Pub Date : 2026-01-22DOI: 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}
Pub Date : 2026-01-22DOI: 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.
{"title":"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","authors":"Philippa Johnstone , Mathias Bressel , John F. Seymour , Surender Juneja , Haris Ahmad , Michael MacManus","doi":"10.1016/j.radonc.2026.111388","DOIUrl":"10.1016/j.radonc.2026.111388","url":null,"abstract":"<div><h3>Background and purpose</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111388"},"PeriodicalIF":5.3,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044115","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 : 2026-01-18DOI: 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.
{"title":"Long-term outcomes from a multicentre study of HDR monotherapy with a single fraction of 19 Gy for localized prostate cancer","authors":"Wiwatchai Sittiwong , Anna Lydon , James Wylie , Imtiaz Ahmed , Amarnath Challapalli , Peter Hoskin","doi":"10.1016/j.radonc.2026.111385","DOIUrl":"10.1016/j.radonc.2026.111385","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111385"},"PeriodicalIF":5.3,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012058","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 : 2026-01-11DOI: 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.
{"title":"Children's outcomes in medulloblastoma proton versus photon craniospinal radiotherapy (CURE): meta-analysis.","authors":"Gustavo A Viani, Ana Carolina Hamamura, Caio Viani Arruda, Carlos E Cardoso, Helio A Salmon, Gustavo O Amaral","doi":"10.1016/j.radonc.2026.111367","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111367","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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; I<sup>2</sup> = 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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111367"},"PeriodicalIF":5.3,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966880","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 : 2026-01-10DOI: 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.
{"title":"AI-based assessment of brain volume decrease after treatment with stereotactic radiosurgery versus whole brain radiotherapy","authors":"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","doi":"10.1016/j.radonc.2026.111377","DOIUrl":"10.1016/j.radonc.2026.111377","url":null,"abstract":"<div><h3>Background</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111377"},"PeriodicalIF":5.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960153","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 : 2026-01-10DOI: 10.1016/j.radonc.2026.111383
Guozhong Deng , Jiapei Ding , Jian Zhu , Lichun Zhou, Xiaomei Wang, Shi Su, Changhui Yu, Haihua Yang
Purpose
This study aims to evaluate the impact of tumor volume reduction at mid-treatment on four-dimensional computed tomography (4D-CT) based lung ventilation function for patients with lung cancer undergoing adaptive radiotherapy (ART), and explores the relationship between radiation dose and ventilation loss to inform personalized lung dose optimization in radiotherapy planning.
Materials and methods
Forty patients with stage III non-small cell lung cancer (NSCLC) who had undergone ART were enrolled. 4D-CT scans were performed at pre- and mid-treatment. Patients were categorized according to the relative volume changes in primary gross tumor volume (GTVp) and nodal gross tumor volume (GTVn). Each metric was used to divide the cohort into three groups, yielding a total of six comparative groups. Pre-treatment lung ventilation maps, divided into high-, medium-, and low-ventilation regions, were intersected with four dose zones that were categorized by the cumulative lung dose. Ventilation changes at mid-treatment ART in these ventilation regions and dose zones were analyzed for each patient group.
Results
Negative correlations were observed between relative changes in the overall ventilation and relative volume changes of the two target contours (GTVp and GTVn), with Spearman correlation coefficients being –0.625 and –0.452, respectively. Ventilation recovery resulting from tumor shrinkage significantly counteracted radiation-induced functional loss. In contrast, patients with minimal tumor volume reduction showed marked declines in pulmonary ventilation. Nearly all patient groups exhibited ventilation reduction in the high-ventilation region and improvement in the low-ventilation region. Ventilation loss showed a clear dose-dependent pattern across all regions, with the high-ventilation region most affected in patients without significant tumor-shrinkage-driven ventilation recovery.
Conclusions
Changes in lung ventilation at mid-treatment were strongly influenced by tumor volume reduction. A clear dose-dependent functional loss pattern was confirmed in the high-ventilation region, with high radiation doses inhibiting lung ventilation. These findings underscore the importance of protecting high-ventilation lung in NSCLC radiotherapy and suggest incorporating tumor volume reduction into adaptive re-planning.
{"title":"Study on the impact of tumor volume change and radiation dose on 4D-CT-based lung ventilation function at mid-treatment adaptive radiotherapy in stage III non-small cell lung cancer","authors":"Guozhong Deng , Jiapei Ding , Jian Zhu , Lichun Zhou, Xiaomei Wang, Shi Su, Changhui Yu, Haihua Yang","doi":"10.1016/j.radonc.2026.111383","DOIUrl":"10.1016/j.radonc.2026.111383","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the impact of tumor volume reduction at mid-treatment on four-dimensional computed tomography (4D-CT) based lung ventilation function for patients with lung cancer undergoing adaptive radiotherapy (ART), and explores the relationship between radiation dose and ventilation loss to inform personalized lung dose optimization in radiotherapy planning.</div></div><div><h3>Materials and methods</h3><div>Forty patients with stage III non-small cell lung cancer (NSCLC) who had undergone ART were enrolled. 4D-CT scans were performed at pre- and mid-treatment. Patients were categorized according to the relative volume changes in primary gross tumor volume (GTV<sub>p</sub>) and nodal gross tumor volume (GTV<sub>n</sub>). Each metric was used to divide the cohort into three groups, yielding a total of six comparative groups. Pre-treatment lung ventilation maps, divided into high-, medium-, and low-ventilation regions, were intersected with four dose zones that were categorized by the cumulative lung dose. Ventilation changes at mid-treatment ART in these ventilation regions and dose zones were analyzed for each patient group.</div></div><div><h3>Results</h3><div>Negative correlations were observed between relative changes in the overall ventilation and relative volume changes of the two target contours (GTV<sub>p</sub> and GTV<sub>n</sub>), with Spearman correlation coefficients being –0.625 and –0.452, respectively. Ventilation recovery resulting from tumor shrinkage significantly counteracted radiation-induced functional loss. In contrast, patients with minimal tumor volume reduction showed marked declines in pulmonary ventilation. Nearly all patient groups exhibited ventilation reduction in the high-ventilation region and improvement in the low-ventilation region.<!--> <!-->Ventilation loss showed a clear dose-dependent pattern across all regions, with the high-ventilation region most affected in patients without significant tumor-shrinkage-driven ventilation recovery.</div></div><div><h3>Conclusions</h3><div>Changes in lung ventilation at mid-treatment were strongly influenced by tumor volume reduction. A clear dose-dependent functional loss pattern was confirmed in the high-ventilation region, with high radiation doses inhibiting lung ventilation. These findings underscore the importance of protecting high-ventilation lung in NSCLC radiotherapy and suggest incorporating tumor volume reduction into adaptive re-planning.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111383"},"PeriodicalIF":5.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960171","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 : 2026-01-09DOI: 10.1016/j.radonc.2026.111372
Riccardo Dal Bello , Serena Psoroulas , Dominik Flückiger , Jerome Krayenbühl , Raphaël Moeckli , Claude Bailat , Anna Subiel , Ileana Silvestre Patallo , Jens von der Grün , Panagiotis Balermpas , Matthias Guckenberger , Stephanie Tanadini-Lang
Background and purpose
The combination of reduced normal tissue damage and unaffected tumor control is referred to as Flash-effect. This phenomenon has been observed with ultra-high dose rate (UHDR) radiotherapy in preclinical models. The Flash-Skin I (NCT06549439) treated seven patients with melanoma skin metastasis. The treatment protocol included 2 × 9 Gy UHDR followed by 1 × 9 Gy conventional radiotherapy. Here we report on the implementation of the study at a converted C-arm clinical linear accelerator.
Materials and methods
A dedicated preclinical radiation therapy quality assurance (RTQA) program was developed and the linac performance was validated for more than one year. Clinically, fourteen fractions of 9 Gy each were delivered with the 9 MeV UHDR electron linac. In-vivo measurements included: skin dose with radiochromic films, linac output with optically stimulated luminescent dosimeter (OSLD), pulse counting and inter-pulse stability with a scintillator, intra-pulse stability with a diamond detector.
Results
The preclinical RTQA identified reduced linac output, which prompted beam tuning and additional quality assurance. This formed the basis for initiation of the clinical trial and successful treatment of all seven patients. All fourteen UHDR fractions showed a dose accuracy within 4.6% or better. The number of delivered pulses consistently matched the planned value, and film measurements confirmed the skin dose. Intra- and inter-pulse stability were within 3.8% and 2.8%, respectively.
Conclusion
The clinical implementation of Flash-Skin I at converted C-arm linac was successfully demonstrated and validated. The developed RTQA program may facilitate the development of future UHDR clinical trials.
{"title":"The prospective phase I “Flash-Skin I” trial: ultra-high dose rate radiotherapy implementation and quality assurance at a clinical linear accelerator","authors":"Riccardo Dal Bello , Serena Psoroulas , Dominik Flückiger , Jerome Krayenbühl , Raphaël Moeckli , Claude Bailat , Anna Subiel , Ileana Silvestre Patallo , Jens von der Grün , Panagiotis Balermpas , Matthias Guckenberger , Stephanie Tanadini-Lang","doi":"10.1016/j.radonc.2026.111372","DOIUrl":"10.1016/j.radonc.2026.111372","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The combination of reduced normal tissue damage and unaffected tumor control is referred to as Flash-effect. This phenomenon has been observed with ultra-high dose rate (UHDR) radiotherapy in preclinical models. The Flash-Skin I (NCT06549439) treated seven patients with melanoma skin metastasis. The treatment protocol included 2 × 9 Gy UHDR followed by 1 × 9 Gy conventional radiotherapy. Here we report on the implementation of the study at a converted C-arm clinical linear accelerator.</div></div><div><h3>Materials and methods</h3><div>A dedicated preclinical radiation therapy quality assurance (RTQA) program was developed and the linac performance was validated for more than one year. Clinically, fourteen fractions of 9 Gy each were delivered with the 9 MeV UHDR electron linac. In-vivo measurements included: skin dose with radiochromic films, linac output with optically stimulated luminescent dosimeter (OSLD), pulse counting and inter-pulse stability with a scintillator, intra-pulse stability with a diamond detector.</div></div><div><h3>Results</h3><div>The preclinical RTQA identified reduced linac output, which prompted beam tuning and additional quality assurance. This formed the basis for initiation of the clinical trial and successful treatment of all seven patients. All fourteen UHDR fractions showed a dose accuracy within 4.6% or better. The number of delivered pulses consistently matched the planned value, and film measurements confirmed the skin dose. Intra- and inter-pulse stability were within 3.8% and 2.8%, respectively.</div></div><div><h3>Conclusion</h3><div>The clinical implementation of Flash-Skin I at converted C-arm linac was successfully demonstrated and validated. The developed RTQA program may facilitate the development of future UHDR clinical trials.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111372"},"PeriodicalIF":5.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952858","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}
Both Transoral laser surgery (TLS) and radiotherapy are used in the treatment of T1aN0 glottic cancer with similar oncological outcomes. Retrospective studies suggest excellent local control with single vocal cord irradiation that targets only the affected vocal cord. So, the aim of this study was to compare the treatment outcome and toxicity of the classic radiotherapy field vs single vocal cord irradiation (SVCI) technique.
Patients and methods
This is a prospective phase 2 randomized study (clinicaltrial.gov registration NCT05679856). A total of 57 patients with T1aN0 glottic cancer were randomized. 28 were assigned to standard of care whole larynx radiotherapy that covers the whole larynx with a prescription dose of 63 Gy/28 Fractions (Fs) The remaining 29 patients were randomized to single vocal irradiation with a prescription dose of 58.08 Gy/16Fs. The primary endpoint was to prove superiority of SVCI in terms of voice quality by comparing voice handicap index (VHI) between the 2 study arms. Baseline VHI was recorded before treatment, at end of radiotherapy, then during each follow up visit.
Results
Demographic and patients’ characteristics were comparable between the 2 arms. The doses to different organs at risk were statistically lower in the SVCI arm. 2-year local control rate was 100% in SVCI arm and 96% in the whole larynx arm, with no significant difference. No grade 3 or 4 toxicities were reported in both treatment arms. Patients in the SVCI arm demonstrated lower VHI scores at 2 months and 1-year post-treatment, with median scores of 4 and 0, respectively, compared with 22 and 21 in the whole-larynx arm.
Conclusion
SVCI is effective and safe treatment for T1aN0 glottic cancer with comparable local control rates and safe toxicity profile. SVCI was associated with superior voice outcome as evidenced by significantly improved VHI scores compared with whole larynx radiotherapy.
{"title":"Single vocal cord irradiation (SVCI) vs whole laryngeal radiotherapy in the treatment of T1aN0 glottic cancer A prospective randomized trial","authors":"Mohamed Mortada Elsharief , Ashraf Hamed Hassouna , Tarek Shouman , Abdelrahman Mosallam , Amr El-Badrawy , Ashraf Shawky , Ayman Amin , Sherweif M. Abdelfatah","doi":"10.1016/j.radonc.2026.111376","DOIUrl":"10.1016/j.radonc.2026.111376","url":null,"abstract":"<div><h3>Introduction</h3><div>Both Transoral laser surgery (TLS) and radiotherapy are used in the treatment of T1aN0 glottic cancer with similar oncological outcomes. Retrospective studies suggest excellent local control with single vocal cord irradiation that targets only the affected vocal cord. So, the aim of this study was to compare the treatment outcome and toxicity of the classic radiotherapy field vs single vocal cord irradiation (SVCI) technique.</div></div><div><h3>Patients and methods</h3><div>This is a prospective phase 2 randomized study (<span><span><u>clinicaltrial.gov</u></span><svg><path></path></svg></span> registration NCT05679856). A total of 57 patients with T1aN0 glottic cancer were randomized. 28 were assigned to standard of care whole larynx radiotherapy that covers the whole larynx with a prescription dose of 63 Gy/28 Fractions (Fs) The remaining 29 patients were randomized to single vocal irradiation with a prescription dose of 58.08 Gy/16Fs. The primary endpoint was to prove superiority of SVCI in terms of voice quality by comparing voice handicap index (VHI) between the 2 study arms. Baseline VHI was recorded before treatment, at end of radiotherapy, then during each follow up visit.</div></div><div><h3>Results</h3><div>Demographic and patients’ characteristics were comparable between the 2 arms. The doses to different organs at risk were statistically lower in the SVCI arm. 2-year local control rate was 100% in SVCI arm and 96% in the whole larynx arm, with no significant difference. No grade 3 or 4 toxicities were reported in both treatment arms. Patients in the SVCI arm demonstrated lower VHI scores at 2 months and 1-year post-treatment, with median scores of 4 and 0, respectively, compared with 22 and 21 in the whole-larynx arm.</div></div><div><h3>Conclusion</h3><div>SVCI is effective and safe treatment for T1aN0 glottic cancer with comparable local control rates and safe toxicity profile. SVCI was associated with superior voice outcome as evidenced by significantly improved VHI scores compared with whole larynx radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111376"},"PeriodicalIF":5.3,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952884","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}
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