0.72/0.72/0.70 for brain RT, and 0.60/0.60/0.60 for brain/thoracic RT, respectively.</div></div><div><h3>Conclusions</h3><div>The patient with extensive stage small cell lung cancer who reach candidacy and receive RT may have a significant improvement in OS compared to the patients treated only with CT or CT-IO. Combined thoracic and prophylactic brain RT seems to be better than either one alone. The impact of radiation whether given to one or two sites may be more beneficial than immunotherapy added to chemotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110619"},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626026","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 : 2024-11-12DOI: 10.1016/j.radonc.2024.110620
Man-yi Zhu , Hai-jun Wu , Ting Fang , Guang-shun Zhang , Run-da Huang , Lu Zhang , Shun-zhen Lu , Lin Wang , Chong Zhao , Jing-jing Miao
Purpose
To evaluate the risk factor of level Ib lymph node metastasis (LNM) and the clinical outcome of its selectively prophylactic irradiation (pRT) in nasopharyngeal carcinoma (NPC) patients treated with IMRT.
Methods
518 NPC patients receiving radical IMRT were collected. The structures of primary tumor invasions and neck LNM levels were analyzed bilaterally to estimate the risk factors of level Ib LNM. Patients with level Ib LNM and submandibular gland (SMG) invasion received level Ib pRT. The level Ib recurrence-free survival (RFSIb), regional recurrence-free survival (RRFS), and the incidence of ≥ grade 2 xerostomia at 1-year post-IMRT were compared in negative level Ib LNM patients who omitted, received unilateral, or bilateral level Ib pRT.
Results
Thirteen (2.5 %) patients with 18 sides had level Ib LNM. Ipsilateral SMG invasion was an independent risk factor for level Ib LNM. With a median follow-up time of 98.0 months, the 5-year RFSIb, 5-year RRFS and the incidence of xerostomia ≥ grade 2 at 1-year post-IMRT in negative level Ib LNM patients who omitted pRT, received unilateral, bilateral pRT to the level Ib were 99.7 % vs.100 % vs. 97.5 % (P = 0.110), 98.0 % vs. 92.1 % vs. 95.1 % (P = 0.120) and 28.0 % vs. 38.3 % vs. 90.0 % (P < 0.001), respectively.
Conclusions
Our study revealed that ipsilateral SMG invasion was the independent risk factor for the level Ib LNM. Omitting pRT in patients without ipsilateral level Ib LNM and SMG invasion did not increase the RFSIB and RRFS, and reduced the incidence of xerostomia. Further multi-center prospective randomized clinical trial is warranted.
目的：评估接受IMRT治疗的鼻咽癌患者发生Ib级淋巴结转移（LNM）的风险因素及其选择性预防性照射（pRT）的临床疗效。方法：收集了518例接受根治性IMRT治疗的鼻咽癌患者，分析了双侧原发肿瘤侵犯结构和颈部LNM水平，以估计Ib级LNM的风险因素。有Ib级LNM和颌下腺（SMG）侵犯的患者接受了Ib级局部放射治疗。比较了省略、接受单侧或双侧Ib级pRT的阴性Ib级LNM患者的Ib级无复发生存率（RFSIb）、区域无复发生存率（RRFS）和IMRT后1年时≥2级口腔异味的发生率：13例（2.5%）患者的18个侧有Ib级LNM。同侧 SMG 受侵是 Ib 级 LNM 的独立风险因素。中位随访时间为98.0个月，IMRT后5年RFSIb、5年RRFS和Ib级LNM阴性患者在IMRT后1年口腔异味≥2级的发生率分别为99.7% vs.100 97.5 % (P = 0.110)、98.0 % vs. 92.1 % vs. 95.1 % (P = 0.120) 和 28.0 % vs. 38.3 % vs. 90.0 % (P 结论：我们的研究表明，同侧 SMG 受侵是 Ib LNM 水平的独立危险因素。没有同侧Ib级LNM和SMG侵犯的患者放弃pRT不会增加RFSIB和RRFS，并降低了口腔异味的发生率。有必要进一步开展多中心前瞻性随机临床试验。
{"title":"Risk factors of level Ib lymph node metastasis and clinical outcome of its selectively prophylactic irradiation in nasopharyngeal carcinoma: A real-world study","authors":"Man-yi Zhu , Hai-jun Wu , Ting Fang , Guang-shun Zhang , Run-da Huang , Lu Zhang , Shun-zhen Lu , Lin Wang , Chong Zhao , Jing-jing Miao","doi":"10.1016/j.radonc.2024.110620","DOIUrl":"10.1016/j.radonc.2024.110620","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk factor of level Ib lymph node metastasis (LNM) and the clinical outcome of its selectively prophylactic irradiation (pRT) in nasopharyngeal carcinoma (NPC) patients treated with IMRT.</div></div><div><h3>Methods</h3><div>518 NPC patients receiving radical IMRT were collected. The structures of primary tumor invasions and neck LNM levels were analyzed bilaterally to estimate the risk factors of level Ib LNM. Patients with level Ib LNM and submandibular gland (SMG) invasion received level Ib pRT. The level Ib recurrence-free survival (RFS<sub>Ib</sub>), regional recurrence-free survival (RRFS), and the incidence of ≥ grade 2 xerostomia at 1-year post-IMRT were compared in negative level Ib LNM patients who omitted, received unilateral, or bilateral level Ib pRT.</div></div><div><h3>Results</h3><div>Thirteen (2.5 %) patients with 18 sides had level Ib LNM. Ipsilateral SMG invasion was an independent risk factor for level Ib LNM. With a median follow-up time of 98.0 months, the 5-year RFS<sub>Ib</sub>, 5-year RRFS and the incidence of xerostomia ≥ grade 2 at 1-year post-IMRT in negative level Ib LNM patients who omitted pRT, received unilateral, bilateral pRT to the level Ib were 99.7 % vs.100 % vs. 97.5 % (<em>P</em> = 0.110), 98.0 % vs. 92.1 % vs. 95.1 % (<em>P</em> = 0.120) and 28.0 % vs. 38.3 % vs. 90.0 % (<em>P</em> < 0.001), respectively.</div></div><div><h3>Conclusions</h3><div>Our study revealed that ipsilateral SMG invasion was the independent risk factor for the level Ib LNM. Omitting pRT in patients without ipsilateral level Ib LNM and SMG invasion did not increase the RFS<sub>IB</sub> and RRFS, and reduced the incidence of xerostomia. Further multi-center prospective randomized clinical trial is warranted.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110620"},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626025","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 : 2024-11-12DOI: 10.1016/j.radonc.2024.110621
Lin-Wen Huang , Jia-Wei Pan , Bo Li , Wen-xiu Wu , Li Guo , Xin-han Zhou , Xianhai Zhang , Ming-yong Gao , Zhi-feng Xu
Purpose
Three dimensional pulsed continuous arterial spin labeling (3D-pCASL) and incoherent movement within voxels (IVIM) imaging was combined to assess dynamic microscopic structure changes of the hippocampus and temporal lobe white matter (TLWM) of nasopharyngeal carcinoma (NPC) patients post intensity-modulated radiation therapy (IMRT).
Methods
Forty-six patients who were first diagnosed with NPC and underwent IMRT were prospectively enrolled. 3D-CASL and IVIM were performed pre-RT, within 1 week (1 W) post-RT, 3 months (3 M) post-RT, 6 months (6 M) post-RT, and 18 months (18 M) post-RT. Twenty-seven patients completed follow-ups for all time periods, and their data were analyzed. The cerebral flow (CBF) derived from ASL, and apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (F) derived from IVIM of hippocampus and TLWM were analyzed. The quantitative parameters were measured before RT as the baseline, and the corresponding parameter values and change rates at each time point post-RT were compared using the non-parametric Wilcoxon rank sum test.
Results
At 1 W post-RT, CBF showed a significant increase and peaked in both the hippocampus and TLWM (p < 0.05) with change rate of 30.3 % and 24.1 %. In the hippocampus, both D and D* were significantly increased from pre-RT to 6 M post-RT with change rate of 6.66 % and 34.7 %, while D*-values remained significantly higher than pre-RT at 12 months post-RT with change rate of 41.2 %. In the TLWM, the F firstly increased and then decreased, and was significantly decreased from pre-RT to 6 M post-RT with change rate of 20.2 %.
Conclusion
3D-PCASL and IVIM can indirectly reflecting the developmental pattern and molecular mechanism of RT induced brain injury.
{"title":"Evaluation of radiation induced brain injury in nasopharyngeal carcinoma patients based on multi-parameter quantitative MRI: A prospective longitudinal study","authors":"Lin-Wen Huang , Jia-Wei Pan , Bo Li , Wen-xiu Wu , Li Guo , Xin-han Zhou , Xianhai Zhang , Ming-yong Gao , Zhi-feng Xu","doi":"10.1016/j.radonc.2024.110621","DOIUrl":"10.1016/j.radonc.2024.110621","url":null,"abstract":"<div><h3>Purpose</h3><div>Three dimensional pulsed continuous arterial spin labeling (3D-pCASL) and incoherent movement within voxels (IVIM) imaging was combined to assess dynamic microscopic structure changes of the hippocampus and temporal lobe white matter (TLWM) of nasopharyngeal carcinoma (NPC) patients post intensity-modulated radiation therapy (IMRT).</div></div><div><h3>Methods</h3><div>Forty-six patients who were first diagnosed with NPC and underwent IMRT were prospectively enrolled. 3D-CASL and IVIM were performed pre-RT, within 1 week (1 W) post-RT, 3 months (3 M) post-RT, 6 months (6 M) post-RT, and 18 months (18 M) post-RT. Twenty-seven patients completed follow-ups for all time periods, and their data were analyzed. The cerebral flow (CBF) derived from ASL, and apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (F) derived from IVIM of hippocampus and TLWM were analyzed. The quantitative parameters were measured before RT as the baseline, and the corresponding parameter values and change rates at each time point post-RT were compared using the non-parametric Wilcoxon rank sum test.</div></div><div><h3>Results</h3><div>At 1 W post-RT, CBF showed a significant increase and peaked in both the hippocampus and TLWM (p < 0.05) with change rate of 30.3 % and 24.1 %. In the hippocampus, both D and D* were significantly increased from pre-RT to 6 M post-RT with change rate of 6.66 % and 34.7 %, while D*-values remained significantly higher than pre-RT at 12 months post-RT with change rate of 41.2 %. In the TLWM, the F firstly increased and then decreased, and was significantly decreased from pre-RT to 6 M post-RT with change rate of 20.2 %.</div></div><div><h3>Conclusion</h3><div>3D-PCASL and IVIM can indirectly reflecting the developmental pattern and molecular mechanism of RT induced brain injury.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110621"},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625537","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}
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