Radiotherapy and Oncology最新文献_第5页

The actual performance of ML/AI models in predicting radiation-induced toxicity in head and neck cancer: a systematic review and meta-analysis ML/AI模型在预测头颈癌辐射毒性中的实际表现：一项系统综述和荟萃分析。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI: 10.1016/j.radonc.2025.111350

Gibson C. Ugwu , Farzad Jalali , Geoffrey Liu , Guojun Li , Johannes Albertus Langendijk , Behrooz Z. Alizadeh

An increasing number of Artificial intelligence (AI) and machine learning (ML) models are being developed to predict radiation-induced toxicities (RITs) in patients with head and neck cancer (HNC). But their performance and reliability remain uncertain. This systematic review and meta-analysis evaluated the predictive accuracy and methodological quality of these models. We comprehensively searched PubMed, EMBASE, Web of Science, and the Cochrane Library to identify studies reporting on ML/AI models for predicting RITs in HNC patients. Eligible studies were assessed for bias risk using the PROBAST tool, and key performance metrics, including the area under the receiver operating curve (AUROC), were extracted. A hierarchical multilevel meta-analysis was performed to estimate pooled AUROC values, and subgroup analyses explored the influence of study characteristics on model performance. A total of 67 studies with a total of 568 models were included, showing moderate discriminatory power of ML/AI models, with a pooled AUROC = 0.76; 95 % CI: 0.73–0.78. Nonetheless, substantial heterogeneity was observed across studies. Incorporating imaging biomarkers significantly improved model performance. Prospective and internal validation showed comparable performance; external validation shows true generalizability. The predominance of retrospective designs and variability in predictor selection may have introduced bias, affecting model reliability and generalisability. ML/AI models hold promise for predicting RITs in HNC patients, but methodological constraints limit their applicability. Standardised and transparent reporting of model development and validation processes is vital for improving comparability among studies. Future research should explore hybrid modelling methods and the integration of clinical, dosimetric, radiomic, and genomic data to boost predictive accuracy.

越来越多的人工智能（AI）和机器学习（ML）模型正在开发中，以预测头颈癌（HNC）患者的辐射诱发毒性（RITs）。但它们的性能和可靠性仍不确定。本系统综述和荟萃分析评估了这些模型的预测准确性和方法学质量。我们全面检索了PubMed、EMBASE、Web of Science和Cochrane Library，以确定报告ML/AI模型预测HNC患者RITs的研究。使用PROBAST工具评估符合条件的研究的偏倚风险，并提取关键绩效指标，包括受试者工作曲线下面积（AUROC）。采用分层多水平元分析来估计汇总的AUC值，并进行亚组分析，探讨研究特征对模型性能的影响。共纳入67项研究，共568个模型，ML/AI模型具有中等的区分力，合并AUC = 0.76；95 % ci: 0.73-0.78。尽管如此，在研究中观察到大量的异质性。结合成像生物标志物可显著提高模型性能。前瞻性和内部验证显示相当的性能；外部验证显示了真正的通用性。回顾性设计的优势和预测器选择的可变性可能会引入偏差，影响模型的可靠性和通用性。ML/AI模型有望预测HNC患者的RITs，但方法上的限制限制了它们的适用性。模型开发和验证过程的标准化和透明报告对于提高研究之间的可比性至关重要。未来的研究应该探索混合建模方法和临床、剂量学、放射学和基因组数据的整合，以提高预测的准确性。

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引用次数: 0

In response to Liu et al 在回应Liu等人。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI: 10.1016/j.radonc.2025.111353

S.P.M. de Vette, J.A. Langendijk, N.M. Sijtsema, L.V. van Dijk

引用次数: 0

Aims+Scope/Editorial Board/ Publication information 目标+范围/编辑委员会/出版信息

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI: 10.1016/S0167-8140(26)00058-7

引用次数: 0

Machine learning model for predicting interfraction motion of the seminal vesicles in prostate cancer radiotherapy 预测前列腺癌放疗中精囊干涉运动的机器学习模型

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 10.1016/j.radonc.2026.111368

Mitsuaki Terabe , Takeshi Kamomae , Yuki Taniguchi , Takayuki Miyachi , Hajime Ichikawa , Risei Miyauchi , Junji Ito , Mariko Kawamura , Shunichi Ishihara , Shinji Naganawa

Background and purpose

In external beam radiotherapy for prostate cancer, inclusion of the seminal vesicles (SV) in the clinical target volume (CTV) is often complicated by considerable SV motion and deformation. This study aimed to investigate the feasibility of predicting patient-specific SV motion using anatomical features surrounding the prostate on planning CT (pCT) images.

Materials and methods

Interfractional SV motion was quantified using five pretreatment cone-beam CT (CBCT) scans per patient from a cohort of 191 prostate cancer patients. Patients whose SV was not fully covered by a 3-mm margin were assigned to the High SV Motion Group, which served as the target for prediction. A total of 42 anatomical features were extracted from the contours of the prostate, SV, bladder, and rectum on the pCT. Feature selection was performed using Random-Forest Recursive Feature Elimination, and a machine learning model was developed and evaluated using both internal and external patient cohorts.

Results

Four anatomical features were selected, including those based on the anatomical relationship between the prostate and the SV. Using these features, the best-performing light gradient boosting machine model achieved an area under the receiver operating characteristic curve of 0.724 in the internal test and 0.632 in the external test for identifying patients in the High SV Motion Group.

Conclusion

This study suggests an association between anatomical features derived from pCT and patient-specific SV motion. Although the current predictive performance is moderate, this approach may help support radiotherapy strategies when the SV is included in the CTV.

背景与目的在前列腺癌的体外放射治疗中，精囊（SV）被纳入临床靶体积（CTV）时，常常伴有相当大的SV运动和变形。本研究旨在探讨利用计划CT （pCT）图像上前列腺周围的解剖特征预测患者特异性SV运动的可行性。材料和方法对191例前列腺癌患者进行5次预处理锥形束CT （CBCT）扫描，量化每位患者的SV分数运动。SV未被3毫米边缘完全覆盖的患者被分配到高SV运动组，作为预测的目标。从pCT上的前列腺、SV、膀胱和直肠的轮廓中提取了总共42个解剖特征，使用随机森林递归特征消除法进行特征选择，并使用内部和外部患者队列开发了机器学习模型并进行了评估。结果选择了4个解剖特征，其中包括基于前列腺与SV解剖关系的解剖特征。利用这些特征，在识别高SV运动组患者时，表现最好的光梯度增强机模型在内部测试和外部测试中获得了接受者工作特征曲线下的面积分别为0.724和0.632。结论：本研究提示pCT解剖特征与患者特异性SV运动之间存在关联。虽然目前的预测效果一般，但当SV包括在CTV中时，该方法可能有助于支持放疗策略。

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引用次数: 0

Photon FLASH spares radiation-induced changes in cardiac function, remodelling and arrythmia in a preclinical model 在临床前模型中，光子闪光避免了辐射引起的心功能、重构和心律失常的变化。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-05 DOI: 10.1016/j.radonc.2026.111369

Mihaela Ghita-Pettigrew , Kathryn H. Brown , Brianna N. Kerr , Gerard M. Walls , Ioannis I. Verginadis , Gabriel Adrian , Kristoffer Petersson , Stephen J. McMahon , Karl T. Butterworth

Introduction

Preclinical studies have demonstrated the ability of FLASH irradiation to expand the therapeutic window by sparing normal tissues. The heart is a critical organ at risk in patients receiving radiotherapy for thoracic cancers. This study aimed to quantify the cardiac sparing effects of photon FLASH delivered as single (FLASH) or FLASH split dose (FSD) exposures.

Methods

Female C57BL/6 mice were irradiated with 18.5 ± 0.6 Gy delivered to the whole heart using a FLASH-SARRP (Xstrahl Life Sciences, UK) at a dose rate of 85.6 ± 1.6 Gy/s (isocentre dose rate 75.9 ± 1.5 Gy/s). Comparative studies were undertaken using 18.6 ± 0.4 Gy delivered using two consecutive pulses (FSD) at an average dose rate of 2.8 ± 0.9 Gy/s, and with 20.1 ± 0.5 Gy using a conventional SARRP at a dose rate of 3.4 ± 0.2 Gy/min (CONV). Transthoracic echocardiography was performed at 10 and 30 weeks with supporting histology and analysis of serum biomarkers 30 weeks post irradiation.

Results

In comparison to CONV and FSD exposures, FLASH significantly reduced radiation-induced loss of cardiac function, cardiac remodelling and arrythmia 30 weeks after irradiation. These observations were supported by reduced myocardial fibrosis, cardiac injury biomarkers and inflammatory cytokines.

Conclusions

This study highlights the ability of photon FLASH to preserve cardiac function and structure from radiation damage with the level of sparing dependent on average dose rate and beam structure.

临床前研究已经证明了FLASH照射通过保留正常组织来扩大治疗窗口的能力。在接受胸部肿瘤放疗的患者中，心脏是有危险的重要器官。本研究旨在量化单次（FLASH）或分次（FSD）照射的光子FLASH对心脏的保护作用。方法:女性C57BL / 6小鼠辐照18.5 ±0.6  Gy交付使用FLASH-SARRP全心(英国Xstrahl生命科学)的剂量率85.6 ±1.6  Gy / s(等中心剂量率75.9 ±1.5  Gy / s)。比较研究是进行使用18.6 ±0.4  Gy交付使用两个连续的脉冲(FSD)平均剂量率2.8 ±0.9  Gy / s,和20.1 ±0.5  Gy使用常规的剂量率SARRP 3.4 ±0.2  Gy /分钟(CONV)。在照射后10周和30 周进行经胸超声心动图检查，并在照射后30 周进行组织学检查和血清生物标志物分析。结果：与CONV和FSD暴露相比，FLASH在照射30 周后显著减少了辐射引起的心功能丧失、心脏重构和心律失常。心肌纤维化、心脏损伤生物标志物和炎症细胞因子的减少支持了这些观察结果。结论：本研究强调了光子闪光保护心脏功能和结构免受辐射损伤的能力，其保护水平取决于平均剂量率和光束结构。

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引用次数: 0

Are the CTV-to-PTV margins currently used in online adaptive radiotherapy for prostate cancer too large? The impact of the distribution of microscopic disease on treatment margin requirements 目前用于前列腺癌在线适应性放疗的ctv - ptv边缘是否过大？微观疾病分布对治疗裕度要求的影响。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.radonc.2025.111351

Mathijs G. Dassen , Marcel van Herk , Marnix G. Witte , Tomas Janssen , Floris Pos , Uulke A. van der Heide

Purpose

Planning target volume (PTV) margin recipes assume all parts of the target are equally important. For the prostate clinical target volume (CTV) this is invalid. We evaluated the impact of the spatial probability distribution of microscopic disease in the prostate on CTV-to-PTV margins.

Materials and methods

A prostate with a volume of 44 cm³ was defined as CTV_prostate. Homogenous dose distributions were created with margins ranging 0–5 mm. The gross tumor volume (GTV) was assumed covered with a separate margin. Microscopic satellites were sampled within the CTV_prostate from a histopathology-based probability distribution for a range of numbers (1–10) and sizes (0.02–0.2 cm³) to define CTV_satellites. Geometric errors were sampled from a 3D Gaussian distribution, simulating online adaptive treatment of 5 fractions. Each CTV was shifted with respect to the dose according to each total error. The PTV margin ensuring 95 % of the prescribed dose to the CTV_satellites in 90 % of simulations was determined and compared with CTV_prostate.

Results

For systematic errors with width (Σ) 0.5 mm and random errors with width (σ_r) 1.5 mm, the margin for the CTV_prostate was 3 mm, whereas for each definition of CTV_satellites this margin was 0–1 mm. For σ_r = 2.7 mm, a margin of 5 mm was adequate for the CTV_prostate and 2–3 mm for all except the most favourable and unfavourable CTV_satellites definition.

Conclusion

The CTV-to-PTV margins used in online adaptive radiotherapy for prostate cancer can be reduced by ∼2 mm, if the GTV is covered with an adequate margin.

目的：计划目标体积（PTV）边缘食谱假设目标的所有部分都同等重要。对于前列腺临床靶体积（CTV），这是无效的。我们评估了前列腺显微疾病的空间概率分布对ctv - ptv边缘的影响。材料和方法：前列腺体积44 cm3定义为CTVprostate。均质剂量分布在0-5 mm范围内。假定肿瘤总体积（GTV）被单独的切缘覆盖。显微卫星从基于组织病理学的概率分布中采样ctv前列腺内的数字（1-10）和大小（0.02-0.2 cm3），以定义ctv卫星。几何误差从三维高斯分布中采样，模拟5个分数的在线自适应处理。每个CTV相对于剂量根据每个总误差进行移位。确定了在90% %的模拟中确保给ctv卫星的规定剂量达到95% %的PTV裕度，并与ctv前列腺进行了比较。结果：对于宽度（Σ）为0.5 mm的系统误差和宽度（Σ r）为1.5 mm的随机误差，CTVprostate的余量为3 mm，而对于ctvsatellite的每个定义，其余量为0-1 mm。对于σr = 2.7 mm，对于ctv前列腺来说，5 mm的裕度是足够的，除了最有利和最不利的ctv卫星定义之外，所有的裕度都是2-3 mm。结论：如果GTV有足够的边缘覆盖，用于前列腺癌在线适应性放疗的ctv - ptv边缘可缩小 ~ 2mm。

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引用次数: 0

Stage-adjusted forecasting of radiotherapy demand and outcome benefits across income groups: Estimating survival and local control gains by 2050 不同收入群体放疗需求和结果收益的分期调整预测：估计到2050年的生存和局部控制收益。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2025-11-22 DOI: 10.1016/j.radonc.2025.111303

Mengqi Zhou , Dania Abu Awwad , Geoffrey Paul Delaney , Vikneswary Batumalai , Aba Scott , Eduardo Zubizarreta , Yavuz Anacak , Soehartati Gondhowiardjo , Tiara B. Mayang Permata , Mei Ling Yap

Background

Radiotherapy is a vital component of cancer care, yet access is limited. Global estimates often overlook cancer stage variability across countries with different income levels. This study assesses the supply–demand gap for megavoltage radiotherapy machines (MVMs) from 2012 to 2022 and projects the survival and local control benefits achievable by meeting optimal radiotherapy needs by 2050.

Methods

Global cancer data were from GLOBOCAN 2022. A validated, stage-adjusted radiotherapy utilisation model was adapted using available cancer stage data from LMICs for each geographical region. Population-based models estimating local control and survival benefit from radiotherapy were also stage-adjusted. The overall shortfall was calculated as patients not receiving treatment due to limited MVM availability. Corresponding outcome gaps were estimated by multiplying shortfall cases by their respective benefit percentages.

Results

Radiotherapy demand increased by 2.4 million cases from 2012 to 2022. Optimising access would yield survival benefits for >860,000 people annually and improved local control for 3.5 million cases annually. Lower-middle-income countries are estimated to derive the highest population-based benefits in local control (10.65 %) and survival (4.94 %). The number of patients missing radiotherapy is projected to reach 7.9 million by 2050, creating a global local control gap of 1.2 million and a survival gap of 500,000 cases per year.

Conclusion

This study highlights the urgent need for enhanced policies and expanded infrastructure to address radiotherapy disparities, particularly in LMICs, to improve local control and survival outcomes.

背景：放射治疗是癌症治疗的重要组成部分，但获取途径有限。全球估计往往忽略了不同收入水平国家之间癌症分期的差异。本研究评估了2012年至2022年巨压放疗机（mvm）的供需缺口，并预测了到2050年满足最优放疗需求所能实现的生存和局部控制效益。方法：全球癌症数据来自GLOBOCAN 2022。使用来自每个地理区域的低收入国家的可用癌症分期数据，对经过验证的分期调整的放疗利用模型进行了调整。基于人群的模型估计局部控制和放疗的生存效益也进行了分期调整。总缺口计算为由于MVM可用性有限而未接受治疗的患者。通过将短缺病例乘以各自的受益百分比来估计相应的结果差距。结果：2012 - 2022年放疗需求增加240万例。优化可及性将使每年860000人的生存受益，并改善每年350万病例的地方控制。估计中低收入国家在地方控制（10.65% %）和生存（4.94% %）方面获得的基于人口的最高效益。预计到2050年，未接受放射治疗的患者人数将达到790万，造成120万的全球局部控制缺口和每年50万例的生存缺口。结论：本研究强调了迫切需要加强政策和扩大基础设施来解决放疗差异，特别是在中低收入国家，以改善局部控制和生存结果。

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引用次数: 0

How can a radiation oncology society support its members and the community to help reduce the carbon footprint of radiation oncology? 放射肿瘤学学会如何支持其会员和社会各界帮助减少放射肿瘤学的碳足迹？

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-22 DOI: 10.1016/j.radonc.2025.111361

Rachel Allcock , Kari Tanderup , Jenny Bertholet , Amanda Webster , Robert Chuter

Background

Climate change is an escalating crisis with significant implications for public health and healthcare services. We aimed to survey radiation oncology (RO) professionals on their understanding and concerns about climate change and the role of ESTRO in addressing the crisis.

Materials and Methods

A 14-item survey covering environmental impact of RO activities, personal actions, and expectations of ESTRO’s responses to the climate crisis was developed, validated, and disseminated to RO professionals by email and online platforms.

Results

706 responses were received out of 9,781 ESTRO members. Concern about climate change was indicated by 90% of respondents and 94% had changed their personal lives to help combat the climate crisis. Yet 50% of respondents could not identify RO’s main contributors to climate change. 39% reported positive attitudes to online conferences and 79% agreed that ESTRO should offer digital participation to reduce the carbon impact of travel. Reported barriers to digital participation were mainly related to lack of face-to-face interaction.

Although additional time was the most common barrier to reducing flying for work-related trips, 47 % of respondents were willing to travel by train for ≥ 7 h to an ESTRO conference. The majority of respondents (82 %) agreed that ESTRO should ‘Increase engagement with manufacturers around environmental sustainability’.

Conclusion

Our results reveal strong concern about the climate crisis among RO professionals, willingness to implement change, lack of knowledge about climate impact of RO and support for ESTRO actions to support its members and the community in these efforts.

背景：气候变化是一场不断升级的危机，对公共卫生和保健服务产生重大影响。我们旨在调查放射肿瘤学（RO）专业人员对气候变化的理解和关注，以及ESTRO在应对危机中的作用。材料和方法：一项包含14个项目的调查，涵盖了RO活动对环境的影响、个人行为以及对ESTRO应对气候危机的期望，并通过电子邮件和在线平台传播给RO专业人员。结果：在9781名ESTRO成员中收到706份回复。90%的受访者表示对气候变化感到担忧，94%的受访者已经改变了他们的个人生活，以帮助应对气候危机。然而，50%的受访者无法确定RO对气候变化的主要影响。39%的受访者对在线会议持积极态度，79%的受访者同意ESTRO应该提供数字参与，以减少旅行的碳影响。报告的数字参与障碍主要与缺乏面对面的互动有关。虽然额外的时间是减少因工作而乘飞机旅行的最常见障碍，但47% 的受访者愿意乘火车前往 ≥ 7 小时参加ESTRO会议。大多数受访者（82% %）同意ESTRO应“加强与制造商在环境可持续性方面的合作”。结论：我们的研究结果揭示了RO专业人员对气候危机的强烈关注，实施变革的意愿，缺乏对RO气候影响的了解，以及对ESTRO行动的支持，以支持其成员和社区的这些努力。

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引用次数: 0

Single vocal cord irradiation (SVCI) vs whole laryngeal radiotherapy in the treatment of T1aN0 glottic cancer A prospective randomized trial 单声带照射（SVCI）与全喉放疗治疗T1aN0声门癌的前瞻性随机试验

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-09 DOI: 10.1016/j.radonc.2026.111376

Mohamed Mortada Elsharief , Ashraf Hamed Hassouna , Tarek Shouman , Abdelrahman Mosallam , Amr El-Badrawy , Ashraf Shawky , Ayman Amin , Sherweif M. Abdelfatah

Introduction

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.

经口激光手术（TLS）和放射治疗均可用于治疗T1aN0声门癌，其肿瘤预后相似。回顾性研究表明，单次声带照射仅针对受影响的声带，具有良好的局部控制效果。因此，本研究的目的是比较经典放射线场与单声带放射（SVCI）技术的治疗效果和毒性。患者和方法：这是一项前瞻性2期随机研究（clinicaltrial.gov注册号NCT05679856）。随机选取57例T1aN0声门癌患者。28例患者接受全喉标准护理放疗，处方剂量为63 Gy/28 Fractions (Fs)，其余29例患者随机接受单次声带放疗，处方剂量为58.08 Gy/16Fs。主要终点是通过比较两个研究组的语音障碍指数（VHI）来证明SVCI在语音质量方面的优越性。在治疗前、放疗结束时和每次随访期间记录基线VHI。结果：两组的人口统计学和患者特征具有可比性。在SVCI组中，对不同危险器官的剂量在统计学上较低。SVCI组2年局部控制率为100%，全喉组为96%，两组间差异无统计学意义。两个治疗组均未报告3级或4级毒性。SVCI组的患者在治疗后2 个月和1年的VHI评分较低，中位评分分别为4分和0分，而全喉组的中位评分为22分和21分。结论：SVCI治疗T1aN0声门癌有效、安全，局部控制率相当，毒副反应安全。与全喉放疗相比，SVCI与更好的语音预后相关，VHI评分显著提高。

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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 : 2026-03-01 Epub 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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引用次数: 0