Radiotherapy and Oncology最新文献_第3页

MRI-based multilevel radiomics and transformer features for predicting radiation-induced carotid artery injury after nasopharyngeal carcinoma radiotherapy: A multicenter study 基于mri的多水平放射组学和变压器特征预测鼻咽癌放疗后辐射诱导的颈动脉损伤：一项多中心研究。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-24 DOI: 10.1016/j.radonc.2026.111390

Heng Zhang , Jiangyi Ding , Longzhen Zhang , Jun Li , Mingjun Ding , Liang Li , Xiaoxiao Hou , Wei Chen , Kangkang Sun , Nannan Cao , Ziyi Wang , Kai Xie , Xia He , Xinye Ni

Purpose

To develop and validate an MRI–based fusion model (Rad–SRad–SwinT) integrating conventional radiomics (Rad), subregional radiomics (SRad), and Transformer–derived deep learning features (Swin Transformer, SwinT) to predict post–radiotherapy radiation–induced carotid artery injury (RICAI) in nasopharyngeal carcinoma (NPC).

Materials and methods

In this multicenter retrospective study, 500 NPC patients from four hospitals were allocated to training (n = 274), internal testing (n = 118), and external testing cohorts (n = 108). Rad features were extracted from MRI–defined carotid artery regions of interest, SRad features from K-means–derived subregions, and deep features from a SwinT backbone. Single-source and fusion models were developed. Discrimination (AUC), classification (ACC/SEN/SPE), calibration (Brier score and calibration curves), reclassification (NRI/IDI), and interpretability (SHAP) were assessed.

Results

RICAI was observed in 48.5%, 48.3%, and 54.6% of the training, internal testing, and external testing cohorts, respectively. Among single–source models, SwinT and SRad showed comparable performance, with Rad slightly inferior; all outperformed the clinical model. The fused Rad–SRad–SwinT achieved the best performance, with AUCs of 0.814 (95% CI: 0.737–0.891) in internal testing and 0.871 (95% CI: 0.794–0.932) in external testing, alongside favorable classification in external testing (ACC 0.815, SEN 0.763, SPE 0.878) and good calibration (Brier score 0.148). NRI/IDI analyses indicated significantly improved reclassification versus single-source models. SHAP analyses demonstrated that SwinT-derived features contributed most to model decisions, followed by SRad and Rad, supporting complementary gains from deep semantic representation and subregional heterogeneity quantification.

Conclusion

Integrating multilevel radiomics with Transformer–derived deep learning features enhances prediction of RICAI after NPC radiotherapy and shows promise as a noninvasive risk–stratification tool.

目的：开发并验证基于mri的融合模型（Rad-SRad-SwinT），整合常规放射组学（Rad）、分区域放射组学（SRad）和Transformer衍生的深度学习特征（Swin Transformer, SwinT），以预测鼻咽癌（NPC）放疗后辐射诱导的颈动脉损伤（RICAI）。材料和方法：在这项多中心回顾性研究中，来自四家医院的500名鼻咽癌患者被分配到培训（n = 274）、内部测试（n = 118）和外部测试队列（n = 108）。Rad特征从mri定义的感兴趣的颈动脉区域提取，SRad特征从k均值衍生的子区域提取，深度特征从swt主干提取。建立了单源模型和聚变模型。对判别（AUC）、分类（ACC/SEN/SPE）、校准（Brier评分和校准曲线）、再分类（NRI/IDI）和可解释性（SHAP）进行评估。结果：在培训组、内测组和外测组中，分别有48.5%、48.3%和54.6%的人观察到RICAI。在单源模型中，SwinT和SRad表现相当，Rad略差；均优于临床模型。融合的Rad-SRad-SwinT表现最佳，内测auc为0.814 (95% CI: 0.737-0.891)，外测auc为0.871 (95% CI: 0.794-0.932)，外测分类良好（ACC 0.815, SEN 0.763, SPE 0.878），校准良好（Brier评分0.148）。NRI/IDI分析表明，与单一来源模型相比，重分类有显著改善。SHAP分析表明，swt衍生的特征对模型决策贡献最大，其次是SRad和Rad，支持深度语义表示和次区域异质性量化的互补收益。结论：将多水平放射组学与transformer衍生的深度学习特征相结合，可以增强鼻咽癌放疗后RICAI的预测，有望成为一种无创风险分层工具。

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引用次数: 0

Clinical outcomes of stereotactic MRI-guided adaptive radiotherapy for renal tumors in patients with a solitary kidney. 立体定向mri引导下的适应性放疗治疗孤立肾患者肾肿瘤的临床效果。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-24 DOI: 10.1016/j.radonc.2026.111389

Claire van Vliet, Joyce Caro, Omar Bohoudi, Axel Bex, Daphne Damhoff, Fons J M van den Eertwegh, Niels M Graafland, Brunolf W Lagerveld, Jeroen R A van Moorselaar, Miguel A Palacios, Shyama U Tetar, Sonja Verheijen, Nienke W Weitkamp, Antoinet van der Wel, Patricia J Zondervan, Ben J Slotman, Anna M E Bruynzeel

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.

背景和目的：单侧肾脏肾细胞癌（RCC）患者的治疗选择有限。立体定向mri引导的自适应放疗（SMART）提供了一种非侵入性的选择，可以保留健康的肾组织。本研究评估了SMART在单侧肾肿瘤患者中的临床效果。评估肿瘤预后、肾功能保存和治疗相关毒性。材料和方法：对2018年至2024年在单一中心连续接受SMART治疗的单侧肾细胞癌患者进行分析。根据RECIST标准，局部控制定义为任何反应或稳定的疾病。Kaplan-Meier分析用于生存结果，配对t检验评估肾功能变化。结果：纳入32例患者，中位年龄为70 岁。大多数患者WHO状态为0-1(93.8%)，既往有肾细胞癌切除术（78.1%）。中位肿瘤大小为4.2 cm，治疗前中位eGFR为45.8 ml/min。7名患者同时或分开治疗多发性病变。大多数患者接受单次（22.8%）或五次（74.3%）治疗。中位随访21.3 个月后，1年和2 年的局部控制率分别为96.2%和90.1%。平均eGFR变化为-6.6 ml/min，无需透析。未观察到 ≥ 3级毒性。2 年总生存率为80.9%。结论：SMART提供了高度的局部控制，对肾功能的影响最小，提供了一种无创的、保留肾脏的治疗选择，也可以在孤立肾脏内重复治疗。

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引用次数: 0

Dosimetric assessment of deep learning based organ-at-risk segmentation: insights from the HaN-Seg challenge 基于深度学习的危险器官分割的剂量学评估：来自HaN-Seg挑战的见解。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-23 DOI: 10.1016/j.radonc.2026.111387

Gašper Podobnik , Bulat Ibragimov , Primož Peterlin , Primož Strojan , Tomaž Vrtovec

Background and purpose

To extend the previously reported geometric analysis of HaN-Seg: The Head and Neck Organ-at-Risk CT and MR Segmentation Challenge by integrating a dosimetric evaluation, thereby offering a comprehensive assessment of challenge results with practical insights into their clinical applicability.

Materials and methods

Participating teams of the HaN-Seg challenge were tasked to auto-segment 30 organs-at-risk (OARs) in the head and neck region using paired contrast-enhanced computed tomography and T1-weighted magnetic resonance images. The teams were ranked according to their geometric performance, measured by the Dice similarity coefficient (DSC) and 95th-percentile Hausdorff distance (HD₉₅). Here, we extend this evaluation with a forward dosimetric analysis, also known as dosimetric impact approximation, including the verification of OAR dosimetric restriction compliance, assessment of OAR priority ratings, evaluation of segmentation performance relative to tumor proximity, and correlation analysis between geometric and dosimetric metrics.

Results

All six teams from the previous geometric analysis were assessed for dosimetric performance on the original 14 test cases. Dosimetric analysis revealed minor performance differences among teams, with the best- and worst-performing teams achieving dosimetric compliance in 70.7% and 67.7% of OAR auto-segmentations, respectively. Most teams successfully met priority 1 dosimetric restrictions including the spinal cord, brainstem, optic chiasm, and optic nerves in 11 out of 14 test cases. The lowest compliance rates were observed for the oral cavity and submandibular glands. Correlation analysis revealed no clear relationship between geometric and dosimetric metrics.

Conclusion

The high dosimetric compliance highlights the practical utility of deep learning OAR auto-segmentation methods. Lower compliance for the oral cavity and submandibular glands most probably stems from their proximity to tumors and the corresponding steep dose gradients, where certain dosimetric constraints are inherently challenging to meet in clinical practice, or from the limitations of the forward dosimetric analysis. These findings underpin the critical need for both geometric and dosimetric evaluations of OAR auto-segmentation tools to ensure robust validation. Such a comprehensive assessment will be essential as commercial deep learning tools become increasingly integrated into the radiotherapy planning workflow.

背景和目的：通过整合剂量学评估，扩展先前报道的HaN-Seg：头颈部高危器官CT和MR分割挑战的几何分析，从而对挑战结果进行全面评估，并对其临床适用性进行实际见解。材料和方法：HaN-Seg挑战的参赛团队的任务是使用配对对比增强计算机断层扫描和t1加权磁共振图像对头颈部区域的30个高危器官（OARs）进行自动分割。这些队伍根据他们的几何表现进行排名，通过骰子相似系数（DSC）和第95百分位豪斯多夫距离（HD95）来衡量。在这里，我们通过前向剂量分析扩展了这一评估，也称为剂量影响近似，包括OAR剂量限制依从性的验证，OAR优先级评级的评估，相对于肿瘤邻近的分割性能的评估，以及几何和剂量计量之间的相关性分析。结果：来自先前几何分析的所有六个小组都对原始14个测试用例的剂量学性能进行了评估。剂量学分析显示，团队之间的表现差异较小，表现最好和最差的团队分别在70.7%和67.7%的OAR自动分割中达到剂量学合规。大多数团队在14个测试案例中的11个中成功地满足了包括脊髓、脑干、视交叉和视神经在内的优先级1剂量限制。口腔和颌下腺的依从率最低。相关分析显示几何计量和剂量计量之间没有明确的关系。结论：高剂量依从性突出了深度学习OAR自动分割方法的实用性。口腔和颌下腺的低依从性很可能是由于它们靠近肿瘤和相应的陡剂量梯度，在临床实践中，某些剂量学限制固有地具有挑战性，或者是由于前向剂量学分析的局限性。这些发现支持了对OAR自动分割工具进行几何和剂量学评估的迫切需要，以确保可靠的验证。随着商业深度学习工具越来越多地融入放射治疗计划工作流程，这种全面的评估将是必不可少的。

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引用次数: 0

Outcomes of combined bispecific antibody and radiation therapy in relapsed/refractory hematologic malignancies 双特异性抗体联合放疗治疗复发/难治性恶性血液病的疗效。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-22 DOI: 10.1016/j.radonc.2026.111386

Hazim S. Ababneh , Andrew J. Yee , Noopur S. Raje , Matthew J. Frigault , P.Connor Johnson , Chirayu G. Patel

Bispecific antibodies (BsAbs) are an emerging treatment avenue offering promising outcomes for patients with relapsed or refractory hematologic malignancies, yet little is known about their use in combination with radiation therapy (RT). Therefore, we sought to report early experience combining RT with BsAbs in 26 heavily pretreated patients (LBCL, n = 7; MM, n = 19). A total of 45 irradiated sites were analyzed, including pre-BsAb (n = 15), peri-BsAb (n = 19), and post-BsAb (n = 11), with median follow-up after each RT course of 6.0 months (range, 0.4–21 months). The median dose/fractionation were 20 Gy (range, 4–41.6 Gy) and 5 fractions (range, 1–26 fractions). Eighteen irradiated sites were bulky (≥5 cm). The overall in-field response rate was 95%, and no grade 3–4 RT-related toxicities were reported. These findings suggest that RT can be safely integrated with BsAbs, achieving effective local control and symptom relief, even in bulky disease, and underscore the need for further investigation into their combined therapeutic potential.

双特异性抗体（BsAbs）是一种新兴的治疗途径，为复发或难治性血液恶性肿瘤患者提供了有希望的结果，但对其与放射治疗（RT）联合使用知之甚少。因此，我们试图报告26例重度预处理患者（LBCL, n = 7；MM, n = 19）的早期经验。共分析了45个放疗部位，包括bsab前（n = 15），bsab期（n = 19）和bsab后（n = 11），每个RT疗程后的中位随访时间为6.0 个月（范围为0.4-21 个月）。中位剂量/分次为20 Gy（范围4-41.6 Gy）和5个分数（范围1-26个分数）。18个辐照部位体积较大（≥5 cm）。总体现场反应率为95%，未报告3-4级rt相关毒性。这些研究结果表明，即使在体积较大的疾病中，RT可以安全地与bsab结合，实现有效的局部控制和症状缓解，并强调需要进一步研究它们的联合治疗潜力。

{"title":"Outcomes of combined bispecific antibody and radiation therapy in relapsed/refractory hematologic malignancies","authors":"Hazim S. Ababneh , Andrew J. Yee , Noopur S. Raje , Matthew J. Frigault , P.Connor Johnson , Chirayu G. Patel","doi":"10.1016/j.radonc.2026.111386","DOIUrl":"10.1016/j.radonc.2026.111386","url":null,"abstract":"<div><div>Bispecific antibodies (BsAbs) are an emerging treatment avenue offering promising outcomes for patients with relapsed or refractory hematologic malignancies, yet little is known about their use in combination with radiation therapy (RT). Therefore, we sought to report early experience combining RT with BsAbs in 26 heavily pretreated patients (LBCL, n = 7; MM, n = 19). A total of 45 irradiated sites were analyzed, including pre-BsAb (n = 15), <em>peri</em>-BsAb (n = 19), and post-BsAb (n = 11), with median follow-up after each RT course of 6.0 months (range, 0.4–21 months). The median dose/fractionation were 20 Gy (range, 4–41.6 Gy) and 5 fractions (range, 1–26 fractions). Eighteen irradiated sites were bulky (≥5 cm). The overall in-field response rate was 95%, and no grade 3–4 RT-related toxicities were reported. These findings suggest that RT can be safely integrated with BsAbs, achieving effective local control and symptom relief, even in bulky disease, and underscore the need for further investigation into their combined therapeutic potential.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111386"},"PeriodicalIF":5.3,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044053","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}

引用次数: 0

Secondary outcomes of the TROG 99.03 randomized trial of systemic therapy after involved-field radiotherapy in early-stage follicular lymphoma, including toxicity, relapse and second malignancy data TROG 99.03随机试验早期滤泡性淋巴瘤累及野放疗后全身治疗的次要结局，包括毒性、复发和二次恶性数据。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-22 DOI: 10.1016/j.radonc.2026.111388

Philippa Johnstone , Mathias Bressel , John F. Seymour , Surender Juneja , Haris Ahmad , Michael MacManus

Background and purpose

The recently-updated TROG 99.03/ALLGLow5 multicentre randomised controlled trial showed that long-term progression-free survival (PFS) in early-stage (I-II) follicular lymphoma (ESFL) after involved-field radiotherapy (IFRT) was dramatically improved by adjuvant rituximab-cyclophosphamide/vincristine/prednisolone (R-CVP) but not CVP. Secondary analyses are presented here.

Materials and methods

We analysed toxicity of RT and RT plus systemic therapy, outcomes for discontinuous stage II disease, second malignancy risks, prognostic impact of indeterminate bone marrow (BM) aggregates and the effect of rituximab on histological transformation. BM trephines from 55 patients from the pre-rituximab era were centrally reviewed.

Results

As previously-reported, 150 patients were randomised to IFRT (n = 75) or IFRT plus systemic therapy (n = 75). After 11.3 years median follow-up, IFRT + R-CVP was associated with improved PFS compared to IFRT or IFRT + CVP (HR 0.36, p = 0.01). Short-term RT-related grade I-II toxicity occurred in >90%, but toxicity after >6 months was rare. Worst acute systemic therapy toxicity was G1 (16 patients, G2 31 and G3 20) with 3 grade 3 neuropathies. R-CVP and CVP were equally toxic. Only 2 of 5 patients with non-contiguous stage II relapsed. Of 64 relapsed patients, 39 commenced salvage therapies and 17 had second progressions. Second malignancies showed no relationship to irradiated-volumes or systemic therapy use. Indeterminate BM aggregates did not worsen PFS.

Conclusion

The improvement in PFS, reduced salvage therapy requirements, and prevention of histological transformation with R-CVP outweigh its significant but transient toxicity, supporting its justifiable use. Patients with indeterminate BM lymphoid aggregates or non-contiguous stage II FL may merit consideration for curative-intent treatment.

背景和目的：最近更新的TROG 99.03/ALLGLow5多中心随机对照试验显示，利美昔单抗-环磷酰胺/长春新碱/prednisolone （R-CVP）辅助治疗可显著改善早期（I-II）滤泡性淋巴瘤（ESFL）受病灶放疗（IFRT）后的长期无进展生存期（PFS），但CVP不能改善。本文给出了二次分析。材料和方法：我们分析了RT和RT加全身治疗的毒性、不连续II期疾病的结局、第二次恶性肿瘤的风险、不确定骨髓（BM）聚集物对预后的影响以及利妥昔单抗对组织学转化的影响。我们集中回顾了55例利妥昔单抗前时代患者的骨髓环钻。结果：正如先前报道的那样，150名患者被随机分配到IFRT （n = 75）或IFRT加全身治疗（n = 75）。中位随访11.3 年后，与IFRT或IFRT + CVP相比，IFRT + R-CVP与PFS改善相关（HR 0.36, p = 0.01）。短期rt相关的I-II级毒性发生在>的90%，但>6 个月后的毒性很少见。急性全身治疗毒性最差的是G1（16例，G2 31例，G3 20例），3级神经病变3例。R-CVP和CVP毒性相同。5例非连续II期患者中只有2例复发。64例复发患者中，39例开始挽救治疗，17例出现第二次进展。第二种恶性肿瘤与放射量或全身治疗没有关系。不确定的BM聚集体不会加重PFS。结论：R-CVP对PFS的改善、挽救性治疗需求的减少和组织转化的预防超过了其显著但短暂的毒性，支持其合理使用。BM淋巴细胞聚集不确定或非连续性II期FL患者可能值得考虑治疗目的治疗。

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引用次数: 0

Long-term outcomes from a multicentre study of HDR monotherapy with a single fraction of 19 Gy for localized prostate cancer 一项针对局限性前列腺癌的HDR单药治疗的多中心研究的长期结果：单个分数为19 Gy。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-18 DOI: 10.1016/j.radonc.2026.111385

Wiwatchai Sittiwong , Anna Lydon , James Wylie , Imtiaz Ahmed , Amarnath Challapalli , Peter Hoskin

Objectives

To evaluate long-term clinical outcomes, toxicity, and prognostic factors in patients with localized prostate cancer treated with single-fraction high-dose-rate (HDR) brachytherapy.

Methods

This multicentre retrospective study included patients from five UK centres who received a single 19 Gy HDR brachytherapy fraction under a standardized protocol. Kaplan-Meier estimates were calculated at median 5 and 8 years for biochemical progression-free survival (bPFS), local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Prognostic factors were assessed using Cox regression. Toxicities were graded using CTCAEv3.0. Quality of life (QoL) was evaluated using IPSS, IIEF, and FACT-P questionnaires.

Results

A total of 320 patients were included, with a median follow-up of 94 months. Five- and 8-year rates were: bPFS 77.1%/66.5%, LRFS 96.1%/90.9%, NRFS 98.3%/97.3%, DMFS 95.9%/93.8%, and OS 91.4%/87.0%. Low-risk patients had significantly better bPFS than intermediate and high-risk (HR12.55, 95%CI:1.74–90.05,p = 0.012), though no significant differences were seen in other outcomes. Subcentimetre pelvic lymph nodes on MR scan were associated with poorer bPFS, LRFS, DMFS, and OS. GS ≥ 8 predicted worse OS. Acute and late ≥ grade 2 GU toxicities occurred in 3.1% and 19.3% of patients, respectively; GI toxicities in 0.8% and 1.5%. QoL scores worsened post-treatment: IPSS + 7 points (p < 0.001), IIEF −9 points (p = 0.043), and FACT-P −3 points (p = 0.02) and returned to baseline.

Conclusion

Single-fraction 19 Gy HDR brachytherapy was tolerable and provided disease control, though contemporary practice favors active surveillance for most low-risk patients. For higher-risk disease, a single fraction is not equivalent to standard multifraction regimens, indicating its role should remain limited.

目的：评估局部前列腺癌患者接受单次高剂量率（HDR）近距离放射治疗的长期临床结果、毒性和预后因素。方法：这项多中心回顾性研究纳入了来自五个英国中心的患者，他们在标准化方案下接受了单个19 Gy HDR近距离放疗。Kaplan-Meier估计以5和8 年为中位数计算生化无进展生存期（bPFS）、局部无复发生存期（LRFS）、淋巴结无复发生存期（NRFS）、远处无转移生存期（DMFS）和总生存期（OS）。采用Cox回归评估预后因素。采用CTCAEv3.0进行毒性分级。使用IPSS、IIEF和FACT-P问卷评估生活质量（QoL）。结果：共纳入320例患者，中位随访时间为94 个月。五年和8年率:带通滤波器77.1 % / 66.5 %,探测器96.1 % / 90.9 %,nrf 98.3 % / 97.3 %,出现时间95.9 % / 93.8 %,OS 91.4 % / 87.0 %。低危患者的bPFS明显优于中危和高危患者（HR12.55, 95 %CI1.74-90.05,p = 0.012），但其他结局无显著差异。MR扫描下的亚厘米骨盆淋巴结与较差的bPFS、LRFS、DMFS和OS相关。GS ≥ 8预示OS较差。急性和晚期 ≥ 2级GU毒性分别发生在3.1% %和19.3% %的患者中；胃肠道毒性分别为0.8 %和1.5 %。治疗后生活质量评分恶化：IPSS + 7分（p ）结论：单分数19 Gy HDR近距离治疗是可耐受的，并提供疾病控制，尽管当代实践倾向于对大多数低风险患者进行主动监测。对于高风险疾病，单组分不等同于标准的多组分方案，这表明其作用仍然有限。

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引用次数: 0

Corrigendum to “Prognostic significance of estimated radiation dose to immune cells in cancer patients undergoing thoracic irradiation: A meta-analysis” [Radiother. Oncol. 212 (2025) 111123] “估计辐射剂量对接受胸部放射治疗的癌症患者免疫细胞的预后意义：一项荟萃分析”的更正[Radiother]。美国法典第212(2025)111123条]

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-17 DOI: 10.1016/j.radonc.2026.111381

Chih-Wei Luan , Yao-Te Tsai , Kuan-Yin Chen , Wing-Keen Yap

引用次数: 0

Corrigendum to “Impact of estimated dose of radiation to immune cells (EDRIC) in locally advanced non-small-cell lung cancer: A secondary analysis of the multicenter randomized PET-Plan trial” [Radiother. Oncol. 208 (2025) 110907] “局部晚期非小细胞肺癌中估计辐射剂量对免疫细胞（EDRIC）的影响：多中心随机PET-Plan试验的二次分析”[Radiother]的更正。法令。208 (2025)110907]

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-16 DOI: 10.1016/j.radonc.2026.111382

Cas Stefaan Dejonckheere , Younèss Nour , Jörg Sahlmann , Michael Tobias Engelhart , Abdelkhalek Hammi , Simeon Ari Barth , Tanja Schimek-Jasch , Sonja Adebahr , Markus Hecht , Cornelius Waller , Severin Schmid , Matthias Miederer , Alexander Brose , Harald Binder , Jochem König , Andreas Rimner , Anca-Ligia Grosu , Ursula Nestle , Eleni Gkika

引用次数: 0

Children's outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis. 成神经管细胞瘤儿童质子与光子颅脊髓放射治疗（CURE）的预后：荟萃分析。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-11 DOI: 10.1016/j.radonc.2026.111367

Gustavo A Viani, Ana Carolina Hamamura, Caio Viani Arruda, Carlos E Cardoso, Helio A Salmon, Gustavo O Amaral

Objective: To compare the efficacy and toxicity of craniospinal irradiation (CSI) with proton (PBT) versus photon (PHT) therapy in pediatric patients with medulloblastoma, evaluating overall survival (OS), growth hormone deficiency (GHD), hypothyroidism, neurocognitive decline, and ototoxicity.

Materials and methods: A systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Retrospective or prospective cohort studies comparing PBT versus PHT-CSI in children (<21 years) with medulloblastoma were included. Outcomes were OS, GHD, hypothyroidism, neurocognitive decline (full-scale IQ), and ototoxicity (grade ≥ 3). Data from 12 studies were extracted and analyzed using a fixed-effects model, calculating risk ratios (RR) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed with Cochran's Q test and I2 statistic.

Results: Ten cohort studies were included (no randomized trials), including 1034 patients (PBT = 537 and PHT = 497). No difference in OS was observed (RR: 0.984; 95 % CI: 0.902-1.073; p = 0.7118; I² = 0 %). PBT significantly reduced GHD (RR: 0.379; p < 0.001, NNT = 2), hypothyroidism (RR: 0.256; p < 0.001, NNT = 2), and neurocognitive decline (SMD: 0.708; p = 0.0001, NNT = 5), with no difference in grade ≥ 3 ototoxicity (RR: 0.88; p = 0.5704). Grade ≤ 2 ototoxicity was increased with PHT (RR: 1.15; p = 0.01, NNT = 15).

Conclusion: PBT-CSI provides equivalent survival to PHT-CSI while significantly reducing GHD, hypothyroidism, mild ototoxicity, and neurocognitive toxicities in children with medulloblastoma. These findings support the preferential use of PBT to minimize long-term sequelae, though prospective studies are needed to confirm benefits and assess cost-effectiveness.

目的：比较质子（PBT）与光子（PHT）治疗颅脑脊髓照射（CSI）对小儿髓母细胞瘤患者的疗效和毒性，评估总生存期（OS）、生长激素缺乏症（GHD）、甲状腺功能减退、神经认知能力下降和耳毒性。材料和方法：系统回顾和荟萃分析遵循PRISMA和Cochrane指南。比较PBT与PHT- csi在儿童中的回顾性或前瞻性队列研究(结果：纳入10项队列研究（无随机试验），包括1034例患者（PBT = 537,PHT = 497）。两组OS无差异（RR: 0.984; 95 % CI: 0.902-1.073; p = 0.7118;I2 = 0 %）。结论：PBT- csi在显著降低髓母细胞瘤患儿GHD、甲状腺功能减退、轻度耳毒性和神经认知毒性的同时，提供了与PHT-CSI相当的生存期。这些发现支持优先使用PBT以尽量减少长期后遗症，尽管需要前瞻性研究来确认益处和评估成本效益。

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引用次数: 0

AI-based assessment of brain volume decrease after treatment with stereotactic radiosurgery versus whole brain radiotherapy 基于人工智能的立体定向放射治疗与全脑放疗后脑容量减少的评估。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-10 DOI: 10.1016/j.radonc.2026.111377

Frederic Thiele , Maria Kawula , Sophie Katzendobler , Robert Forbrig , Christopher Kurz , Florian Ringel , Sebastian H. Maier , Sebastian N. Marschner , Klaus Belka , Guillaume Landry , Maximilian Niyazi , Raphael Bodensohn , Jonathan Weller

Background

Radiotherapy is a cornerstone in the treatment of brain metastases, but its mid- and long-term impact on brain parenchyma remains poorly understood. This study aimed to assess the differential volumetric alterations in the brain following two different modalities of Radiotherapy-Stereotactic Radiosurgery (SRS) and Whole-Brain Radiotherapy (WBRT).

Methods

Patients treated with SRS were drawn from the prospective dataset of the STEREOBRAIN study (DRKS00014694) that recruited patients with 4–10 brain metastases from 2017 to 2020. Patients that had received WBRT for the treatment of 4–10 brain metastases from 2012 to 2017 were included retrospectively. Patients with clinical and radiographic signs of hydrocephalus were excluded. Volumetric analysis of CSF space was implemented as a measure of brain volume decrease. Images were registered to MNI305 space and segmented by a pretrained UNesT artificial network.

Results

Overall, 59 patients were included. 29 patients received SRS and 30 WBRT respectively. The ventricular system volume increased significantly in both SRS (p-value 0.014) and WBRT (p-value < 0.0001) groups. In the WBRT group, ventricular enlargement was more pronounced, both in absolute and ventricle-brain-ratio terms (p-value < 0.0001). WBRT was associated with significantly larger increases in ventricular volume than SRS, both in absolute (p = 0.0127) and relative (p = 0.0017) terms.

Conclusion

Radiotherapy is associated with a decrease in brain volume, which seems be less pronounced in patients treated with SRS as compared to WBRT. The clinical implication of this finding, e.g., the impact of brain volume decrease on overall-survival and neuro-cognitive function, is yet to be determined.

背景：放疗是脑转移瘤治疗的基石，但其对脑实质的中长期影响尚不清楚。本研究旨在评估两种不同方式的放射治疗-立体定向放射外科（SRS）和全脑放射治疗（WBRT）后脑容量的差异改变。方法：接受SRS治疗的患者来自STEREOBRAIN研究的前瞻性数据集（DRKS00014694），该研究招募了2017年至2020年期间4-10例脑转移患者。回顾性分析了2012年至2017年接受WBRT治疗的4-10例脑转移患者。排除有脑积水临床和影像学征象的患者。脑脊液空间容量分析作为脑容量减少的测量方法。将图像配准到MNI305空间，通过预训练的UNesT人工网络进行分割。结果：共纳入59例患者。29例接受SRS治疗，30例接受WBRT治疗。SRS组和WBRT组脑室系统体积均显著增加（p值为0.014）（p值为 ）结论：放疗与脑体积减少有关，但与WBRT相比，SRS组的脑体积减少似乎不那么明显。这一发现的临床意义，例如，脑容量减少对总体生存和神经认知功能的影响，还有待确定。

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