Pub Date : 2025-12-07DOI: 10.1016/j.radonc.2025.111322
Olivier Riou , Pascal Fenoglietto , Marta Jarlier , Jessica Prunaretty , Norbert Aillères , Grégoire Poinas , Pierre Debuire , Sophie Gourgou , Laetitia Meignant , Bruno Segui , Carmen Llacer Moscardo , Marie Charissoux , David Azria
Background and purpose
Intensity-modulated (IMRT) and image-guided (IGRT) radiotherapies reduce radiation-induced toxicities in localized prostate cancer. This randomized phase II trial (NCT03254420) evaluated late pelvic toxicity (LPT) and quality of life after IMRT/IGRT with standard or reduced margins in patients with low- to intermediate-risk prostate cancer.
Materials and methods
Between August 2016 and May 2022, 74 patients were randomized (1:2) to IMRT/IGRT with standard (Control, n = 30) or reduced (Experimental, n = 44) margins. Control IGRT used cone-beam computed tomography (CBCT), while experimental IGRT combined CBCT with real-time tracking (Calypso® 4D Localization System) and smaller margins. Prostate margins were 3 mm in the Experimental arm versus 1 cm (0.5 cm posteriorly) in the Control arm. The primary endpoint was grade ≥ 2 LPT (CTCAE v4.03). Toxicities were assessed by physician-scored CTCAE and patient-reported quality-of-life outcomes.
Results
Grade ≥ 2 LPT occurred in 5 patients in each arm. Over the study period, 88.6 % (95 % CI: 75.4–96.2) of patients in the Experimental arm and 80.8 % (95 % CI: 60.6–93.4) in the Control arm did not experience a grade ≥ 2 LPT. Under conventional fractionation, the Experimental arm had significantly lower rectal (V70Gy, D50%) and bladder (D50%, V70Gy, V76Gy) doses (p < 0.01), but higher rectal (D1%, V76Gy) and bladder (V80Gy) doses (p < 0.01). At two years post-radiotherapy, urinary symptom scores were significantly lower in the Experimental arm (mean 12.3 vs. 21.2, p = 0.028).
Conclusion
IMRT/IGRT with reduced margins is feasible and may improve some dosimetric outcomes. Both arms had low LPT rates, but reduced margins may improve patient-reported urinary symptoms.
{"title":"Image-guided intensity-modulated radiotherapy with reduced margins in patients with prostate cancer: Results of the RCMIGI randomized phase II trial","authors":"Olivier Riou , Pascal Fenoglietto , Marta Jarlier , Jessica Prunaretty , Norbert Aillères , Grégoire Poinas , Pierre Debuire , Sophie Gourgou , Laetitia Meignant , Bruno Segui , Carmen Llacer Moscardo , Marie Charissoux , David Azria","doi":"10.1016/j.radonc.2025.111322","DOIUrl":"10.1016/j.radonc.2025.111322","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Intensity-modulated (IMRT) and image-guided (IGRT) radiotherapies reduce radiation-induced toxicities in localized prostate cancer. This randomized phase II trial (NCT03254420) evaluated late pelvic toxicity (LPT) and quality of life after IMRT/IGRT with standard or reduced margins in patients with low- to intermediate-risk prostate cancer.</div></div><div><h3>Materials and methods</h3><div>Between August 2016 and May 2022, 74 patients were randomized (1:2) to IMRT/IGRT with standard (Control, n = 30) or reduced (Experimental, n = 44) margins. Control IGRT used cone-beam computed tomography (CBCT), while experimental IGRT combined CBCT with real-time tracking (Calypso® 4D Localization System) and smaller margins. Prostate margins were 3 mm in the Experimental arm versus 1 cm (0.5 cm posteriorly) in the Control arm. The primary endpoint was grade ≥ 2 LPT (CTCAE v4.03). Toxicities were assessed by physician-scored CTCAE and patient-reported quality-of-life outcomes.</div></div><div><h3>Results</h3><div>Grade ≥ 2 LPT occurred in 5 patients in each arm. Over the study period, 88.6 % (95 % CI: 75.4–96.2) of patients in the Experimental arm and 80.8 % (95 % CI: 60.6–93.4) in the Control arm did not experience a grade ≥ 2 LPT. Under conventional fractionation, the Experimental arm had significantly lower rectal (V<sub>70Gy</sub>, D<sub>50%</sub>) and bladder (D<sub>50%</sub>, V<sub>70Gy</sub>, V<sub>76Gy</sub>) doses (p < 0.01), but higher rectal (D<sub>1%</sub>, V<sub>76Gy</sub>) and bladder (V<sub>80Gy</sub>) doses (p < 0.01). At two years post-radiotherapy, urinary symptom scores were significantly lower in the Experimental arm (mean 12.3 vs. 21.2, p = 0.028).</div></div><div><h3>Conclusion</h3><div>IMRT/IGRT with reduced margins is feasible and may improve some dosimetric outcomes. Both arms had low LPT rates, but reduced margins may improve patient-reported urinary symptoms.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"215 ","pages":"Article 111322"},"PeriodicalIF":5.3,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715659","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}
World Health Organization (WHO)-defined central nervous system (CNS) grade 4 high-grade gliomas (HGGs) are aggressive brain tumors marked by hypoxia and diffuse infiltration, which leaves residual tumor cells after surgery and drives inevitable local recurrence. Here, we propose a novel local therapeutic approach with 64Cu-diacetyl-bis(N4-methylthiosemicarbazone) ([64Cu]Cu-ATSM), a hypoxia-targeting radiopharmaceutical, using HGG-patient-derived xenograft (PDX) models.
Methods
The maximum tolerated dose (MTD) of local injection of [64Cu]Cu-ATSM into the tumor was determined in mice via biodistribution, dosimetry, and toxicity analyses. Intratumoral distribution was evaluated using PET/CT and MRI in multiple HGG-PDX models recapitulating human tumor characteristics. Therapeutic efficacy was assessed by survival analysis, along with evaluation of DNA damage and apoptosis.
Results
The MTD of [64Cu]Cu-ATSM local injection was established at 3.7 MBq. PET/CT demonstrated rapid intratumoral penetration, widespread distribution, and prolonged retention of [64Cu]Cu-ATSM in HGG-PDX tumors. Local treatment significantly extended survival and induced pronounced DNA double-strand breaks and apoptosis within tumors.
Conclusion
Local injection of [64Cu]Cu-ATSM into the tumor is a novel therapeutic strategy for HGG-PDX models, which combines hypoxia-targeted radiotherapy with PET-based treatment monitoring to address residual tumor cells and improve therapeutic outcomes.
{"title":"Local therapy with hypoxia-targeting radiopharmaceutical [64Cu]Cu-ATSM in high-grade glioma patient-derived xenograft models","authors":"Yukie Yoshii , Fukiko Hihara , Hiroki Matsumoto , Chika Igarashi , Tomoko Tachibana , Mitsuhiro Shinada , Makoto Ohtake , Hisashi Suzuki , Ming-Rong Zhang , Akito Oshima , Tomohiro Kaneta , Nobuhiro Nitta , Sayaka Shibata , Hidemitsu Sato , Kimiteru Ito , Yoshitaka Narita , Daniel P. Cahill , Hiroaki Wakimoto , Ukihide Tateishi , Hiroaki Kurihara , Kensuke Tateishi","doi":"10.1016/j.radonc.2025.111325","DOIUrl":"10.1016/j.radonc.2025.111325","url":null,"abstract":"<div><h3>Background</h3><div>World Health Organization (WHO)-defined central nervous system (CNS) grade 4 high-grade gliomas (HGGs) are aggressive brain tumors marked by hypoxia and diffuse infiltration, which leaves residual tumor cells after surgery and drives inevitable local recurrence. Here, we propose a novel local therapeutic approach with <sup>64</sup>Cu-diacetyl-bis(N4-methylthiosemicarbazone) ([<sup>64</sup>Cu]Cu-ATSM), a hypoxia-targeting radiopharmaceutical, using HGG-patient-derived xenograft (PDX) models.</div></div><div><h3>Methods</h3><div>The maximum tolerated dose (MTD) of local injection of [<sup>64</sup>Cu]Cu-ATSM into the tumor was determined in mice via biodistribution, dosimetry, and toxicity analyses. Intratumoral distribution was evaluated using PET/CT and MRI in multiple HGG-PDX models recapitulating human tumor characteristics.<!--> <!-->Therapeutic efficacy was assessed by survival analysis, along with evaluation of DNA damage and apoptosis.</div></div><div><h3>Results</h3><div>The MTD of [<sup>64</sup>Cu]Cu-ATSM local injection was established at 3.7 MBq. PET/CT demonstrated rapid intratumoral penetration, widespread distribution, and prolonged retention of [<sup>64</sup>Cu]Cu-ATSM in HGG-PDX tumors. Local treatment significantly extended survival and induced pronounced DNA double-strand breaks and apoptosis within tumors.</div></div><div><h3>Conclusion</h3><div>Local injection of [<sup>64</sup>Cu]Cu-ATSM into the tumor is a novel therapeutic strategy for HGG-PDX models, which combines hypoxia-targeted radiotherapy with PET-based treatment monitoring to address residual tumor cells and improve therapeutic outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111325"},"PeriodicalIF":5.3,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715706","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 : 2025-12-07DOI: 10.1016/j.radonc.2025.111324
D. Majorova , R. Samuel , R. Muirhead , A. Hasson , DJ. MacLean , F. Ismail , EJ. Cheadle , C. Jacobs , D. Halliday , M. Saunders , BD. Nicholson , E. O’Neill , D. Sebag-Montefiore , A. Samson , MM. Olcina
Background
Identification of easily measurable biomarkers that are able to predict locoregional failure or disease progression following chemoradiotherapy (CRT) would enable more personalised cancer management. Anal squamous cell cancer (ASCC) is the most common type of anal cancer, accounting for approximately 90% of all cases. While CRT is the standard of care for most locally advanced anal cancers, treatment failure occurs in up to 30% of patients. However, it is currently difficult to predict which patients will fail to respond to treatment, highlighting the need for predictive biomarkers. This study aims to assess whether plasma levels of complement proteins can serve as potential biomarkers of treatment response.
Materials and Methods
Serial peripheral blood samples from ASCC patients (n = 40) were collected before, during, and after CRT, alongside 6-month clinical and radiological outcomes. Using multiplex ELISA-based technology, we assessed levels of 14 complement proteins at baseline, during CRT, and 3 months post-CRT. Additionally, the same technology was used to compare levels of complement analytes in ASCC and in age- and sex-matched patients without a cancer diagnosis.
Results
Our data indicate that CRT decreases levels of most complement analytes measured, with intact C2, intact C3, intact C5, C3a, C5a, Ba, Bb, SC5b9, Factor D, Factor H, Factor I, and Factor P decreasing 3 months after treatment specifically in those patients achieving complete responses (all p < 0.05). Moreover, the treatment failure group showed changes indicative of persistent alternative complement pathway activation, with a less pronounced decline following CRT compared to responders. Furthermore, intact C2 and intact C5 levels were significantly higher in ASCC patients compared to age- and sex-matched patients without a cancer diagnosis (both p < 0.005). In contrast, C3a and C4a were expressed at higher levels in patients without cancer diagnosis compared to ASCC patients (both p < 0.02). Importantly, patients in the treatment failure group had elevated baseline (pre-treatment) levels of intact C2 and Factor D compared to those achieving complete response (both p < 0.03).
Conclusions
These findings suggest that dysregulation of the complement system, particularly involving the alternative pathway, may be more prevalent in patients with a poor treatment response. Intact C2 and Factor D may represent potential markers of treatment failure.
{"title":"Systemic complement protein levels as biomarkers of chemoradiotherapy response in anal squamous cell carcinoma","authors":"D. Majorova , R. Samuel , R. Muirhead , A. Hasson , DJ. MacLean , F. Ismail , EJ. Cheadle , C. Jacobs , D. Halliday , M. Saunders , BD. Nicholson , E. O’Neill , D. Sebag-Montefiore , A. Samson , MM. Olcina","doi":"10.1016/j.radonc.2025.111324","DOIUrl":"10.1016/j.radonc.2025.111324","url":null,"abstract":"<div><h3>Background</h3><div>Identification of easily measurable biomarkers that are able to predict locoregional failure or disease progression following chemoradiotherapy (CRT) would enable more personalised cancer management. Anal squamous cell cancer (ASCC) is the most common type of anal cancer, accounting for approximately 90% of all cases. While CRT is the standard of care for most locally advanced anal cancers, treatment failure occurs in up to 30% of patients. However, it is currently difficult to predict which patients will fail to respond to treatment, highlighting the need for predictive biomarkers. This study aims to assess whether plasma levels of complement proteins can serve as potential biomarkers of treatment response.</div></div><div><h3>Materials and Methods</h3><div>Serial peripheral blood samples from ASCC patients (n = 40) were collected before, during, and after CRT, alongside 6-month clinical and radiological outcomes. Using multiplex ELISA-based technology, we assessed levels of 14 complement proteins at baseline, during CRT, and 3 months post-CRT. Additionally, the same technology was used to compare levels of complement analytes in ASCC and in age- and sex-matched patients without a cancer diagnosis.</div></div><div><h3>Results</h3><div>Our data indicate that CRT decreases levels of most complement analytes measured, with intact C2, intact C3, intact C5, C3a, C5a, Ba, Bb, SC5b9, Factor D, Factor H, Factor I, and Factor P decreasing 3 months after treatment specifically in those patients achieving complete responses (all p < 0.05). Moreover, the treatment failure group showed changes indicative of persistent alternative complement pathway activation, with a less pronounced decline following CRT compared to responders. Furthermore, intact C2 and intact C5 levels were significantly higher in ASCC patients compared to age- and sex-matched patients without a cancer diagnosis (both p < 0.005). In contrast, C3a and C4a were expressed at higher levels in patients without cancer diagnosis compared to ASCC patients (both p < 0.02). Importantly, patients in the treatment failure group had elevated baseline (pre-treatment) levels of intact C2 and Factor D compared to those achieving complete response (both p < 0.03).</div></div><div><h3>Conclusions</h3><div>These findings suggest that dysregulation of the complement system, particularly involving the alternative pathway, may be more prevalent in patients with a poor treatment response. Intact C2 and Factor D may represent potential markers of treatment failure.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111324"},"PeriodicalIF":5.3,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715740","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 : 2025-12-04DOI: 10.1016/j.radonc.2025.111316
P. Maury , Y. Sayous , D. Vernerey , X.S. Sun , J. Bourhis , A. Falcoz , J. Thariat
Background
Stereotactic ablative radiotherapy (SABR) is increasingly used in the management of oligometastatic disease. However, variability in SABR plans raises questions about their impact on local control at SABR-treated lesions (LC). We aimed to explore whether quantitative dosimetric parameters could predict LC in head and neck squamous cell carcinoma (HNSCC) patients in the OMET (GORTEC 2014–04) trial.
Methods
OMET is a multicentre randomized phase II trial comparing SABR-alone versus chemo-SABR in patients with ≤ 3 PET-confirmed oligometastases. A post-hoc analysis of all irradiated lesions (N = 98) from 69 patients was performed. Twenty spatial and dosimetric indices, together with conventional metrics including Dmin, Dmean, Dmax, total target volume and homogeneity/conformity indices, were extracted from the DICOM files. Hierarchical clustering was used to identify phenotypes of plan quality. Kaplan–Meier analyses evaluated associations with LC.
Results
Wide inter-patient variability in dosimetric parameters and three clusters was observed, despite SABR standardization per trial protocol. The cluster of lesions (N = 13) with high intra-tumoral dose heterogeneity and non-optimal conformity was associated with significantly improved LC. In contrast, a more homogeneous and conformal phenotype was linked to inferior LC (N = 14). The largest cluster (N = 69) showed no clearly distinctive pattern and had intermediate LC.
Conclusions
In SABR for oligometastatic HNSCC, intra-tumoral dose heterogeneity may be more predictive of LC than strict conformity, particularly in high-dose per fraction regimens. A quantitative, phenotype-based machine learning approach using unsupervised clustering of composite dosimetric metrics may be explored further within SABR quality assurance frameworks beyond binary expert review alone.
{"title":"Clustering of dosimetric profiles reveals distinct local control probabilities after SABR in oligometastatic head and neck cancer: insights from the OMET phase II trial quality assurance Process","authors":"P. Maury , Y. Sayous , D. Vernerey , X.S. Sun , J. Bourhis , A. Falcoz , J. Thariat","doi":"10.1016/j.radonc.2025.111316","DOIUrl":"10.1016/j.radonc.2025.111316","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic ablative radiotherapy (SABR) is increasingly used in the management of oligometastatic disease. However, variability in SABR plans raises questions about their impact on local control at SABR-treated lesions (LC). We aimed to explore whether quantitative dosimetric parameters could predict LC in head and neck squamous cell carcinoma (HNSCC) patients in the OMET (GORTEC 2014–04) trial.</div></div><div><h3>Methods</h3><div>OMET is a multicentre randomized phase II trial comparing SABR-alone versus chemo-SABR in patients with ≤ 3 PET-confirmed oligometastases. A post-hoc analysis of all irradiated lesions (N = 98) from 69 patients was performed. Twenty spatial and dosimetric indices, together with conventional metrics including Dmin, Dmean, Dmax, total target volume and homogeneity/conformity indices, were extracted from the DICOM files. Hierarchical clustering was used to identify phenotypes of plan quality. Kaplan–Meier analyses evaluated associations with LC.</div></div><div><h3>Results</h3><div>Wide inter-patient variability in dosimetric parameters and three clusters was observed, despite SABR standardization per trial protocol. The cluster of lesions (N = 13) with high intra-tumoral dose heterogeneity and non-optimal conformity was associated with significantly improved LC. In contrast, a more homogeneous and conformal phenotype was linked to inferior LC (N = 14). The largest cluster (N = 69) showed no clearly distinctive pattern and had intermediate LC.</div></div><div><h3>Conclusions</h3><div>In SABR for oligometastatic HNSCC, intra-tumoral dose heterogeneity may be more predictive of LC than strict conformity, particularly in high-dose per fraction regimens. A quantitative, phenotype-based machine learning approach using unsupervised clustering of composite dosimetric metrics may be explored further within SABR quality assurance frameworks beyond binary expert review alone.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111316"},"PeriodicalIF":5.3,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145690446","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 : 2025-12-02DOI: 10.1016/j.radonc.2025.111304
Filippo Alongi , Francesco Cuccia , Rupesh Kotecha , Marina Campione , Alexander V. Louie , Lijun Ma , Giuseppe Minniti , Alison C. Tree , Max Dahele , Simon Lo , Per Munck af Rosenschold , John H. Suh , Maximilian Niyazi , Jason Sheehan , Matthias Guckenberger , Arjun Sahgal
Background
Stereotactic body radiotherapy (SBRT) is an established treatment for previously unirradiated spinal metastases; however, the literature is limited with respect to SBRT as a re-irradiation salvage therapy. We performed a systematic review and meta-analysis as basis for joint ESTRO-ISRS clinical practice recommendations of salvage SBRT for spinal metastases.
Methods
A systematic review and meta-analysis were performed using PRISMA methodology, including publications from January 2006 to September 2024, reporting on the clinical outcomes of ≥ 5 patients treated with spine SBRT re-irradiation (≥5 Gy per fraction) for vertebral metastases. These data served as basis for joint ESTRO-ISRS clinical practice recommendations.
Results
After the initial article screen, 20 studies (5 prospective, 15 retrospective) met the inclusion criteria for analysis. A total of 1538 spine metastases were treated in 1284 patients. The median re-irradiation dose was 24 Gy in 2 fractions (range: 16–30 Gy in 1–5 fractions) after a median 30 Gy in 10 fractions of prior conventional radiotherapy. Vertebral compression fracture, nerve root damage, and myelopathy events were observed in a pooled proportion of 5.0 %, 5.6 %, and 1.7 %, respectively. With a median follow-up of 12 months, the pooled 1- and 2-year LC rates were 81 % (95 % CI: 77–86 %) and 70 % (95 % CI: 61–79 %), respectively. Despite the low level of evidence, a consensus was reached after the first round of voting for 11 practice recommendations, suggesting a substantial level of agreement among the experts.
Conclusions
Re-irradiation with SBRT for spine metastases following prior conventional radiation or SBRT was efficacious, safe, and is a recommended treatment option in appropriately selected patients. Joint practice recommendations are provided on behalf of ESTRO and ISRS to guide clinical practice.
{"title":"ESTRO-ISRS clinical practice recommendations for re-irradiation of spinal metastases with Stereotactic Body Radiotherapy: Delphi consensus supported by a systematic review and meta-analysis","authors":"Filippo Alongi , Francesco Cuccia , Rupesh Kotecha , Marina Campione , Alexander V. Louie , Lijun Ma , Giuseppe Minniti , Alison C. Tree , Max Dahele , Simon Lo , Per Munck af Rosenschold , John H. Suh , Maximilian Niyazi , Jason Sheehan , Matthias Guckenberger , Arjun Sahgal","doi":"10.1016/j.radonc.2025.111304","DOIUrl":"10.1016/j.radonc.2025.111304","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic body radiotherapy (SBRT) is an established treatment for previously unirradiated spinal metastases; however, the literature is limited with respect to SBRT as a re-irradiation salvage therapy. We performed a systematic review and <em>meta</em>-analysis as basis for joint ESTRO-ISRS clinical practice recommendations of salvage SBRT for spinal metastases.</div></div><div><h3>Methods</h3><div>A systematic review and <em>meta</em>-analysis were performed using PRISMA methodology, including publications from January 2006 to September 2024, reporting on the clinical outcomes of ≥ 5 patients treated with spine SBRT re-irradiation (≥5 Gy per fraction) for vertebral metastases. These data served as basis for joint ESTRO-ISRS clinical practice recommendations.</div></div><div><h3>Results</h3><div>After the initial article screen, 20 studies (5 prospective, 15 retrospective) met the inclusion criteria for analysis. A total of 1538 spine metastases were treated in 1284 patients. The median re-irradiation dose was 24 Gy in 2 fractions (range: 16–30 Gy in 1–5 fractions) after a median 30 Gy in 10 fractions of prior conventional radiotherapy. Vertebral compression fracture, nerve root damage, and myelopathy events were observed in a pooled proportion of 5.0 %, 5.6 %, and 1.7 %, respectively. With a median follow-up of 12 months, the pooled 1- and 2-year LC rates were 81 % (95 % CI: 77–86 %) and 70 % (95 % CI: 61–79 %), respectively. Despite the low level of evidence, a consensus was reached after the first round of voting for 11 practice recommendations, suggesting a substantial level of agreement among the experts.</div></div><div><h3>Conclusions</h3><div>Re-irradiation with SBRT for spine metastases following prior conventional radiation or SBRT was efficacious, safe, and is a recommended treatment option in appropriately selected patients. Joint practice recommendations are provided on behalf of ESTRO and ISRS to guide clinical practice.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111304"},"PeriodicalIF":5.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678629","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 : 2025-11-30DOI: 10.1016/j.radonc.2025.111310
Dieuwke R. Mink van der Molen , Marilot C.T. Batenburg , Tanja van ’t Westeinde , Antonetta C. Houweling , Wies Maarse , Karolien Verhoeven , Jennifer Strijbos , Lars Murrer , Sabine Siesling , Evelyn M. Monninkhof , Helena M. Verkooijen , Liesbeth J. Boersma , Femke van der Leij , UMBRELLA study group
Background and purpose
The FAST-Forward trial demonstrated that 26 Gy in 5 fractions for whole breast irradiation (WBI) has similar outcomes as 40 Gy in 15 fractions. Since radiation treatment plans in the Netherlands in general deliver higher target doses, we aimed to compare acute toxicity and quality of life of the adjuvant 26 Gy and the 40 Gy schedules in a real-world setting, including after oncoplastic surgery.
Materials and methods
Eligible were women ≥50 years with breast cancer receiving WBI or partial breast irradiation (PBI) between 2018 and 2023 in two Dutch centres, with either 26 Gy/5 fractions in 1 week or 40 Gy/15 fractions in 3 weeks. Acute toxicity was assessed using CTCAE v5.0 during and ≤ 4 weeks following radiotherapy. Patient-reported outcomes were evaluated using EORTC-QLQ-C30/BR23 prior to radiotherapy, at 3 months and 1 year post-radiotherapy.
Results
In total, 832 patients received 26 Gy/5 fractions (70.2% WBI, 12.9% oncoplastic surgery) and 845 patients 40 Gy/15 fractions (81.9% WBI, 14.2% oncoplastic surgery). For WBI and PBI, grade ≥ 1 dermatitis and fatigue were less common after 26 Gy than 40 Gy: 61–67 % versus 86–91% and 42–43% versus 56% respectively (p < 0.001–0.005). After oncoplastic surgery, 26 Gy patients less often experienced grade ≥ 1 dermatitis than 40 Gy patients (77% vs 94%, p < 0.001). At 3 months and 1-year post-radiotherapy, 26 Gy and 40 Gy patients reported comparable patient-reported outcomes.
Conclusion
We confirmed the safety of the 26 Gy/5 fractions schedule in terms of acute toxicity and quality of life compared to the 40 Gy/15 fractions schedule, also when treated with higher target coverage and following oncoplastic breast-conserving surgery.
{"title":"Acute toxicity and quality of life after 5-fraction versus 15-fraction adjuvant radiotherapy following conventional or oncoplastic breast-conserving surgery − a real-world prospective cohort study","authors":"Dieuwke R. Mink van der Molen , Marilot C.T. Batenburg , Tanja van ’t Westeinde , Antonetta C. Houweling , Wies Maarse , Karolien Verhoeven , Jennifer Strijbos , Lars Murrer , Sabine Siesling , Evelyn M. Monninkhof , Helena M. Verkooijen , Liesbeth J. Boersma , Femke van der Leij , UMBRELLA study group","doi":"10.1016/j.radonc.2025.111310","DOIUrl":"10.1016/j.radonc.2025.111310","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The FAST-Forward trial demonstrated that 26 Gy in 5 fractions for whole breast irradiation (WBI) has similar outcomes as 40 Gy in 15 fractions. Since radiation treatment plans in the Netherlands in general deliver higher target doses, we aimed to compare acute toxicity and quality of life of the adjuvant 26 Gy and the 40 Gy schedules in a real-world setting, including after oncoplastic surgery.</div></div><div><h3>Materials and methods</h3><div>Eligible were women ≥50 years with breast cancer receiving WBI or partial breast irradiation (PBI) between 2018 and 2023 in two Dutch centres, with either 26 Gy/5 fractions in 1 week or 40 Gy/15 fractions in 3 weeks. Acute toxicity was assessed using CTCAE v5.0 during and ≤ 4 weeks following radiotherapy. Patient-reported outcomes were evaluated using EORTC-QLQ-C30/BR23 prior to radiotherapy, at 3 months and 1 year post-radiotherapy.</div></div><div><h3>Results</h3><div>In total, 832 patients received 26 Gy/5 fractions (70.2% WBI, 12.9% oncoplastic surgery) and 845 patients 40 Gy/15 fractions (81.9% WBI, 14.2% oncoplastic surgery). For WBI and PBI, grade ≥ 1 dermatitis and fatigue were less common after 26 Gy than 40 Gy: 61–67 % versus 86–91% and 42–43% versus 56% respectively (p < 0.001–0.005). After oncoplastic surgery, 26 Gy patients less often experienced grade ≥ 1 dermatitis than 40 Gy patients (77% vs 94%, p < 0.001). At 3 months and 1-year post-radiotherapy, 26 Gy and 40 Gy patients reported comparable patient-reported outcomes.</div></div><div><h3>Conclusion</h3><div>We confirmed the safety of the 26 Gy/5 fractions schedule in terms of acute toxicity and quality of life compared to the 40 Gy/15 fractions schedule, also when treated with higher target coverage and following oncoplastic breast-conserving surgery.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111310"},"PeriodicalIF":5.3,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661764","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}
Total neoadjuvant therapy (TNT) is increasingly used to treat locally advanced rectal cancer (LARC) due to more complete responses and fewer systemic recurrences. However, its impact on quality-of-life (QoL) or late toxicity remains under-investigated. This study evaluates this in a large real-world Swedish cohort treated with an abbreviated RAPIDO-TNT-protocol (LARCT-US).
Material and methods
In the prospective LARCT-US study, 273 LARC patients from 16 Swedish hospitals received short-course radiotherapy (5x5 Gy) followed by four cycles of CAPOX (or six cycles of mFOLFOX-6). An additional 189 patients who received similar treatment were included (ad modum LARCT-US, AdmL). QoL was assessed three years post-treatment using EORTC QLQ-C30, QLQ-CR29 and bowel function using the LARS-score. Physician-reported grade 3+ late toxicity was recorded at three- and five-years follow-up.
Results
Of curatively treated recurrence-free LARCT-US patients, 144/176 (82%) were included in the QoL assessment. Global health score (GHS) and all functioning scores were high (mean 73 and ∼86, respectively). Flatulence, urinary frequency, and fatigue were the most commonly reported symptoms. LARS was present in 79% of patients (n = 42/53), with 47% experiencing major LARS. Grade 3+ late toxicity occurred in 12% (n = 33/265) of LARCT-US/AdmL patients after three years and in 8% (n = 16/254) after five years. Patients with late toxicity reported worse scores for GHS, fatigue, dysuria, financial difficulties, and role and social functioning.
Conclusions
An abbreviated TNT schedule, compared with the RAPIDO-study, used in LARCT-US, achieves favourable oncological outcomes with low risk of late toxicity, and an acceptable QoL similar to other less effective neoadjuvant treatments.
{"title":"Quality of life and late toxicity after total neoadjuvant treatment for locally advanced rectal cancer – LARCT-US","authors":"Israa Imam , Tanweera Khan , Per J Nilsson , Bengt Glimelius","doi":"10.1016/j.radonc.2025.111318","DOIUrl":"10.1016/j.radonc.2025.111318","url":null,"abstract":"<div><h3>Introduction</h3><div>Total neoadjuvant therapy (TNT) is increasingly used to treat locally advanced rectal cancer (LARC) due to more complete responses and fewer systemic recurrences. However, its impact on quality-of-life (QoL) or late toxicity remains under-investigated. This study evaluates this in a large real-world Swedish cohort treated with an abbreviated RAPIDO-TNT-protocol (LARCT-US).</div></div><div><h3>Material and methods</h3><div>In the prospective LARCT-US study, 273 LARC patients from 16 Swedish hospitals received short-course radiotherapy (5x5 Gy) followed by four cycles of CAPOX (or six cycles of mFOLFOX-6). An additional 189 patients who received similar treatment were included (<em>ad modum</em> LARCT-US, AdmL). QoL was assessed three years post-treatment using EORTC QLQ-C30, QLQ-CR29 and bowel function using the LARS-score. Physician-reported grade 3+ late toxicity was recorded at three- and five-years follow-up.</div></div><div><h3>Results</h3><div>Of curatively treated recurrence-free LARCT-US patients, 144/176 (82%) were included in the QoL assessment. Global health score (GHS) and all functioning scores were high (mean 73 and ∼86, respectively). Flatulence, urinary frequency, and fatigue were the most commonly reported symptoms. LARS was present in 79% of patients (n = 42/53), with 47% experiencing major LARS. Grade 3+ late toxicity occurred in 12% (n = 33/265) of LARCT-US/AdmL patients after three years and in 8% (n = 16/254) after five years. Patients with late toxicity reported worse scores for GHS, fatigue, dysuria, financial difficulties, and role and social functioning.</div></div><div><h3>Conclusions</h3><div>An abbreviated TNT schedule, compared with the RAPIDO-study, used in LARCT-US, achieves favourable oncological outcomes with low risk of late toxicity, and an acceptable QoL similar to other less effective neoadjuvant treatments.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111318"},"PeriodicalIF":5.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649236","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 : 2025-11-28DOI: 10.1016/j.radonc.2025.111314
Ankita Nachankar , Joanna Gora , Mansure Schafasand , Martina Fuß , Eugen Hug , Antonio Carlino , Carola Lütgendorf-Caucig , Markus Stock , Piero Fossati
Background
In head and neck carbon-ion radiotherapy (CIRT), high dose-averaged LET (LETd) and relative biological effectiveness weighted dose (DRBE) often overlap the oro-pharyngeal-mucosa (mucosa of oral cavity, oro-pharynx, nasopharynx, pharynx) beyond the target, resulting in serious complications. We investigated clinical and dosimetric predictors for late severe mucosal-toxicity/ oro-antral fistula (OAF) post-CIRT.
Materials and methods
CIRT plans for 51 patients with non-squamous head and neck cancers (NSHNCs) were evaluated and correlated with clinical outcome. Prescription was DRBE of 68.8 Gy (65.6–76.8)/16 fractions optimized using Local Effect Model-I (LEM-I). After the first 21 patients a mucosa-sparing approach (MS-CIRT) was adopted, delineating healthy mucosa-to-spare within the high-dose PTV and applying DRBE constraints (DRBE|0.1cm3 < 70 Gy), maintaining target coverage. For the present analysis, DRBE was recomputed also with the modified microdosimetric kinetic model (mMKM) and LETd was calculated. Several clinical and dosimetric parameters including DLV-parameters (61 Gy ≤ DRBE ≤ 70 Gy, LETd ≥ 50 keV/µm, volume) that may be predictors of OAF were analyzed.
Results
MS-CIRT reduced mucosal doses to < 70 Gy, preserving local control (preliminary results in limited number of patients). Seven patients developed late G3 OAF after median follow-up of 23 months, including 2 with MS-CIRT. Doses to oro-pharyngeal mucosa > 70 Gy were predictive of OAF development. Even moderate-high doses correlated with OAF if they coincided with high-LETd. For instance, when more than 1 cm3 of mucosa-to-spare was exposed to DRBE|mMKM ≥ 63 Gy and LETd ≥ 75 keV/µm, 2-yr OAF-free survival probability was 38 % versus 100 % in cases where these thresholds were not exceeded (p < 0.001). Sino-nasal primary and HD–CTV ≥ 100 cm3 also influenced OAF development.
Conclusion
Besides MS-CIRT strategy, optimizing DLV-parameters for oro-pharyngeal-mucosa may be a promising strategy in preventing late G3 OAF post-CIRT.
{"title":"Impact of dose and dose-averaged linear energy transfer on oro-pharyngeal-mucosal toxicity in patients with non-squamous head and neck cancers treated with carbon-ion radiotherapy","authors":"Ankita Nachankar , Joanna Gora , Mansure Schafasand , Martina Fuß , Eugen Hug , Antonio Carlino , Carola Lütgendorf-Caucig , Markus Stock , Piero Fossati","doi":"10.1016/j.radonc.2025.111314","DOIUrl":"10.1016/j.radonc.2025.111314","url":null,"abstract":"<div><h3>Background</h3><div>In head and neck carbon-ion radiotherapy (CIRT), high dose-averaged LET (LETd) and relative biological effectiveness weighted dose (D<sub>RBE</sub>) often overlap the oro-pharyngeal-mucosa (mucosa of oral cavity, oro-pharynx, nasopharynx, pharynx) beyond the target, resulting in serious complications. We investigated clinical and dosimetric predictors for late severe mucosal-toxicity/ oro-antral fistula (OAF) post-CIRT.</div></div><div><h3>Materials and methods</h3><div>CIRT plans for 51 patients with non-squamous head and neck cancers (NSHNCs) were evaluated and correlated with clinical outcome. Prescription was D<sub>RBE</sub> of 68.8 Gy (65.6–76.8)/16 fractions optimized using Local Effect Model-I (LEM-I). After the first 21 patients a mucosa-sparing approach (MS-CIRT) was adopted, delineating healthy mucosa-to-spare within the high-dose PTV and applying D<sub>RBE</sub> constraints (D<sub>RBE|0.1cm</sub><sub>3</sub> < 70 Gy), maintaining target coverage. For the present analysis, D<sub>RBE</sub> was recomputed also with the modified microdosimetric kinetic model (mMKM) and LETd was calculated. Several clinical and dosimetric parameters including DLV-parameters (61 Gy ≤ D<sub>RBE</sub> ≤ 70 Gy, LETd ≥ 50 keV/µm, volume) that may be predictors of OAF were analyzed.</div></div><div><h3>Results</h3><div>MS-CIRT reduced mucosal doses to < 70 Gy, preserving local control (preliminary results in limited number of patients). Seven patients developed late G3 OAF after median follow-up of 23 months, including 2 with MS-CIRT. Doses to oro-pharyngeal mucosa > 70 Gy were predictive of OAF development. Even moderate-high doses correlated with OAF if they coincided with high-LETd. For instance, when more than 1 cm<sup>3</sup> of mucosa-to-spare was exposed to D<sub>RBE|mMKM</sub> ≥ 63 Gy and LETd ≥ 75 keV/µm, 2-yr OAF-free survival probability was 38 % versus 100 % in cases where these thresholds were not exceeded (<em>p</em> < 0.001). Sino-nasal primary and HD–CTV ≥ 100 cm<sup>3</sup> also influenced OAF development.</div></div><div><h3>Conclusion</h3><div>Besides MS-CIRT strategy, optimizing DLV-parameters for oro-pharyngeal-mucosa may be a promising strategy in preventing late G3 OAF post-CIRT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111314"},"PeriodicalIF":5.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638168","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 : 2025-11-28DOI: 10.1016/j.radonc.2025.111319
Esmée L. Looman , Tineke W.H. van Zon-Meijer , Alexander Rühle , Henning Schäfer , Roman Ludwig , Yoel Pérez Haas , Johannes A Langendijk , Matthias Guckenberger , Panagiotis Balermpas , Jan Unkelbach
Introduction
Aiming for personalization of the elective nodal irradiation (ENI) in hypopharyngeal squamous cell carcinoma (SCC) patients, we describe the regional lymphatic spread patterns and risk of lymph node metastases, considering not only T-stage, location and lateralization of the primary tumor, but also involvement of adjacent lymph node levels (LNLs).
Materials and methods
Patients with newly diagnosed hypopharyngeal SCC diagnosed at University Hospital Zurich between 2013–2021, UMCG Groningen between 2006–2023 and University Medical Center Freiburg between 2011–2019 were analyzed. Lymphatic involvement per level was assessed based on imaging and, if available, pathology. The dataset is made publicly available and can be visualized on https://lyprox.org/.
Results
390 patients with hypopharyngeal SCC were included, 81 % had one or more cervical lymph node metastases. Overall prevalence of involvement in LNLs II, III, IV, V was consistent with literature: ipsilateral 65 %, 54 %, 23 %, 11 %; contralateral 25 %, 16 %, 6 %, 3 %. For lateralized tumors not affecting the midline (N = 143), contralateral involvement was 11 %, 4 %, 1 % 1 %. When contralateral LNL II was negative (N = 291), involvement of downstream LNLs III, IV, V was 5 %, 3 %, 1 %. Ipsilateral LNL IV involvement was reduced to 7 % in patients with negative LNL II and III. Ipsilateral level I and VII involvement was 6 % and 13 % in T4-tumors, but only 2 % and 3 % in T1–T3 tumors.
Conclusion
We provide detailed information about lymphatic spread patterns of hypopharyngeal SCC, where subgroups of patients may be identified in whom the ENI may be reduced. For lateralized tumors, contralateral irradiation may be limited to LNL II in patients without contralateral involvement.
{"title":"Patterns of lymphatic spread in hypopharyngeal squamous cell carcinoma – Findings from a multicenter study","authors":"Esmée L. Looman , Tineke W.H. van Zon-Meijer , Alexander Rühle , Henning Schäfer , Roman Ludwig , Yoel Pérez Haas , Johannes A Langendijk , Matthias Guckenberger , Panagiotis Balermpas , Jan Unkelbach","doi":"10.1016/j.radonc.2025.111319","DOIUrl":"10.1016/j.radonc.2025.111319","url":null,"abstract":"<div><h3>Introduction</h3><div>Aiming for personalization of the elective nodal irradiation (ENI) in hypopharyngeal squamous cell carcinoma (SCC) patients, we describe the regional lymphatic spread patterns and risk of lymph node metastases, considering not only T-stage, location and lateralization of the primary tumor, but also involvement of adjacent lymph node levels (LNLs).</div></div><div><h3>Materials and methods</h3><div>Patients with newly diagnosed hypopharyngeal SCC diagnosed at University Hospital Zurich between 2013–2021, UMCG Groningen between 2006–2023 and University Medical Center Freiburg between 2011–2019 were analyzed. Lymphatic involvement per level was assessed based on imaging and, if available, pathology. The dataset is made publicly available and can be visualized on <span><span>https://lyprox.org/</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>390 patients with hypopharyngeal SCC were included, 81 % had one or more cervical lymph node metastases. Overall prevalence of involvement in LNLs II, III, IV, V was consistent with literature: ipsilateral 65 %, 54 %, 23 %, 11 %; contralateral 25 %, 16 %, 6 %, 3 %. For lateralized tumors not affecting the midline (N = 143), contralateral involvement was 11 %, 4 %, 1 % 1 %. When contralateral LNL II was negative (N = 291), involvement of downstream LNLs III, IV, V was 5 %, 3 %, 1 %. Ipsilateral LNL IV involvement was reduced to 7 % in patients with negative LNL II and III.<!--> <!-->Ipsilateral level I and VII involvement was 6 % and 13 % in T4-tumors, but only 2 % and 3 % in T1–T3 tumors.</div></div><div><h3>Conclusion</h3><div>We provide detailed information about lymphatic spread patterns of hypopharyngeal SCC, where subgroups of patients may be identified in whom the ENI may be reduced. For lateralized tumors, contralateral irradiation may be limited to LNL II in patients without contralateral involvement.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111319"},"PeriodicalIF":5.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649316","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}
This prospective study evaluated the positional reproducibility of anatomical landmarks and estimated planning target volume (PTV) margins using a spirometry-based system during deep inspiration breath-hold (DIBH), and evaluated the system’s potential as a surrogate for dynamic tumour tracking (DTT).
Patients and Methods
The study comprised two components, each involving 10 patients and utilising a spirometry-based system. Part A evaluated inter- and intra-fractional variations at 12 bronchial bifurcation landmarks and estimated PTV margins based on vertebral- and carina-based registrations. Part B assessed six 4D tumour position prediction models using varying ratios of spirometry- and surface-based inputs. The root-mean-square error (RMSE) was used to evaluate the prediction accuracy over two time intervals. For short-term evaluation, 20 s of data were used for model training, and the subsequent 50 s for validation. For long-term evaluation, a separate 70-second dataset was used.
Results
In Part A, mean inter- and intra-fractional variations across the 12 landmarks were 4.2 ± 2.0 mm and 2.9 ± 2.0 mm, respectively. PTV margins remained < 5 mm for both registrations, except in the superior-inferior direction of the left anteromedial segment. In Part B, no significant RMSE differences were observed in short-term predictions. For long-term predictions, the spirometry-only and combined-input models showed significantly lower RMSE than the surface-only model (P = 0.049 and P = 0.021, respectively).
Conclusions
Spirometry-based DIBH demonstrated acceptable positional reproducibility; however, individualised PTV margins may be necessary for specific regions. Spirometry-based prediction remained robust during free breathing, supporting its utility as a surrogate for DTT.
{"title":"A prospective study using a spirometry-based system on the positional reproducibility of anatomical landmarks and tumour-tracking accuracy","authors":"Noriko Kishi , Yukinori Matsuo , Mitsuhiro Nakamura , Tomohiro Ono , Nobutaka Mukumoto , Hiraku Iramina , Yuta Sakurai , Norimasa Matsushita , Yusuke Tsuruta , Hideaki Hirashima , Makoto Sasaki , Takahiro Fujimoto , Yusuke Iizuka , Michio Yoshimura , Takashi Mizowaki","doi":"10.1016/j.radonc.2025.111315","DOIUrl":"10.1016/j.radonc.2025.111315","url":null,"abstract":"<div><h3>Purpose</h3><div>This prospective study evaluated the positional reproducibility of anatomical landmarks and estimated planning target volume (PTV) margins using a spirometry-based system during deep inspiration breath-hold (DIBH), and evaluated the system’s potential as a surrogate for dynamic tumour tracking (DTT).</div></div><div><h3>Patients and Methods</h3><div>The study comprised two components, each involving 10 patients and utilising a spirometry-based system. Part A evaluated inter- and intra-fractional variations at 12 bronchial bifurcation landmarks and estimated PTV margins based on vertebral- and carina-based registrations. Part B assessed six 4D tumour position prediction models using varying ratios of spirometry- and surface-based inputs. The root-mean-square error (RMSE) was used to evaluate the prediction accuracy over two time intervals. For short-term evaluation, 20 s of data were used for model training, and the subsequent 50 s for validation. For long-term evaluation, a separate 70-second dataset was used.</div></div><div><h3>Results</h3><div>In Part A, mean inter- and intra-fractional variations across the 12 landmarks were 4.2 ± 2.0 mm and 2.9 ± 2.0 mm, respectively. PTV margins remained < 5 mm for both registrations, except in the superior-inferior direction of the left anteromedial segment. In Part B, no significant RMSE differences were observed in short-term predictions. For long-term predictions, the spirometry-only and combined-input models showed significantly lower RMSE than the surface-only model (P = 0.049 and P = 0.021, respectively).</div></div><div><h3>Conclusions</h3><div>Spirometry-based DIBH demonstrated acceptable positional reproducibility; however, individualised PTV margins may be necessary for specific regions. Spirometry-based prediction remained robust during free breathing, supporting its utility as a surrogate for DTT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111315"},"PeriodicalIF":5.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638131","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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