Radiotherapy and Oncology最新文献_第5页

Development and validation of A CCTA-based risk prediction model for major adverse cardiovascular events in esophageal cancer patients receiving radiotherapy 基于ccta的食管癌放疗患者主要心血管不良事件风险预测模型的建立与验证

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-06 DOI: 10.1016/j.radonc.2026.111364

Qian Xu , Hesong Shen , Liting Wen , Chunrong Tu , Wei Deng , Renwei Liu , Fandong Zhang , Dechun Zheng , Jiuquan Zhang

Background and purpose

Major adverse cardiovascular events (MACEs) remain a significant concern in esophageal cancer (EC) patients receiving radiotherapy (RT). This study aimed to develop and validate a CCTA-based model for predicting MACEs in this population.

Materials and methods

322 and 216 patients with EC at thoracic middle or lower segment from hospital 1 were randomly divided into the training and internal validation cohorts, while 227 patients from hospital 2 were assigned to the external validation cohort. Pericoronary adipose tissue (PCAT) radiomics features were selected by the least absolute shrinkage and selection operator Cox regression (Lasso-Cox) and Max-Relevance and Min-Redundancy (mRMR). Radiomics model was constructed and compared using seven machine-learning classifiers. A nomogram for predicting MACEs was developed with multivariable Cox regression analysis. Predictive performance of models was evaluated by C-index, and feature importance was interpreted using SHapley Additive exPlanations (SHAP) analysis.

Results

The median follow-up was 31 months (IQR, 25–36 months), during which 139 of 765 (18.2 %) patients experienced MACEs. The eXtreme gradient boosting (XGBoost) was used to construct radiomics model. A nomogram incorporating the PCAT radiomics signature, age, mean dose of left circumflex artery (LCX), and fat attenuation index of LCX achieved a moderate to strong predictive capacity across the training, internal, and external validation cohorts (C-index = 0.855, 0.839, and 0.845, respectively). SHAP analysis revealed that the PCAT radiomics signature was the most important predictor of MACEs.

Conclusion

A nomogram combining clinical risk factors, CCTA-derived parameters, and PCAT radiomics signature can predict MACEs in patients with EC receiving radiotherapy.

背景与目的食管癌（EC）放疗患者的主要不良心血管事件（mace）仍然是一个值得关注的问题。本研究旨在开发和验证基于ccta的模型来预测该人群的mace。材料与方法将来自第一医院的322例和216例胸椎中下段EC患者随机分为训练组和内部验证组，而来自第二医院的227例患者被分配到外部验证组。冠状动脉周围脂肪组织（PCAT）放射组学特征通过最小绝对收缩和选择算子Cox回归（Lasso-Cox）和最大相关性和最小冗余（mRMR）来选择。利用7种机器学习分类器构建放射组学模型并进行比较。采用多变量Cox回归分析，建立了预测mace的nomogram。采用c指数评价模型的预测性能，采用SHapley加性解释（SHAP）分析对特征重要性进行解释。结果中位随访31个月（IQR， 25-36个月），765例患者中有139例（18.2%）出现mace。采用极限梯度增强（eXtreme gradient boost, XGBoost）构建放射组学模型。结合PCAT放射组学特征、年龄、左旋动脉（LCX）的平均剂量和LCX的脂肪衰减指数的nomogram，在训练、内部和外部验证队列中均具有中等到较强的预测能力（C-index分别为0.855、0.839和0.845）。SHAP分析显示PCAT放射组学特征是mace最重要的预测因子。结论结合临床危险因素、ccta衍生参数和PCAT放射组学特征的nomogram预测EC放疗患者的mace。

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引用次数: 0

Individual patient-reported symptom items discriminate imaging-graded dysphagia in head and neck cancer patients treated with radiotherapy: secondary analysis of pooled prospective studies 个体患者报告的症状项目区分放疗治疗的头颈癌患者影像学分级吞咽困难：汇总前瞻性研究的二次分析

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-06 DOI: 10.1016/j.radonc.2026.111365

Beatrice Manduchi , Taylor C. Jefferson , Amy C. Moreno , Carly E.A. Barbon , Meagan Whisenant , Rosemary Martino , Clifton D. Fuller , Katherine A. Hutcheson , on behalf of OPC-SURVIVOR Research Program

Background and purpose

To determine clinically actionable thresholds for the MD Anderson Symptom Inventory–Head and Neck (MDASI-HN) −Swallow and −Choke items by comparing discriminant capacity against imaging-based markers of dysphagia in head and neck cancer (HNC) patients undergoing (chemo)radiotherapy (RT).

Materials and methods

A retrospective secondary analysis used single-institution prospective registries of HNC patients treated with RT who completed the MDASI-HN and a modified barium swallow (MBS) before, during, or after RT. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) overall (D), efficiency (E), and safety (S) scores were compared to a priori-defined (≥6) and data-driven thresholds using binomial regression. Diagnostic accuracy was evaluated using sensitivity (SN), specificity (SP), PPV and NPV, using DIGEST D, E, S ≥ 1 (any impairment) and ≥ 2 (moderate-severe) as reference standards.

Results

Among 264 patients (mean age 62; 87 % male; 47 % nasopharyngeal cancer; 55 % post-RT), −Swallow ≥ 6 was associated with D ≥ 1 and D ≥ 2 (RRs = 1.8–2.6, p < 0.05), showing high SP (92–95 %) but low SN (23–30 %). −Choke ≥ 6 demonstrated stronger associations for D ≥ 2 (RR = 3.5, p < 0.05), and similar SN/SP tradeoffs. Data-driven thresholds improved accuracy: for D ≥ 1, a combined threshold (−Swallow or −Choke) ≥ 2 yielded SN 77 %, SP 64 %; for D ≥ 2, −Choke ≥ 1 showed SN 85 %, SP 69 %, while −Choke ≥ 2 increased SP to 84 %. For aspiration risk (S ≥ 2), −Choke ≥ 1 had SN 88 %, SP 66 %; −Choke ≥ 2 improved SP to 83 %.

Conclusion

MDASI-Swallow and −Choke correlate with imaging-based dysphagia. While ≥ 6 may flag moderate-severe impairment, lower thresholds (≥1-2) offer better sensitivity, supporting early detection. Combined thresholds may enhance screening and guide survivorship care.

背景和目的：通过比较接受（化疗）放疗（RT）的头颈癌（HNC）患者吞咽困难影像学标志物的鉴别能力，确定MD安德森症状清单-头颈(MDASI-HN) -吞咽和窒息项目的临床可操作阈值。材料和方法：对接受RT治疗的HNC患者在RT之前、期间或之后完成MDASI-HN和改良钡吞咽（MBS）的单机构前瞻性登记进行回顾性二次分析。吞咽毒性动态成像分级（DIGEST）总体(D)、效率(E)和安全性(S)评分与优先定义的（≥6）和数据驱动的阈值进行二项回归比较。以DIGEST D、E、S ≥ 1（任何损害）和 ≥ 2（中重度）为参考标准，采用敏感性（SN）、特异性（SP）、PPV和NPV评价诊断准确性。结果:在264例患者(平均年龄62;87 %男性,47 %鼻咽癌;55 % post-RT),燕子 ≥ 6与D ≥ 1和D ≥ 2 (RRs = 1.8 - -2.6,p 结论:MDASI-Swallow和窒息与成像进行吞咽困难。虽然 ≥ 6可能标志着中重度损伤，但较低的阈值（≥1-2）提供了更好的灵敏度，支持早期发现。联合阈值可以增强筛查和指导生存护理。

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引用次数: 0

Acute adverse events in the DESTINATION 1 trial: A prospective prostate SBRT dose de-escalation feasibility study DESTINATION 1试验中的急性不良事件：一项前瞻性前列腺SBRT剂量递减可行性研究

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-06 DOI: 10.1016/j.radonc.2026.111363

Sian Cooper , Sophie Alexander , Charlotte Cherry , Joan Chick , Mathijs G. Dassen , Alex Dunlop , Shermarke Hassan , Trina Herbert , Francesca Mason , Adam Mitchell , Simeon Nill , Uwe Oelfke , Floris Pos , Murtuza Saifuddin , Rosalyne Westley , Uulke A van der Heide , Danny Vesprini , Alison Tree

Background

Stereotactic body radiotherapy (SBRT) is effective for localised prostate cancer but increases genitourinary adverse events (AE). Focal boost to the dominant lesion may improve disease control. The DESTINATION study investigates whole gland dose de-escalation, with focal boost, using MR-guided adaptive radiotherapy (MRgART), to maintain cancer control whilst demonstrating acceptable AE.

Methods

DESTINATION is a prospective, phase II federated study that enrolled men with localised prostate cancer across three institutions (The Royal Marsden Hospital, Sunnybrook Health Sciences Centre, and The Netherlands Cancer Institute). Patients received MRgART with daily online replanning to deliver 30 Gy in 5 fractions to the whole prostate with no margin. The gross tumour volume (GTV) + 4 mm intra-prostatic margin received an isotoxic boost of 45 Gy. Acute AE were assessed using CTCAEv5 at baseline, end of treatment, 4 weeks, and 12 weeks post-treatment. Patient-reported outcomes were collected using IPSS, EPIC-26 and IIEF5.

Results

All 60 patients completed 12-weeks follow-up. Grade 2 genitourinary AE occurred in 55 % of patients by 12 weeks. Grade 2 gastrointestinal AE occurred in 11.7 %. Patient-reported outcomes demonstrated expected symptom flare at final fraction of treatment followed by gradual recovery. EPIC scores were consistently higher at NKI compared to RMH/SB, with sexual function decline during follow-up across all centres.

Conclusion

The DESTINATION study demonstrates that dose de-escalation 5-fraction SBRT with isotoxic focal boost produces acute AE rates similar to or above the levels seen in the PACE-B trial. The focal boost may have offset any potential decrease in AE from whole gland de-escalation.

背景：立体定向放射治疗（SBRT）对局部前列腺癌有效，但会增加泌尿生殖系统不良事件（AE）。对显性病变的局部强化可改善疾病控制。DESTINATION研究使用mr引导的适应性放疗（MRgART）研究了整个腺体剂量的降低，局部增强，以维持癌症控制，同时显示可接受的AE。destination是一项前瞻性II期联合研究，招募了来自三个机构（皇家马斯登医院、Sunnybrook健康科学中心和荷兰癌症研究所）的局限性前列腺癌患者。患者接受MRgART每日在线重新计划，分5次向整个前列腺无边界地输送30 Gy。总肿瘤体积(GTV) + 4mm前列腺内边缘接受45 Gy的同毒增强。在基线、治疗结束、治疗后4周和12周使用CTCAEv5评估急性AE。使用IPSS、EPIC-26和IIEF5收集患者报告的结果。结果60例患者均完成随访12周。到12周时，55%的患者发生2级泌尿生殖系统AE。2级胃肠道AE发生率为11.7%。患者报告的结果显示，预期的症状在治疗的最后阶段出现，随后逐渐恢复。与RMH/SB相比，NKI的EPIC评分始终较高，在所有中心的随访期间性功能下降。DESTINATION研究表明，剂量递减5分次SBRT加等毒性局灶增强可产生与PACE-B试验相似或高于其水平的急性AE。局部增强可能抵消了整个腺体降级引起的声发射的任何潜在下降。

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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 : 2026-01-05 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。

{"title":"Photon FLASH spares radiation-induced changes in cardiac function, remodelling and arrythmia in a preclinical model","authors":"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","doi":"10.1016/j.radonc.2026.111369","DOIUrl":"10.1016/j.radonc.2026.111369","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111369"},"PeriodicalIF":5.3,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A seven-gene 5-hydroxymethylcytosine signature in circulating cell-free DNA for prognostic stratification of nasopharyngeal carcinoma 鼻咽癌预后分层循环无细胞DNA中的7基因5-羟甲基胞嘧啶特征。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2026-01-05 DOI: 10.1016/j.radonc.2026.111366

Bijuan Chen , Di Wang , Jiali Huang , Sisi Yu , Siping Fang , Chuying Chen , Jie Wang , Jianji Pan , Shaojun Lin , Qiaojuan Guo , Yun Xu , Zhouwei Zhan

Background

Circulating cell-free DNA (cfDNA) 5-hydroxymethylcytosine (5hmC) is a promising epigenetic biomarker in cancer. Its prognostic role in nasopharyngeal carcinoma (NPC), however, remains unclear.

Methods

Genome-wide 5hmC profiling was conducted using 5hmC-Seal sequencing on cfDNA from 174 newly diagnosed NPC patients. Patients were randomly assigned to training (n = 105) and test (n = 69) sets. Differential analysis was performed by survival outcome, EBV status, and tumor stage. The primary endpoint was overall survival (OS); the secondary endpoint was event-free survival (EFS). A prognostic score based on a seven-gene 5hmC signature was developed using LASSO-Cox regression in the training set and validated in the test cohort. A nomogram integrating the 5hmC score, tumor stage, and EBV status was constructed. Model performance was assessed via Kaplan-Meier survival analysis, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA).

Results

Marked 5hmC differences were detected between survivors and non-survivors. The 5hmC score stratified OS with AUCs of 0.83 (3-year) and 0.87 (5-year) in the training set and 0.78 (3-year) and 0.80 (5-year) in the test set, and remained predictive across EBV and stage subgroups. The integrated nomogram demonstrated robust calibration and offered the greatest net clinical benefit in DCA, with a 5-year C-index of 0.796.

Conclusions

cfDNA 5hmC profiling enables noninvasive prognostic risk stratification in NPC. The proposed model may support personalized treatment planning and long-term management.

背景：循环细胞游离DNA (cfDNA) 5-羟甲基胞嘧啶（5hmC）是一种很有前途的癌症表观遗传生物标志物。然而，其在鼻咽癌（NPC）中的预后作用尚不清楚。方法：采用5hmC- seal测序方法对174例新诊断鼻咽癌患者的cfDNA进行全基因组5hmC分析。患者被随机分配到训练组（n = 105）和测试组（n = 69）。根据生存结果、EBV状态和肿瘤分期进行差异分析。主要终点是总生存期（OS）；次要终点为无事件生存期（EFS）。在训练集中使用LASSO-Cox回归建立基于7个基因5hmC特征的预后评分，并在测试队列中进行验证。构建5hmC评分、肿瘤分期和EBV状态的nomogram。通过Kaplan-Meier生存分析、随时间变化的ROC曲线、校准图和决策曲线分析（DCA）评估模型的性能。结果：幸存者和非幸存者之间检测到显著的5hmC差异。5hmC评分将OS分层，训练集的auc分别为0.83（3年）和0.87（5年），测试集的auc分别为0.78（3年）和0.80（5年），并且在EBV和分期亚组之间仍然具有预测性。综合nomogram显示了稳健的校准，并为DCA提供了最大的净临床效益，其5年c指数为0.796。结论：cfDNA 5hmC分析可实现鼻咽癌无创预后风险分层。所提出的模型可能支持个性化治疗计划和长期管理。

{"title":"A seven-gene 5-hydroxymethylcytosine signature in circulating cell-free DNA for prognostic stratification of nasopharyngeal carcinoma","authors":"Bijuan Chen , Di Wang , Jiali Huang , Sisi Yu , Siping Fang , Chuying Chen , Jie Wang , Jianji Pan , Shaojun Lin , Qiaojuan Guo , Yun Xu , Zhouwei Zhan","doi":"10.1016/j.radonc.2026.111366","DOIUrl":"10.1016/j.radonc.2026.111366","url":null,"abstract":"<div><h3>Background</h3><div>Circulating cell-free DNA (cfDNA) 5-hydroxymethylcytosine (5hmC) is a promising epigenetic biomarker in cancer. Its prognostic role in nasopharyngeal carcinoma (NPC), however, remains unclear.</div></div><div><h3>Methods</h3><div>Genome-wide 5hmC profiling was conducted using 5hmC-Seal sequencing on cfDNA from 174 newly diagnosed NPC patients. Patients were randomly assigned to training (n = 105) and test (n = 69) sets. Differential analysis was performed by survival outcome, EBV status, and tumor stage. The primary endpoint was overall survival (OS); the secondary endpoint was event-free survival (EFS). A prognostic score based on a seven-gene 5hmC signature was developed using LASSO-Cox regression in the training set and validated in the test cohort. A nomogram integrating the 5hmC score, tumor stage, and EBV status was constructed. Model performance was assessed via Kaplan-Meier survival analysis, time-dependent ROC curves, calibration plots, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>Marked 5hmC differences were detected between survivors and non-survivors. The 5hmC score stratified OS with AUCs of 0.83 (3-year) and 0.87 (5-year) in the training set and 0.78 (3-year) and 0.80 (5-year) in the test set, and remained predictive across EBV and stage subgroups. The integrated nomogram demonstrated robust calibration and offered the greatest net clinical benefit in DCA, with a 5-year C-index of 0.796.</div></div><div><h3>Conclusions</h3><div>cfDNA 5hmC profiling enables noninvasive prognostic risk stratification in NPC. The proposed model may support personalized treatment planning and long-term management.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111366"},"PeriodicalIF":5.3,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development and external validation of an MRI radiomics-based machine learning model to predict tumour recurrence in brain metastases treated with Gamma Knife radiosurgery 基于MRI放射组学的机器学习模型的开发和外部验证，以预测伽玛刀放射治疗的脑转移瘤复发。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-12-25 DOI: 10.1016/j.radonc.2025.111362

Abdulrahman Umaru , Hanani Abdul Manan , Ramesh Kumar Athi Kumar , Siti Khadijah Hamsan , Daryl Tan , Noorazrul Yahya

Background

Predicting recurrence after gamma knife radiosurgery (GKRS) is clinically important, as it informs salvage treatment and patient management. MRI-based radiomics combined with machine learning (ML) offers promise for predicting tumour recurrence in brain metastasis, yet most studies lack external validation, limiting clinical translation. This study developed and externally validated radiomics-based models for predicting recurrence in brain metastases treated with GKRS.

Methods

The primary dataset comprised 103 metastases from our institution (23 recurrent) and 125 lesions from the Cancer Imaging Archive (TCIA; 20 recurrent) for external validation. IBSI-compliant radiomics features were extracted from contrast-enhanced T1-weighted MRI using 64-bin grey-level discretisation and mean relative ROI ± 3 SD intensity rescaling, with and without LOG filtering. Feature selection combined correlation analysis and LASSO regression. Logistic regression classifiers were trained on 80 % of the data and tested on 20 %, followed by external validation. Five models were developed: MRI-only, LOG-filtered MRI, MRI + clinical, LOG-filtered MRI + clinical, and clinical + dosimetric. SHAP analysis was used for feature attribution, and methodological rigour was assessed using the Radiomics Quality Score (RQS).

Results

The best-performing model (LOG-filtered MRI + clinical features) achieved 81 % accuracy and an AUC of 0.93 in internal testing, and 79 % accuracy with an AUC of 0.78 on external validation, demonstrating strong robustness and generalisability. Adding clinical features significantly improved performance compared with MRI-only models. SHAP analysis revealed that tumour shape complexity (Compactness2 [IBSI: BQWJ]) and voxel intensity heterogeneity (IntensityRange[IBSI: 2OJQ]) were strong predictors, while maximum dose, gender, and primary tumour site also contributed among the clinical factors.

Conclusion

The MRI-based radiomics model integrating LOG-filtered MRI features with clinical variables achieved high external validation performance. Unlike many black-box models that prioritise accuracy with limited interpretability, this approach combines predictive strength with transparent feature attribution, enhancing biology interpretability and supporting clinical translation. Prospective multi-centre studies are warranted to confirm its clinical utility.

背景：预测伽玛刀放射手术（GKRS）后的复发在临床上具有重要意义，因为它可以为抢救治疗和患者管理提供信息。基于mri的放射组学结合机器学习（ML）为预测脑转移肿瘤复发提供了希望，但大多数研究缺乏外部验证，限制了临床转化。该研究开发并外部验证了基于放射组学的模型，用于预测GKRS治疗脑转移瘤的复发。方法：主要数据集包括来自我们机构的103例转移（23例复发）和来自癌症影像档案（TCIA）的125例病变，其中20例复发)进行外部验证。使用64 bin灰度离散和平均相对ROI ± 3 SD强度重新缩放，在有和没有LOG滤波的情况下，从对比度增强的t1加权MRI中提取符合ibsi的放射组学特征。特征选择结合相关分析和LASSO回归。逻辑回归分类器在80% %的数据上进行训练，在20% %的数据上进行测试，然后进行外部验证。开发了5种模型：仅MRI、log -filter MRI、MRI +临床、log -filter MRI +临床和临床 + 剂量测定。特征归因采用SHAP分析，方法严谨性采用放射组学质量评分（RQS）进行评估。结果：表现最好的模型（log -filter MRI + 临床特征）在内部测试中达到81 %的准确率和0.93的AUC，在外部验证中达到79 %的准确率和0.78的AUC，显示出很强的稳健性和通用性。与仅使用mri的模型相比，添加临床特征显著提高了性能。SHAP分析显示，肿瘤形状复杂性（Compactness2 [IBSI: BQWJ]）和体素强度异质性（IntensityRange[IBSI: 2OJQ]）是重要的预测因素，最大剂量、性别和原发肿瘤部位也是重要的临床因素。结论：基于MRI的放射组学模型将日志过滤的MRI特征与临床变量相结合，获得了较高的外部验证性能。与许多优先考虑准确性和有限可解释性的黑箱模型不同，该方法将预测强度与透明特征归因相结合，增强了生物学可解释性并支持临床翻译。有必要进行前瞻性多中心研究以证实其临床应用。

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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 : 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。

{"title":"How can a radiation oncology society support its members and the community to help reduce the carbon footprint of radiation oncology?","authors":"Rachel Allcock , Kari Tanderup , Jenny Bertholet , Amanda Webster , Robert Chuter","doi":"10.1016/j.radonc.2025.111361","DOIUrl":"10.1016/j.radonc.2025.111361","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div><div>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’.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111361"},"PeriodicalIF":5.3,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Same risk, different scales: outcome calibration and contour provenance in a 3D deep NTCP for dysphagia? 相同的风险，不同的量表：吞咽困难的3D深度NTCP的结果校准和轮廓来源？

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-12-20 DOI: 10.1016/j.radonc.2025.111352

Xuan Liu, Xiao Liang, Ting Huang, Yaqi Luo, Rong Li

引用次数: 0

Development of the first prediction model for radiation-induced contrast enhancement after proton therapy for posterior fossa tumours in paediatric patients 小儿后窝肿瘤质子治疗后放射诱导造影剂增强第一个预测模型的建立。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-12-20 DOI: 10.1016/j.radonc.2025.111360

Abel Bregman , Jikke J. Rutgers , Truls Andersen , Arjen van der Schaaf , Charlotte L. Brouwer , Geert O. Janssens , Eelco W. Hoving , Maarten H. Lequin , Rutger A.J. Nievelstein , Stefan Both , Johannes A. Langendijk , Hiska L. van der Weide , John H. Maduro , Dirk Wagenaar

Background/purpose

Radiation-induced contrast enhancement (RICE) has been identified as a metric of subclinical toxicity. The aim of this study was to develop a normal tissue complication probability (NTCP) model for RICE after proton therapy in paediatric patients with posterior fossa tumours.

Materials and methods

Paediatric patients (n = 75) treated with proton radiotherapy (49.6–59.4 Gy (RBE)), focally or in combination with craniospinal axis irradiation, were included. Follow-up magnetic resonance imaging scans were evaluated for RICE. Dose (D), dose multiplied by dose-averaged linear energy transfer (D⋅LETd), organ at risk association, RICE association and age data were extracted to construct a multivariable logistic regression model to predict RICE in voxels. NTCP was calculated using univariable logistic regression with RICE status as the dependent variable and the expected number of RICE voxels as the independent variable.

Results

A total of 60 RICE lesions were identified in 23 patients (30.7 %), of which 36 (60 %) were located in the brainstem, primarily the pons. We observed an increased density of RICE voxels in regions with a combination of high D (38.32–55.94 Gy) and medium-to-high LETd (1.89–6.00 keV/µm) values. In addition, younger age and the anatomical location in the pons were identified as independent risk factors for RICE. The NTCP model’s optimism corrected area under the receiver operating characteristic curve (AUC) was 0.79, and the Brier score was 0.16.

Conclusion

We developed models to predict RICE in paediatric patients. The RICE probability at the voxel- and patient-level increased with D and D⋅LETd, younger age and within the brainstem pons.

背景/目的：辐射诱导的对比增强（RICE）已被确定为亚临床毒性的度量标准。本研究的目的是建立小儿后窝肿瘤患者质子治疗后RICE的正常组织并发症概率（NTCP）模型。材料和方法：纳入接受质子放射治疗（49.6-59.4 Gy (RBE)），局部或联合颅脊髓轴放射治疗的儿科患者（n = 75）。随访核磁共振成像扫描评估RICE。提取剂量(D)、剂量乘以剂量平均线性能量传递（D⋅LETd）、器官危险关联、RICE关联和年龄数据，构建多变量logistic回归模型，以体素为单位预测RICE。NTCP以RICE状态为因变量，期望RICE体素数为自变量，采用单变量logistic回归计算。结果：23例患者共发现60例RICE病变（30.7 %），其中36例（60 %）位于脑干，主要是脑桥。我们观察到高D（38.32-55.94 Gy）和中高LETd（1.89-6.00 keV/µm）值区域的RICE体素密度增加。此外，年龄较小和脑桥的解剖位置被认为是RICE的独立危险因素。NTCP模型的乐观修正面积（AUC）为0.79，Brier评分为0.16。结论：我们建立了预测儿童RICE的模型。体素和患者水平上的RICE概率随D和D·LETd、年龄的增加和脑干桥内的增加而增加。

{"title":"Development of the first prediction model for radiation-induced contrast enhancement after proton therapy for posterior fossa tumours in paediatric patients","authors":"Abel Bregman , Jikke J. Rutgers , Truls Andersen , Arjen van der Schaaf , Charlotte L. Brouwer , Geert O. Janssens , Eelco W. Hoving , Maarten H. Lequin , Rutger A.J. Nievelstein , Stefan Both , Johannes A. Langendijk , Hiska L. van der Weide , John H. Maduro , Dirk Wagenaar","doi":"10.1016/j.radonc.2025.111360","DOIUrl":"10.1016/j.radonc.2025.111360","url":null,"abstract":"<div><h3>Background/purpose</h3><div>Radiation-induced contrast enhancement (RICE) has been identified as a metric of subclinical toxicity. The aim of this study was to develop a normal tissue complication probability (NTCP) model for RICE after proton therapy in paediatric patients with posterior fossa tumours.</div></div><div><h3>Materials and methods</h3><div>Paediatric patients (n = 75) treated with proton radiotherapy (49.6–59.4 Gy (RBE)), focally or in combination with craniospinal axis irradiation, were included. Follow-up magnetic resonance imaging scans were evaluated for RICE. Dose (<em>D</em>), dose multiplied by dose-averaged linear energy transfer (<em>D⋅LETd),</em> organ at risk association, RICE association and age data were extracted to construct a multivariable logistic regression model to predict RICE in voxels. NTCP was calculated using univariable logistic regression with RICE status as the dependent variable and the expected number of RICE voxels as the independent variable.</div></div><div><h3>Results</h3><div>A total of 60 RICE lesions were identified in 23 patients (30.7 %), of which 36 (60 %) were located in the brainstem, primarily the pons. We observed an increased density of RICE voxels in regions with a combination of high <em>D</em> (38.32–55.94 Gy) and medium-to-high <em>LETd (</em>1.89–6.00 keV/µm) values. In addition, younger age and the anatomical location in the pons were identified as independent risk factors for RICE. The NTCP model’s optimism corrected area under the receiver operating characteristic curve (AUC) was 0.79, and the Brier score was 0.16.</div></div><div><h3>Conclusion</h3><div>We developed models to predict RICE in paediatric patients. The RICE probability at the voxel- and patient-level increased with <em>D</em> and <em>D⋅LETd,</em> younger age and within the brainstem pons.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111360"},"PeriodicalIF":5.3,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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 : 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