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}
Pub Date : 2024-11-10DOI: 10.1016/j.radonc.2024.110624
Jonas Willmann , Panagiotis Balermpas , Andreas Rimner , Ane L Appelt , Eliana Maria Vasquez Osorio , Heidi S. Rønde , Madalyne Day , Anna Embring , Dorota Gabryś , Marianne G. Guren , Peter Hoskin , Mariangela Massaccesi , Charles Mayo , Louise Murray , Carsten Nieder , Matthias Guckenberger , Nicolaus Andratschke
Introduction
Reirradiation has gained increasing interest, as advances in systemic therapy increase the survival of patients with cancer, and modern radiation techniques allow more precise treatments. However, high-quality prospective evidence on the safety and efficacy of reirradiation to guide clinical practice remains scarce. This systematic review evaluates ongoing prospective studies on reirradiation to identify research gaps and priorities.
Methods
A systematic review of ClinicalTrials.gov was conducted on July 11, 2024, using search terms related to reirradiation. Inclusion criteria were prospective studies that were “recruiting,” “not yet recruiting,” or “active, not recruiting.” Studies with published results, retrospective, and in-silico studies were excluded. The review followed PRISMA 2020 guidelines and recommendations for systematic searches of clinical trial registries.
Results
Among 1026 identified studies, 307 were screened, 99 were included. Fourty (40%) focused on central nervous system (CNS), 23 (23%) head and neck, and 17 (17%) on pelvic reirradiation. Most studies (90%) were interventional, with 32 (32%) phase II and 4 (4%) phase III trials. Sixteen trials were randomized (RCTs), including the 4 phase III trials for recurrent glioblastoma, rectal and nasopharyngeal cancer. Ten dose escalation trials focus on recurrent prostate, rectal, and non-small cell lung cancer as well as glioma. Modern high-precision radiotherapy techniques were frequently used, with 21 (21%) studies using stereotactic radiotherapy and 17 (17%) using particle therapy. Combinations with systemic therapies were investigated in 41 (41%) studies.
Conclusion
Ongoing studies most frequently focus on CNS, head and neck, and pelvic reirradiation. There remains a critical need for RCTs, in particular for lung, breast, and gynecological cancers. Dose escalation trials, application of precision radiation techniques and combinations with modern systemic therapy may help define the optimal multimodality treatment schedules.
{"title":"Ongoing prospective studies on reirradiation: A systematic review of a clinical trials database","authors":"Jonas Willmann , Panagiotis Balermpas , Andreas Rimner , Ane L Appelt , Eliana Maria Vasquez Osorio , Heidi S. Rønde , Madalyne Day , Anna Embring , Dorota Gabryś , Marianne G. Guren , Peter Hoskin , Mariangela Massaccesi , Charles Mayo , Louise Murray , Carsten Nieder , Matthias Guckenberger , Nicolaus Andratschke","doi":"10.1016/j.radonc.2024.110624","DOIUrl":"10.1016/j.radonc.2024.110624","url":null,"abstract":"<div><h3>Introduction</h3><div>Reirradiation has gained increasing interest, as advances in systemic therapy increase the survival of patients with cancer, and modern radiation techniques allow more precise treatments. However, high-quality prospective evidence on the safety and efficacy of reirradiation to guide clinical practice remains scarce. This systematic review evaluates ongoing prospective studies on reirradiation to identify research gaps and priorities.</div></div><div><h3>Methods</h3><div>A systematic review of <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> was conducted on July 11, 2024, using search terms related to reirradiation. Inclusion criteria were prospective studies that were “recruiting,” “not yet recruiting,” or “active, not recruiting.” Studies with published results, retrospective, and in-silico studies were excluded. The review followed PRISMA 2020 guidelines and recommendations for systematic searches of clinical trial registries.</div></div><div><h3>Results</h3><div>Among 1026 identified studies, 307 were screened, 99 were included. Fourty (40%) focused on central nervous system (CNS), 23 (23%) head and neck, and 17 (17%) on pelvic reirradiation. Most studies (90%) were interventional, with 32 (32%) phase II and 4 (4%) phase III trials. Sixteen trials were randomized (RCTs), including the 4 phase III trials for recurrent glioblastoma, rectal and nasopharyngeal cancer. Ten dose escalation trials focus on recurrent prostate, rectal, and non-small cell lung cancer as well as glioma. Modern high-precision radiotherapy techniques were frequently used, with 21 (21%) studies using stereotactic radiotherapy and 17 (17%) using particle therapy. Combinations with systemic therapies were investigated in 41 (41%) studies.</div></div><div><h3>Conclusion</h3><div>Ongoing studies most frequently focus on CNS, head and neck, and pelvic reirradiation. There remains a critical need for RCTs, in particular for lung, breast, and gynecological cancers. Dose escalation trials, application of precision radiation techniques and combinations with modern systemic therapy may help define the optimal multimodality treatment schedules.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110624"},"PeriodicalIF":4.9,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625927","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 : 2024-11-09DOI: 10.1016/j.radonc.2024.110623
Bethany Rothwell, Alejandro Bertolet, Jan Schuemann
Background and purpose
Proton arc therapy and FLASH radiotherapy (FLASH-RT) each offer unique advantages in proton therapy. However, clinical translation of FLASH-RT faces challenges in defining and delivering high dose rates. We propose the use of proton FLASH-arc therapy (PFAT) to leverage the benefits of arc while addressing FLASH delivery concerns by spatially fractionating dose delivery to healthy tissue.
Materials and methods
Treatment plans for an abdominal phantom and a clinical brain case were designed in OpenTPS, using monoenergetic beams within a 360-degree gantry rotation. Beams were optimized to achieve target coverage while maximizing spatial fractionation in non-target regions. The temporal dose delivery to healthy-tissue voxels, or in specified organs-at-risk (OARs), was constrained via selective spot removal in the beamlets matrix. The dose, LET, number of spots per voxel, and voxel-wise average dose rate were calculated for each PFAT plan and compared to a corresponding IMPT scenario.
Results
PFAT plans demonstrated comparable dose conformity to IMPT, with LET hotspots shifted towards the target center. The number of spots influencing healthy-tissue voxels was reduced, leading to regions of substantially higher dose rates in many points outside the target. OAR dose-rate optimization in the brain plan resulted in dose rates exceeding 40 Gy/s in the majority of points in the brainstem.
Conclusion
The PFAT technique combines the advantages of FLASH and arc therapy, providing improved LET distributions and enhanced biological effect in the target, while achieving high dose rates in healthy tissue, thus reducing healthy tissue damage. This feasibility study demonstrates the capability of PFAT, setting the foundation for further optimization and application in diverse patient cases and complex geometries.
{"title":"Proton FLASH-arc therapy (PFAT): A feasibility study for meeting FLASH dose-rate requirements in the clinic","authors":"Bethany Rothwell, Alejandro Bertolet, Jan Schuemann","doi":"10.1016/j.radonc.2024.110623","DOIUrl":"10.1016/j.radonc.2024.110623","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Proton arc therapy and FLASH radiotherapy (FLASH-RT) each offer unique advantages in proton therapy. However, clinical translation of FLASH-RT faces challenges in defining and delivering high dose rates. We propose the use of proton FLASH-arc therapy (PFAT) to leverage the benefits of arc while addressing FLASH delivery concerns by spatially fractionating dose delivery to healthy tissue.</div></div><div><h3>Materials and methods</h3><div>Treatment plans for an abdominal phantom and a clinical brain case were designed in OpenTPS, using monoenergetic beams within a 360-degree gantry rotation. Beams were optimized to achieve target coverage while maximizing spatial fractionation in non-target regions. The temporal dose delivery to healthy-tissue voxels, or in specified organs-at-risk (OARs), was constrained via selective spot removal in the beamlets matrix. The dose, LET, number of spots per voxel, and voxel-wise average dose rate were calculated for each PFAT plan and compared to a corresponding IMPT scenario.</div></div><div><h3>Results</h3><div>PFAT plans demonstrated comparable dose conformity to IMPT, with LET hotspots shifted towards the target center. The number of spots influencing healthy-tissue voxels was reduced, leading to regions of substantially higher dose rates in many points outside the target. OAR dose-rate optimization in the brain plan resulted in dose rates exceeding 40 Gy/s in the majority of points in the brainstem.</div></div><div><h3>Conclusion</h3><div>The PFAT technique combines the advantages of FLASH and arc therapy, providing improved LET distributions and enhanced biological effect in the target, while achieving high dose rates in healthy tissue, thus reducing healthy tissue damage. This feasibility study demonstrates the capability of PFAT, setting the foundation for further optimization and application in diverse patient cases and complex geometries.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110623"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626117","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 : 2024-11-09DOI: 10.1016/j.radonc.2024.110612
Anna Liza M.P. de Leeuw , Jordi Giralt , Yungan Tao , Sergi Benavente , Thanh-Vân F Nguyen , Frank J.P. Hoebers , Ann Hoeben , Chris H.J. Terhaard , Lip Wai Lee , Signe Friesland , Roel J.H.M. Steenbakkers , Lisa Tans , Simon R. van Kranen , Jeroen B. van de Kamer , Harry Bartelink , Coen R.N. Rasch , Jan-Jakob Sonke , Olga Hamming-Vrieze
Purpose
To report on quality assurance (QA) and protocol adherence (PA) in a multicentre phase III trial for head and neck cancer, evaluate patterns of protocol deviations and investigate the effect of PA on study outcomes.
Methods
All 221 patients from the ARTFORCE trial (NCT01504815) were included in this study. Pre- and per-treatment QA measures included protocol guidelines, a dummy run, early case reviews and trial meetings. FDG-PET-guided dose painting and scheduled adaptive radiotherapy were reviewed in patients in the experimental arm (eRT). Patient and disease characteristics, as well as institutes’ accrual rate and timing were examined for correlation with PA. Cox regression was used to determine the impact of PA on outcome.
Results
The dummy run was completed in all nine institutes and early case reviews were completed in five out of nine institutes that contributed 190 out of 221 patients. Among all patients randomized to eRT, 64 % had at least one deviation of the experimental trial components. Protocol deviations were significantly correlated with the institute patients were treated at (Cramer’sV 0.34–0.48). Despite early identification of institute-specific deviations in QA, these continued during the trial. No significant associations were seen between deviations and accrual timing or rate (P ≥ 0.26). Within eRT, no significant relation was observed between experimental PA and locoregional control (LRC), the primary endpoint of the trial (P≥.15).
Conclusions
Despite QA, protocol deviations persisted during the trial, which were mostly institute-specific. However, deviations of the experimental treatment strategy did not significantly impact LRC and therefore the trial conclusion.
目的：报告头颈部癌症多中心 III 期试验中的质量保证（QA）和方案依从性（PA）情况，评估方案偏离的模式，并调查 PA 对研究结果的影响：本研究纳入了ARTFORCE试验（NCT01504815）的所有221名患者。治疗前和治疗过程中的质量保证措施包括方案指南、模拟运行、早期病例审查和试验会议。对试验组（eRT）患者的 FDG-PET 引导剂量绘制和计划自适应放疗进行了审查。研究了患者和疾病特征以及研究机构的应计率和时间与 PA 的相关性。采用 Cox 回归确定 PA 对结果的影响：所有九家研究机构都完成了虚拟运行，九家研究机构中有五家完成了早期病例审查，在221例患者中，有190例接受了早期病例审查。在所有随机接受 eRT 治疗的患者中，64% 的患者至少有一项实验内容出现偏差。方案偏差与患者接受治疗的机构有明显相关性（Cramer'sV 0.34-0.48）。尽管在 QA 中很早就发现了特定机构的偏差，但这些偏差在试验期间仍在继续。偏差与应计时间或应计率之间无明显关联（P ≥ 0.26）。在 eRT 中，实验 PA 与局部区域控制（LRC）（试验的主要终点）之间未发现明显关系（P≥.15）：尽管进行了质量保证，但试验过程中仍存在方案偏差，这些偏差主要是针对特定机构的。然而，实验治疗策略的偏差并未对LRC产生重大影响，因此也未对试验结论产生重大影响。
{"title":"Protocol compliance in a multicentric phase III trial investigating scheduled adaptive radiotherapy and dose painting in head and neck cancer","authors":"Anna Liza M.P. de Leeuw , Jordi Giralt , Yungan Tao , Sergi Benavente , Thanh-Vân F Nguyen , Frank J.P. Hoebers , Ann Hoeben , Chris H.J. Terhaard , Lip Wai Lee , Signe Friesland , Roel J.H.M. Steenbakkers , Lisa Tans , Simon R. van Kranen , Jeroen B. van de Kamer , Harry Bartelink , Coen R.N. Rasch , Jan-Jakob Sonke , Olga Hamming-Vrieze","doi":"10.1016/j.radonc.2024.110612","DOIUrl":"10.1016/j.radonc.2024.110612","url":null,"abstract":"<div><h3>Purpose</h3><div>To report on quality assurance (QA) and protocol adherence (PA) in a multicentre phase III trial for head and neck cancer, evaluate patterns of protocol deviations and investigate the effect of PA on study outcomes.</div></div><div><h3>Methods</h3><div>All 221 patients from the ARTFORCE trial (NCT01504815) were included in this study. Pre- and per-treatment QA measures included protocol guidelines, a dummy run, early case reviews and trial meetings. FDG-PET-guided dose painting and scheduled adaptive radiotherapy were reviewed in patients in the experimental arm (eRT). Patient and disease characteristics, as well as institutes’ accrual rate and timing were examined for correlation with PA. Cox regression was used to determine the impact of PA on outcome.</div></div><div><h3>Results</h3><div>The dummy run was completed in all nine institutes and early case reviews were completed in five out of nine institutes that contributed 190 out of 221 patients. Among all patients randomized to eRT, 64 % had at least one deviation of the experimental trial components. Protocol deviations were significantly correlated with the institute patients were treated at (Cramer’sV 0.34–0.48). Despite early identification of institute-specific deviations in QA, these continued during the trial. No significant associations were seen between deviations and accrual timing or rate (P ≥ 0.26). Within eRT, no significant relation was observed between experimental PA and locoregional control (LRC), the primary endpoint of the trial (P≥.15).</div></div><div><h3>Conclusions</h3><div>Despite QA, protocol deviations persisted during the trial, which were mostly institute-specific. However, deviations of the experimental treatment strategy did not significantly impact LRC and therefore the trial conclusion.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110612"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625957","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}
Radiotherapy is frequently employed for palliative treatment in locally advanced head and neck squamous cell carcinoma (HNSCC) but radiation dose fractionation regimens are not well-defined. We designed this phase 3 randomized controlled trial to compare two weekly hypo fractionated regimes and study the effect on progression-free survival (PFS) in this subset of patients.
Materials and Methods
Non-metastatic locally advanced HNSCC patients (n = 305) who were not suitable for curative treatment were randomized to Arm A (20 Gy/5#/5 days) and Arm B (30 Gy/5#/5 days). PFS and OS were recorded along with acute toxicity using patient-reported quality of life HN QLQ 43.
Results
From April 2020 to August 2023, 390 patients were randomized, of which 305 were eligible for final analysis. At a median follow-up of 13.9 months, PFS and median overall survival (OS) for the entire cohort was 7.4 and 10.03 months, respectively. PFS (p-0.553) and OS (p-0.203) did not differ significantly between the two groups. Toxicity rates were similar between the two arms and dose escalation was well tolerated. Patients with a better PS were found to have significantly better OS. No significant benefit in OS or PFS was observed in patients who received neoadjuvant chemotherapy (NACT), underwent definitive conversion, or received palliative chemotherapy at progression.
Conclusion
This is the largest phase 3 RCT to analyze the safety and efficacy of weekly palliative radiotherapy regimens and has not demonstrated further improvement with dose escalation.
{"title":"Optimum radiation dose for palliation in head and neck squamous cell carcinoma (OpRAH) – A phase 3 randomized controlled trial","authors":"Supriya Mallick , Abhilash Dagar , Adrija Ghosh , Aashita , Jaswin Raj , Sangeeta Hazarika , Jitendra K. Meena , Akash Kumar , Jyoti Sharma , Smriti Panda , Aman Sharma , Mayank Singh , Dayanand Sharma , Alok Thakar","doi":"10.1016/j.radonc.2024.110611","DOIUrl":"10.1016/j.radonc.2024.110611","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiotherapy is frequently employed for palliative treatment in locally advanced head and neck squamous cell carcinoma (HNSCC) but radiation dose fractionation regimens are not well-defined. We designed this phase 3 randomized controlled trial to compare two weekly hypo fractionated regimes and study the effect on progression-free survival (PFS) in this subset of patients.</div></div><div><h3>Materials and Methods</h3><div>Non-metastatic locally advanced HNSCC patients (n = 305) who were not suitable for curative treatment were randomized to Arm A (20 Gy/5#/5 days) and Arm B (30 Gy/5#/5 days). PFS and OS were recorded along with acute toxicity using patient-reported quality of life HN QLQ 43.</div></div><div><h3>Results</h3><div>From April 2020 to August 2023, 390 patients were randomized, of which 305 were eligible for final analysis. At a median follow-up of 13.9 months, PFS and median overall survival (OS) for the entire cohort was 7.4 and 10.03 months, respectively. PFS (p-0.553) and OS (p-0.203) did not differ significantly between the two groups. Toxicity rates were similar between the two arms and dose escalation was well tolerated. Patients with a better PS were found to have significantly better OS. No significant benefit in OS or PFS was observed in patients who received neoadjuvant chemotherapy (NACT), underwent definitive conversion, or received palliative chemotherapy at progression.</div></div><div><h3>Conclusion</h3><div>This is the largest phase 3 RCT to analyze the safety and efficacy of weekly palliative radiotherapy regimens and has not demonstrated further improvement with dose escalation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110611"},"PeriodicalIF":4.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625865","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 : 2024-11-08DOI: 10.1016/j.radonc.2024.110606
Ariel Shimoni-Sebag , Ifat Abramovich , Bella Agranovich , Rami Massri , Chani Stossel , Dikla Atias , Maria Raites-Gurevich , Keren Yizhak , Talia Golan , Eyal Gottlieb , Yaacov Richard Lawrence
Purpose
Pancreatic ductal adenocarcinoma (PDAC) is remarkably resistant to standard modalities, including radiotherapy. We hypothesized that metabolic reprogramming may underlie PDAC radioresistance, and moreover, that it would be possible to exploit these metabolic changes for therapeutic intent.
Methods and materials
We established two matched models of radioresistant PDAC cells by exposing the AsPC-1 and MIAPaCa-2 human pancreatic cancer cells to incremental doses of radiation. The metabolic profile of parental and radioresistant cells was investigated using Nanostring technology, labeled-glucose tracing by liquid chromatography-mass spectrometry, Seahorse analysis and exposure to metabolic inhibitors. The synergistic effect of radiation combined with a pentose-phosphate pathway inhibitor, 6-aminonicotinamide (6-AN) was evaluated in a xenograft model established by subcutaneous injection of radioresistant-AsPC-1 cells into nude mice.
Results
The radioresistant cells overexpressed pyruvate dehydrogenase kinase (PDK) and consistently, displayed increased glycolysis and downregulated the tricarboxylic acid (TCA) cycle and oxidative phosphorylation. Metabolic flux through the pentose-phosphate pathway (PPP) was increased, as were levels of reduced glutathione; pharmacological inhibition of the PPP dramatically potentiated radiation-induced cell death. Furthermore, the combined treatment of radiation with the PPP inhibitor 6-AN synergistically inhibited tumor growth in-vivo.
Conclusions
We provide a mechanistic understanding of the metabolic changes that underlie radioresistance in PDAC. Furthermore, we demonstrate that pancreatic cancer cells can be re-sensitized to radiation via metabolic manipulation, in particular, inhibition of the PPP. Exploitation of the metabolic vulnerabilities of radioresistant pancreatic cancer cells constitutes a new approach to pancreatic cancer, with a potential to improve clinical outcomes.
{"title":"A metabolic switch to the pentose-phosphate pathway induces radiation resistance in pancreatic cancer","authors":"Ariel Shimoni-Sebag , Ifat Abramovich , Bella Agranovich , Rami Massri , Chani Stossel , Dikla Atias , Maria Raites-Gurevich , Keren Yizhak , Talia Golan , Eyal Gottlieb , Yaacov Richard Lawrence","doi":"10.1016/j.radonc.2024.110606","DOIUrl":"10.1016/j.radonc.2024.110606","url":null,"abstract":"<div><h3>Purpose</h3><div>Pancreatic ductal adenocarcinoma (PDAC) is remarkably resistant to standard modalities, including radiotherapy. We hypothesized that metabolic reprogramming may underlie PDAC radioresistance, and moreover, that it would be possible to exploit these metabolic changes for therapeutic intent.</div></div><div><h3>Methods and materials</h3><div>We established two matched models of radioresistant PDAC cells by exposing the AsPC-1 and MIAPaCa-2 human pancreatic cancer cells to incremental doses of radiation. The metabolic profile of parental and radioresistant cells was investigated using Nanostring technology, labeled-glucose tracing by liquid chromatography-mass spectrometry, Seahorse analysis and exposure to metabolic inhibitors. The synergistic effect of radiation combined with a pentose-phosphate pathway inhibitor, 6-aminonicotinamide (6-AN) was evaluated in a xenograft model established by subcutaneous injection of radioresistant-AsPC-1 cells into nude mice.</div></div><div><h3>Results</h3><div>The radioresistant cells overexpressed pyruvate dehydrogenase kinase (PDK) and consistently, displayed increased glycolysis and downregulated the tricarboxylic acid (TCA) cycle and oxidative phosphorylation. Metabolic flux through the pentose-phosphate pathway (PPP) was increased, as were levels of reduced glutathione; pharmacological inhibition of the PPP dramatically potentiated radiation-induced cell death. Furthermore, the combined treatment of radiation with the PPP inhibitor 6-AN synergistically inhibited tumor growth in-vivo.</div></div><div><h3>Conclusions</h3><div>We provide a mechanistic understanding of the metabolic changes that underlie radioresistance in PDAC. Furthermore, we demonstrate that pancreatic cancer cells can be re-sensitized to radiation via metabolic manipulation, in particular, inhibition of the PPP. Exploitation of the metabolic vulnerabilities of radioresistant pancreatic cancer cells constitutes a new approach to pancreatic cancer, with a potential to improve clinical outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110606"},"PeriodicalIF":4.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625433","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 : 2024-11-08DOI: 10.1016/j.radonc.2024.110600
Lasse Refsgaard , Emma S. Buhl , Anders W. Mølby Nielsen , Mette S. Thomsen , Karen Andersen , Ingelise Jensen , Martin Berg , Ebbe L. Lorenzen , Lise B.J. Thorsen , Jens Overgaard , Stine S. Korreman , Birgitte V. Offersen , on behalf of the DBCG RT Committee
Purpose/objective
The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.
Material/methods
Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.
Results
Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8–100.0) in right-sided patients and 20.4 % (IQR 0.9–55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.
Conclusion
For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.
{"title":"Quality assurance of internal mammary node irradiation in the DBCG IMN2 study","authors":"Lasse Refsgaard , Emma S. Buhl , Anders W. Mølby Nielsen , Mette S. Thomsen , Karen Andersen , Ingelise Jensen , Martin Berg , Ebbe L. Lorenzen , Lise B.J. Thorsen , Jens Overgaard , Stine S. Korreman , Birgitte V. Offersen , on behalf of the DBCG RT Committee","doi":"10.1016/j.radonc.2024.110600","DOIUrl":"10.1016/j.radonc.2024.110600","url":null,"abstract":"<div><h3>Purpose/objective</h3><div>The Danish Breast Cancer Group (DBCG) IMN2 study investigated the gain from internal mammary node irradiation (IMNI) in node-positive breast cancer patients. IMNI was indicated in right-sided patients, but not in left-sided. Target volume delineations were based on bony landmarks in contrast to the contemporary vessel-based ESTRO consensus guideline. Our objective was to compare IMNI doses in right-sided versus left-sided patients.</div></div><div><h3>Material/methods</h3><div>Treatment plans and delineated structures including CTVn_IMN (IMN_old) from 2008 to 2014 were collected from the DBCG RT Nation study. During the study period, IMN_old was only delineated in right-sided patients. Right and left-sided CTVn_IMN structures were auto-segmented following the ESTRO guidelines (IMN_ESTRO). Due to cranial discordance between IMN_old and IMN_ESTRO, the IMN_ESTRO models were separated into IMN_ESTRO_cranial and IMN_ESTRO_intercostal space(IC)1-3, IC1-4, and IC4_only.</div></div><div><h3>Results</h3><div>Treatment plans for 2837 patients were available (62.5 % of patients in the IMN2 study). In right-sided patients, the median IMN_old dose coverage (92.4 %) was higher than IMN_ESTRO (71.7 %), p < 0.001. Dose coverage in IMN_ESTRO_IC1-3 was comparable to IMN_old. Comparing IMN_ESTRO_IC1-3 in all patients by laterality, the median CTVn_V90% was 94.6 % (IQR 64.8–100.0) in right-sided patients and 20.4 % (IQR 0.9–55.8) in left-sided patients, p < 0.001. For right-sided patients, median CTV_V90% was 82.3 % in IMN_ESTRO_IC4_only. Median mean heart doses were lower in right-sided patients (1.2 Gy) than in left-sided (2.3 Gy), p < 0.001. Median mean lung doses were higher in right-sided patients (16.0 Gy) than in left-sided (12.7 Gy), p < 0.001.</div></div><div><h3>Conclusion</h3><div>For IMN_ESTRO_IC1-3, we found a significantly higher IMN dose coverage in right-sided than in left-sided patients supporting treatment according to study guidelines in the DBCG IMN2 study.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110600"},"PeriodicalIF":4.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625999","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 : 2024-11-07DOI: 10.1016/j.radonc.2024.110595
Yan-hong Lyu , Jia-qi Liu , Fa-han Wang , Wen-jingchi Yan , An-hong Ming , Geng-sheng Li , Jun-li Ge , Ru Jing , Shu-juan Liu , Hong-Yang , Yuan-yuan He , Jia-Li
Background and purpose
To investigate the impact of radiotherapy (RT) on the risk of secondary pelvic neoplasms (SPN) and the survival outcomes of patients following a diagnosis of female patients with genital neoplasm(FGN).
Materials and Methods
Utilizing SEER databases, this study involved 102,895 patients from nine oncology centers, spanning 1990 to 2015. We employed the Fine-Gray competing risks regression methodology to chart the trajectory of SPN development and used the Kaplan–Meier method to calculate the 10-year overall survival rates.
Results
This study included 25,774 patients in the RT group and 77,121 in the non-radiotherapy (NRT) group. The cumulative incidence rate of SPN was 5.10 % in the RT group and 3.42 % in the NRT group. The RT group showed a significantly higher incidence of bladder cancer (adjusted hazard ratio [HR]: 1.75; 95 % confidence interval [CI]: 1.43–2.14; P < 0.05), colon cancer (adjusted HR: 1.32; 95 % CI: 1.16–1.49; P < 0.05), and rectal cancer (adjusted HR: 1.34; 95 % CI: 1.10–1.65; P < 0.05) compared to the NRT group. After propensity score matching, patients in the RT group who developed bladder cancer had significantly reduced 10-year survival rates compared to patients with primary pelvic tumors (P = 0.01).
Conclusion
RT is identified as an independent risk factor for the development of SPN in patients with FGN. Patients with FGN who undergo RT demonstrate a significant increase in the risk of developing secondary neoplasms, specifically bladder cancers, and experience a reduction in 10-year survival rates.
{"title":"Risk and survival outcomes of secondary pelvic neoplasm after radiotherapy in female patients with genital neoplasms: A large Population-Based cohort study","authors":"Yan-hong Lyu , Jia-qi Liu , Fa-han Wang , Wen-jingchi Yan , An-hong Ming , Geng-sheng Li , Jun-li Ge , Ru Jing , Shu-juan Liu , Hong-Yang , Yuan-yuan He , Jia-Li","doi":"10.1016/j.radonc.2024.110595","DOIUrl":"10.1016/j.radonc.2024.110595","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To investigate the impact of radiotherapy (RT) on the risk of secondary pelvic neoplasms (SPN) and the survival outcomes of patients following a diagnosis of female patients with genital neoplasm(FGN).</div></div><div><h3>Materials and Methods</h3><div>Utilizing SEER databases, this study involved 102,895 patients from nine oncology centers, spanning 1990 to 2015. We employed the Fine-Gray competing risks regression methodology to chart the trajectory of SPN development and used the Kaplan–Meier method to calculate the 10-year overall survival rates.</div></div><div><h3>Results</h3><div>This study included 25,774 patients in the RT group and 77,121 in the non-radiotherapy (NRT) group. The cumulative incidence rate of SPN was 5.10 % in the RT group and 3.42 % in the NRT group. The RT group showed a significantly higher incidence of bladder cancer (adjusted hazard ratio [HR]: 1.75; 95 % confidence interval [CI]: 1.43–2.14; P < 0.05), colon cancer (adjusted HR: 1.32; 95 % CI: 1.16–1.49; P < 0.05), and rectal cancer (adjusted HR: 1.34; 95 % CI: 1.10–1.65; P < 0.05) compared to the NRT group. After propensity score matching, patients in the RT group who developed bladder cancer had significantly reduced 10-year survival rates compared to patients with primary pelvic tumors (P = 0.01).</div></div><div><h3>Conclusion</h3><div>RT is identified as an independent risk factor for the development of SPN in patients with FGN. Patients with FGN who undergo RT demonstrate a significant increase in the risk of developing secondary neoplasms, specifically bladder cancers, and experience a reduction in 10-year survival rates.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110595"},"PeriodicalIF":4.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626000","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 : 2024-11-06DOI: 10.1016/j.radonc.2024.110617
Argen Omurzakov, Sanjeev Rampam, Marcos R. Gonzalez, Santiago A. Lozano-Calderon
Background
Radiation-associated fractures (RAFs) are a challenging complication in oncologic patients, yet their incidence remains unknown and optimal management lacks consensus.
Aim
This review aimed to evaluate the incidence of RAFs in the trunk, pelvis, and extremities as well as non-union rates of surgical and non-surgical treatment.
Materials and methods
A systematic review of PubMed and Embase databases was conducted. The study was registered on PROSPERO (ID: CRD42024513017). Studies were included if they reported RAFs in oncologic populations, had a sample size of at least five patients, and provided extractable data on RAF incidence or number. The STROBE checklist was utilized for evaluation of study quality. For eligible studies, quantitative analyses were conducted to determine weighted incidence of RAF and fracture non-union.
Results
Thirty-five studies comprising 9,980 patients treated with radiation therapy were included. The weighted incidence of RAFs was calculated to be 6.5% across 8,061 patients. The weighted incidence of femoral RAF was 5.2%, while pelvic RAF incidence was 17.1%. Non-union rates after initial treatment varied from 4% to 100%, with an overall weighted incidence of 48%. Treatments included intramedullary nailing, fixation with screws/plate, prosthetic replacement, conservative treatment, and amputation, with varying success rates.
Conclusion
This review highlights RAFs as a significant complication of radiation therapy, with a weighted incidence of 6.5% and a non-union rate of 48%. Advanced radiation techniques have reduced RAF occurrences, but non-union remains a challenge, necessitating tailored treatment strategies. Further research is needed to optimize RAF management and improve patient outcomes.
{"title":"What is the incidence and non-union rate of radiation-associated fractures? – A systematic review of the literature","authors":"Argen Omurzakov, Sanjeev Rampam, Marcos R. Gonzalez, Santiago A. Lozano-Calderon","doi":"10.1016/j.radonc.2024.110617","DOIUrl":"10.1016/j.radonc.2024.110617","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-associated fractures (RAFs) are a challenging complication in oncologic patients, yet their incidence remains unknown and optimal management lacks consensus.</div></div><div><h3>Aim</h3><div>This review aimed to evaluate the incidence of RAFs in the trunk, pelvis, and extremities as well as non-union rates of surgical and non-surgical treatment.</div></div><div><h3>Materials and methods</h3><div>A systematic review of PubMed and Embase databases was conducted. The study was registered on PROSPERO (ID: CRD42024513017). Studies were included if they reported RAFs in oncologic populations, had a sample size of at least five patients, and provided extractable data on RAF incidence or number. The STROBE checklist was utilized for evaluation of study quality. For eligible studies, quantitative analyses were conducted to determine weighted incidence of RAF and fracture non-union.</div></div><div><h3>Results</h3><div>Thirty-five studies comprising 9,980 patients treated with radiation therapy were included. The weighted incidence of RAFs was calculated to be 6.5% across 8,061 patients. The weighted incidence of femoral RAF was 5.2%, while pelvic RAF incidence was 17.1%. Non-union rates after initial treatment varied from 4% to 100%, with an overall weighted incidence of 48%. Treatments included intramedullary nailing, fixation with screws/plate, prosthetic replacement, conservative treatment, and amputation, with varying success rates.</div></div><div><h3>Conclusion</h3><div>This review highlights RAFs as a significant complication of radiation therapy, with a weighted incidence of 6.5% and a non-union rate of 48%. Advanced radiation techniques have reduced RAF occurrences, but non-union remains a challenge, necessitating tailored treatment strategies. Further research is needed to optimize RAF management and improve patient outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110617"},"PeriodicalIF":4.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606186","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号