Radiotherapy and Oncology最新文献_第7页

Modulation of the local angiotensin II: Suppression of ferroptosis and radiosensitivity in nasopharyngeal carcinoma via the HIF-1α-HILPDA axis 局部血管紧张素II的调节：通过HIF-1α-HILPDA轴增强鼻咽癌的铁下垂和放射敏感性。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110686

Xiuting Huang , Kehai Lin , Weirui Chen , Donghui Zhang , Muhammad Khan , Xiaoxin Ye , Baiyao Wang , Chengcong Chen , Yunhong Tian , Yawei Yuan , Jie Lin

Purpose

Radiotherapy presents a curative approach for nasopharyngeal carcinoma (NPC); however, the cellular radiosensitivity heterogeneity limits its efficacy. Thus, investigating the specific mechanisms of radioresistance in NPC is crucial for identifying and employing effective radiosensitizing agents to enhance treatment success.

Methods and Materials

Radioresistant NPC cell lines HONE1-RR and SUNE1-RR were established. Quantitative reverse transcription-PCR (qRT-PCR), western blot, and enzyme-linked immuno sorbent assay (ELISA) were employed to detect the activation of the angiotensinogen (AGT) and local angiotensin II (Ang II). Transmission electron microscopy, ferrous ion detection, and lipid oxidation levels were utilized to detect radiation-induced ferroptosis in NPC. Bioinformatics analysis, along with qRT-PCR, western blotting, co-immunoprecipitation, and dual-luciferase assays were employed to explore downstream mechanisms. Colony formation assay, Cell Counting Kit-8 (CCK-8) assay, and a nude mouse xenograft model were utilized to assess NPC radiosensitivity. The expression of AGT, hypoxia-inducible factor-1 alpha (HIF-1α), hypoxia-inducible lipid droplet-associated protein (HILPDA), and glutathione peroxidase 4 (GPX4) in NPC tissues was detected through immunohistochemistry.

Results

Activation of local Ang II was revealed to play a critical role in driving radioresistance in NPC cells modulating ferroptosis. This local Ang II established a positive feedback loop with HIF-1α through two parallel pathways; Ang II stabilizes HIF-1α by activating the MAPK pathway, and AGT directly binds HIF-1α to prevent its degradation. This AGT-HIF-1α loop regulated NPC cell ferroptosis via transcriptional regulation of HILPDA expression. Moreover, the co-administration of Ang II receptor antagonist (ARB) and ferroptosis inducers markedly increased NPC radiosensitivity. Additionally, the expression of AGT, HIF-1α, and HILPDA was closely correlated with the intensity of ferroptosis, radiosensitivity, and prognosis in NPC.

Conclusions

Our findings suggest that the AGT-HIF-1α-HILPDA pathway promotes radioresistance in NPC by enhancing lipid droplet accumulation, thereby suppressing ferroptosis. Targeting local Ang II alongside ferroptosis induction offers a promising strategy to improve radiosensitivity in NPC.

目的：放疗是鼻咽癌的一种治疗方法；然而，细胞放射敏感性的异质性限制了其疗效。因此，研究鼻咽癌放射耐药的具体机制对于确定和使用有效的放射增敏剂以提高治疗成功率至关重要。方法与材料：建立鼻咽癌耐辐射细胞株HONE1-RR和SUNE1-RR。采用定量逆转录- pcr （qRT-PCR）、western blot和酶联免疫吸附法（ELISA）检测血管紧张素原（AGT）和局部血管紧张素II （Ang II）的激活情况。透射电镜、亚铁离子检测和脂质氧化水平检测辐射诱导的鼻咽癌铁下垂。采用生物信息学分析、qRT-PCR、western blotting、共免疫沉淀和双荧光素酶检测来探索下游机制。采用集落形成法、细胞计数试剂盒-8 （CCK-8）法和裸鼠异种移植模型评估鼻咽癌放射敏感性。免疫组化法检测鼻咽癌组织中AGT、缺氧诱导因子-1α (HIF-1α)、缺氧诱导脂滴相关蛋白（HILPDA）和谷胱甘肽过氧化物酶4 （GPX4）的表达。结果：局部Ang II的激活在鼻咽癌细胞调节铁凋亡的辐射抗性驱动中发挥关键作用。该局部Ang II通过两条平行通路与HIF-1α建立正反馈回路；Ang II通过激活MAPK通路稳定HIF-1α， AGT直接结合HIF-1α阻止其降解。这种AGT-HIF-1α环通过转录调节HILPDA的表达来调节鼻咽癌细胞铁下垂。此外，Ang II受体拮抗剂（ARB）和铁下垂诱导剂的联合使用显著增加了鼻咽癌的放射敏感性。此外，AGT、HIF-1α和HILPDA的表达与鼻咽癌铁下垂程度、放射敏感性及预后密切相关。结论：我们的研究结果表明，AGT-HIF-1α-HILPDA途径通过促进脂滴积累来促进鼻咽癌的放射抵抗，从而抑制铁下垂。在诱导铁下垂的同时靶向局部Ang II是改善鼻咽癌放射敏感性的有希望的策略。

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引用次数: 0

The proton RBE and the distal edge effect for acute and late normal tissue damage in vivo 质子RBE和远端边缘效应对体内急性和晚期正常组织损伤的影响。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110668

Cathrine Bang Overgaard , Fardous Reaz , Christina Ankjærgaard , Claus E. Andersen , Mateusz Sitarz , Per Poulsen , Harald Spejlborg , Jacob G. Johansen , Jens Overgaard , Cai Grau , Niels Bassler , Brita Singers Sørensen

Background and purpose

In proton therapy, a relative biological effectiveness (RBE) of 1.1 is used to reach an isoeffective biological response between photon and proton doses. However, the RBE varies with biological endpoints and linear energy transfer (LET), two key parameters in radiotherapy. Few in vivo studies have investigated the increasing RBE with increasing LET. This study aims to test the hypothesis that the RBE varies between endpoints and has a distal edge effect in vivo.

Materials and methods

Unanesthetized mice were restrained in jigs where their right hind legs were irradiated with a single dose of protons at the center (LET, _all = 5.3 keV/μm) and distal edge (LET, _all = 7.6 keV/μm) of a spread-out Bragg peak (SOBP). 6 MV photons were used as reference. The acute damage and skin toxicity were scored daily until day 30, and the late damage was evaluated using a joint contracture assay for one year after treatment.

Results

An acute damage RBE of 1.06 ± 0.02(1.02–1.10) and late damage RBE of 1.16 ± 0.08(1.00–1.32) were found, displaying an enhanced RBE for late damage in the center SOBP. The distal edge RBE for acute and late damage was 1.15 ± 0.02(1.10–1.19) and 1.26 ± 0.09(1.07–1.43), showing a similar center-to-distal edge RBE enhancement of 8 % and 9 % for acute and late damage.

Conclusion

The findings demonstrate an increased RBE for late damage than acute damage and the distal edge effect is evident with increased RBE at the distal end of the proton SOBP in vivo.

背景和目的：在质子治疗中，相对生物效应（RBE）为 1.1，以达到光子和质子剂量之间的等效生物反应。然而，RBE 随生物终点和线性能量传递（LET）这两个放疗中的关键参数而变化。很少有体内研究调查 RBE 随 LET 的增加而增加的情况。本研究旨在检验 RBE 随终点的不同而变化并在体内具有远端边缘效应的假设：将未麻醉的小鼠束缚在夹具中，用单剂量质子辐照其右后腿，辐照中心（LET，均=5.3 keV/μm）和远端边缘（LET，均=7.6 keV/μm）的扩散布拉格峰（SOBP）。以 6 MV 光子为参考。每天对急性损伤和皮肤毒性进行评分，直至第 30 天，并在治疗后一年内使用关节挛缩试验对后期损伤进行评估：结果：急性损伤 RBE 为 1.06 ± 0.02(1.02-1.10)，晚期损伤 RBE 为 1.16 ± 0.08(1.00-1.32)。急性和晚期损伤的远端边缘 RBE 分别为 1.15 ± 0.02(1.10-1.19) 和 1.26 ± 0.09(1.07-1.43)，显示急性和晚期损伤的中心到远端边缘 RBE 增强率相似，分别为 8% 和 9%：结论：研究结果表明，晚期损伤的 RBE 比急性损伤增加。此外，远端边缘效应也很明显，质子 SOBP 远端 RBE 增加。

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引用次数: 0

Predictive biomarkers of radiotherapy- related dermatitis, xerostomia, mucositis and dysphagia in head and neck cancer: A systematic review 头颈癌放疗相关皮炎、口干、黏膜炎和吞咽困难的预测性生物标志物：一项系统综述。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110689

Alexander Koch , Philipp Reinhardt , Olgun Elicin , Daniel M. Aebersold , Daniel H. Schanne

Background

Radiotherapy is essential for treating head and neck cancer but often leads to severe toxicity. Traditional predictors include anatomical location, tumor extent, and dosimetric data. Recently, biomarkers have been explored to better predict and understand toxicity. This review aims to summarize the current literature, assess data quality, and guide future research.

Methods

Two reviewers independently screened EMBASE and PubMed for studies published between 2010 and 2023. Endpoints were dermatitis, mucositis, sticky saliva/xerostomia, and dysphagia. Statistical analysis was performed using R, and bias assessed via a modified QUIPS questionnaire. Pathway analysis was conducted using gProfiler. The study adhered to PRISMA and COSMOS-E guidelines and was registered in the PROSPERO database (#CRD42023361245).

Results

Of 2,550 abstracts, 69 publications met the inclusion criteria. These studies involved a median of 81 patients, primarily male (75 %), with common primary tumors in the nasopharynx (32 %) and oropharynx (27 %). Most patients (84 %) had advanced disease (stage III/IV). The most frequently studied biomarkers were DNA-based single-nucleotide polymorphisms (SNPs, 59 %), salivary proteins (13 %), and bacteria (10 %). Ten statistically-significant biomarkers (all SNPs) in low-bias publications were identified, particularly in DNA repair and cell detoxification pathways. Data quality was often poor and few validation studies were present in the dataset.

Conclusion

This review provides an overview of the research landscape, highlights research gaps and provides recommendations for future research directions. We identified several potential biomarkers, particularly in DNA repair pathways, that align with current understanding of radiation-induced cell damage. However, the overall data quality was poor, with key clinical variables often missing. Overall, rigorous standardization of reporting, validation studies and multi-center collaborations to increase study power and sample sizes are necessary to build high-level evidence for clinical application.

背景：放疗是治疗头颈癌的必要手段，但往往会导致严重的毒性。传统的预测指标包括解剖位置、肿瘤范围和剂量学数据。最近，生物标志物已被探索，以更好地预测和了解毒性。本文旨在总结现有文献，评估数据质量，指导未来的研究。方法：两位审稿人独立筛选EMBASE和PubMed在2010年至2023年间发表的研究。终点为皮炎、粘膜炎、唾液粘稠/口干和吞咽困难。采用R进行统计分析，并通过改进的QUIPS问卷评估偏倚。使用gProfiler进行通路分析。该研究遵循PRISMA和COSMOS-E指南，并在PROSPERO数据库中注册（#CRD42023361245）。结果：2550篇摘要中，69篇符合纳入标准。这些研究中位纳入了81例患者，主要是男性（75% %），鼻咽部（32% %）和口咽部（27% %）有常见的原发性肿瘤。大多数患者（84% %）为晚期疾病（III/IV期）。最常研究的生物标志物是基于dna的单核苷酸多态性（snp, 59 %）、唾液蛋白（13 %）和细菌（10 %）。在低偏倚出版物中发现了10个具有统计学意义的生物标志物（所有snp），特别是在DNA修复和细胞解毒途径中。数据质量通常很差，数据集中很少有验证研究。结论：本文综述了该领域的研究概况，指出了研究空白，并对未来的研究方向提出了建议。我们确定了几个潜在的生物标志物，特别是在DNA修复途径中，与目前对辐射诱导的细胞损伤的理解一致。然而，总体数据质量较差，往往缺少关键的临床变量。总的来说，报告、验证研究和多中心合作的严格标准化对于建立临床应用的高水平证据是必要的，以增加研究能力和样本量。

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引用次数: 0

Aims+Scope/Editorial Board/ Publication information

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/S0167-8140(25)00025-8

引用次数: 0

Prolonged interval hypofractionated radiotherapy facilitates better antitumor immunity 延长间隔低分割放疗有利于更好的抗肿瘤免疫。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110664

Jie Xiao , Shilong Shao , Yue Deng , Dan Wang , Yi Liu , Shanshan He , Yue Zhao , Wenjun Liao , Jun Zhang , Mu Yang , Shichuan Zhang

Purpose

To evaluate the impact of hypofractionated radiotherapy (Hypo-RT) with different interfraction intervals on tumor growth, immune response, and synergistic effects with anti-PD-1 immunotherapy.

Methods

The mouse MC38 colon cancer model was utilized. Various radiation regimens were designed to investigate the effects of fraction interval and fraction size on tumor growth, immune mobilization, and combination effects with anti-PD-1 immunotherapy.

Results

For a fixed-dose experiment, the 6 × 5 Gy for every other day (qod) regimen demonstrated an equivalent effect on tumor growth compared to the 6 × 5 Gy once daily (qd) regimen, while the 6 × 5 Gy for twice weekly (biw) regimen failed to inhibit tumor growth. Both qod and biw regimens induced an enhanced immune response, unlike the qd regimen. For a fixed biologically equivalent dose experiment, 6 × 5 Gy qod, 4 × 7 Gy biw, and 2 × 11 Gy once weekly (qw) regimens exhibited similar tumor suppression to the 12 × 3 Gy qd regimen. The long-interval Hypo-RT regimens significantly mobilized host immunity, whereas 12 × 3 Gy qd did not. The peripheral and intratumoral T cells increased as the fraction interval and size increased. All Hypo-RT regimens combined with anti-PD-1 immunotherapy demonstrated higher intratumoral CD8 + T cells and more effective tumor growth delay compared to the 12 × 3 Gy qd regime.

Conclusions

The current study suggested that a prolonged inter-fraction interval with an increased fraction size in Hypo-RT may be a promising option to balance the therapeutic effect on tumor and immune activation.

目的：探讨不同间隔时间低分割放疗对肿瘤生长、免疫应答及与抗pd -1免疫治疗协同作用的影响。方法：采用小鼠MC38结肠癌模型。我们设计了不同的放射治疗方案，以研究碎片间隔和碎片大小对肿瘤生长、免疫动员以及与抗pd -1免疫治疗的联合效应的影响。结果：在固定剂量实验中，6 × 5 Gy每隔一天（qod）方案与6 × 5 Gy每天一次（qd）方案相比，对肿瘤生长的影响相当，而6 × 5 Gy每周两次（biw）方案未能抑制肿瘤生长。与qd方案不同，qd方案和bw方案均诱导免疫反应增强。固定生物等效剂量实验6 × 5 Gy qod 4 × 7 Gy车身,和2 × 11 Gy一旦每周(qw)方案表现出相似的肿瘤抑制的12 × 3 Gy qd方案。长时间的hyport方案显著调动宿主免疫，而12 × 3 Gy qd则没有。外周和瘤内T细胞随着分数间隔和大小的增加而增加。与12 × 3 Gy qd方案相比，所有hyport方案联合抗pd -1免疫治疗均显示出更高的肿瘤内CD8 + T细胞和更有效的肿瘤生长延迟。结论：目前的研究表明，在hyport中延长间隔时间和增加分数可能是一个有希望的选择，以平衡对肿瘤和免疫激活的治疗效果。

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引用次数: 0

The prognostic significance of sarcopenia in patients treated with definitive radiotherapy: A systematic review 接受明确放疗的患者肌肉减少症的预后意义：一项系统综述。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110663

Alexander J. Vickers , Dónal M. McSweeney , Ananya Choudhury , Jamie Weaver , Gareth Price , Alan McWilliam

Sarcopenia describes the degenerative loss of muscle mass and strength, and is emerging as a pan-cancer prognostic biomarker. It is linked with increased treatment toxicity, decreased survival and significant healthcare financial burden. Systematic analyses of sarcopenia studies have focused on outcomes in patients treated surgically or with systemic therapies. There are few publications concerning patients treated with radiotherapy. This manuscript presents a pan-cancer systematic review of the association between sarcopenia and survival outcomes in patients treated with definitive (chemo-)radiotherapy. A literature search was performed, with 26 studies identified, including a total of 5,784 patients. The prognostic significance of sarcopenia was mixed. This may reflect lack of consensus in methods used to measure skeletal muscle mass and define sarcopenia. Many papers analyse small samples and present sarcopenia cutoffs optimised on the local population, which may not generalise to external populations. Recent advances in artificial intelligence allow for automatic measurement of body composition by segmenting the muscle compartment on routinely collected imaging. This provides opportunity for standardisation of measurement methods and definitions across populations. Adopting sarcopenia diagnosis into clinical workflows could reduce futile treatments and associated financial burden, by reducing treatment toxicities, and improving treatment completion, patient survival, and quality-of-life after cancer.

肌肉疏松症是指肌肉质量和力量的退化性丧失，正在成为一种泛癌症预后生物标志物。肌肉疏松症与治疗毒性增加、生存率下降和重大医疗财务负担有关。对肌肉疏松症研究的系统分析主要集中在接受手术治疗或全身治疗的患者的结果。有关接受放射治疗的患者的文献很少。本手稿对接受确定性（化疗）放疗患者的肌肉疏松症与生存结果之间的关系进行了泛癌症系统性回顾。我们进行了文献检索，发现了 26 项研究，共涉及 5784 名患者。关于肌肉疏松症的预后意义，研究结果不一。这可能反映了测量骨骼肌质量和定义肌肉疏松症的方法缺乏共识。许多论文对小样本进行了分析，并提出了针对本地人群进行优化的肌肉疏松症临界值，但这些临界值可能并不适用于外部人群。人工智能领域的最新进展使我们可以通过对常规采集的图像进行肌肉分割，自动测量身体成分。这为不同人群的测量方法和定义标准化提供了机会。将 "肌肉疏松症 "诊断纳入临床工作流程，可减少治疗毒性，提高治疗完成率、患者生存率和癌症后的生活质量，从而减少无效治疗和相关的经济负担。

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引用次数: 0

Cost-effectiveness of a nurse-led sexual rehabilitation intervention for women treated with radiotherapy for gynaecological cancer in a randomized trial 在一项随机试验中，对接受妇科癌症放疗的妇女进行由护士指导的性康复干预的成本效益。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110683

Isabelle Suvaal , Wilbert B. van den Hout , Susanna B. Hummel , Jan-Willem M. Mens , Charlotte C. Tuijnman-Raasveld , Laura A. Velema , Henrike Westerveld , Jeltsje S. Cnossen , An Snyers , Ina M. Jürgenliemk-Schulz , Ludy C.H.W. Lutgens , Jannet C. Beukema , Marie A.D. Haverkort , Marlies E. Nowee , Remi A. Nout , Cor D. de Kroon , Helena C. van Doorn , Carien L. Creutzberg , Moniek M. ter Kuile

Purpose

To compare the cost-effectiveness of a nurse-led sexual rehabilitation intervention with standard care in women treated with external beam radiotherapy, with or without brachytherapy, for gynaecological cancers.

Methods

Eligible women were randomly assigned to the intervention (n = 112) or standard care (n = 117). Primary endpoint was sexual functioning at 12-months post-radiotherapy, assessed by the Female Sexual Function Index (FSFI). Nurses documented frequency and duration of intervention sessions, patients reported sexual healthcare and functioning at 1, 3, 6, and 12-months. Costs were related to quality-adjusted-life-years (QALYs) using the EuroQol-5 Dimensions and visual analogue scale, and to sexual functioning improvement at 12-months. T-tests compared mean QALYs and costs, with multiple imputation for missing data.

Results

The nurse-led intervention added €172 per patient, including training costs and 4–5 sessions. Other sexual rehabilitation costs were higher in the standard care group (€107 versus €141, p = 0.02). Total costs were €478 for the intervention group and €357 for standard care (p = 0.03). Valued at €20.000 per QALY, the intervention was 60 %–70 % likely to be cost-effective and less than 50 % likely to be cost-effective in terms of improved sexual functioning.

Conclusion

The nurse-led sexual rehabilitation intervention is not more cost-effective than standard care, however with low costs in both groups. Since costs for standard care were slightly lower, it is preferred from a health-economic perspective. It includes detailed patient education and a dedicated sexual rehabilitation session within the first three months post-radiotherapy, which is better provided at lower cost by a trained nurse.

目的：比较护士主导的性康复干预与标准护理的成本效益，在接受外束放疗的妇女中，有或没有近距离放疗，治疗妇科癌症。方法：将符合条件的女性随机分配到干预组（n = 112）或标准治疗组（n = 117）。主要终点是放疗后12个月的性功能，由女性性功能指数（FSFI）评估。护士记录了干预疗程的频率和持续时间，患者在1、3、6和12个月时报告了性保健和性功能。成本与使用EuroQol-5维度和视觉模拟量表的质量调整生命年（QALYs）以及12个月时性功能改善有关。t检验比较了平均质量年和成本，对缺失数据进行了多重输入。结果：护士主导的干预为每位患者增加了172欧元，包括培训费用和4-5次治疗。标准治疗组的其他性康复费用更高（107欧元对141欧元，p = 0.02）。干预组的总费用为478欧元，标准护理组为357欧元（p = 0.03）。每个QALY价值20,000欧元，干预措施的成本效益为60% %- 70% %，在改善性功能方面的成本效益低于50% %。结论：护士主导的性康复干预并不比标准治疗更具成本效益，但两组的成本均较低。由于标准护理的费用略低，因此从健康经济的角度来看，它是首选。它包括详细的病人教育和在放疗后的头三个月内的专门的性康复会议，由训练有素的护士以较低的成本提供更好。

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引用次数: 0

Deep learning dose prediction to approach Erasmus-iCycle dosimetric plan quality within seconds for instantaneous treatment planning 深度学习剂量预测，在几秒钟内接近Erasmus-iCycle剂量计计划质量，用于即时治疗计划。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110662

Joep van Genderingen , Dan Nguyen , Franziska Knuth , Hazem A.A. Nomer , Luca Incrocci , Abdul Wahab M. Sharfo , András Zolnay , Uwe Oelfke , Steve Jiang , Linda Rossi , Ben J.M. Heijmen , Sebastiaan Breedveld

Background and purpose

Fast, high-quality deep learning (DL) prediction of patient-specific 3D dose distributions can enable instantaneous treatment planning (IP), in which the treating physician can evaluate the dose and approve the plan immediately after contouring, rather than days later. This would greatly benefit clinical workload, patient waiting times and treatment quality. IP requires that predicted dose distributions closely match the ground truth. This study examines how training dataset size and model size affect dose prediction accuracy for Erasmus-iCycle GT plans to enable IP.

Materials and methods

For 1250 prostate patients, dose distributions were automatically generated using Erasmus-iCycle. Hierarchically Densely Connected U-Nets with 2/3/4/5/6 pooling layers were trained with datasets of 50/100/250/500/1000 patients, using a validation set of 100 patients. A fixed test set of 150 patients was used for evaluations.

Results

For all model sizes, prediction accuracy increased with the number of training patients, without levelling off at 1000 patients. For 4–6 level models with 1000 training patients, prediction accuracies were high and comparable. For 6 levels and 1000 training patients, the median prediction errors and interquartile ranges for PTV V_95%, rectum V₇₅_Gy and bladder V₆₅_Gy were 0.01 [-0.06,0.15], 0.01 [-0.20,0.29] and −0.02 [-0.27,0.27] %-point. Dose prediction times were around 1.2 s.

Conclusion

Although even for 1000 training patients there was no convergence in obtained prediction accuracy yet, the accuracy for the 6-level model with 1000 training patients may be adequate for the pursued instantaneous planning, which is subject of further research.

背景和目的：快速、高质量的深度学习（DL）预测患者特异性3D剂量分布可以实现瞬时治疗计划（IP），其中治疗医生可以在轮廓后立即评估剂量并批准计划，而不是几天后。这将大大有利于临床工作量、患者等待时间和治疗质量。IP要求预测的剂量分布与实际情况密切匹配。本研究探讨了训练数据集大小和模型大小如何影响Erasmus-iCycle GT计划的剂量预测精度，以实现IP。材料与方法：采用Erasmus-iCycle自动生成1250例前列腺患者的剂量分布。使用100名患者的验证集，使用50/100/250/500/1000患者的数据集训练具有2/3/4/5/6池化层的分层密集连接U-Nets。采用固定的150例患者测试集进行评估。结果：对于所有模型大小，预测精度随着训练患者数量的增加而增加，在1000名患者时没有趋于稳定。对于有1000名训练患者的4-6级模型，预测精度很高，具有可比性。在6个水平、1000名训练患者中，PTV V95%、直肠V75Gy和膀胱V65Gy的中位预测误差和四分位数范围分别为0.01[-0.06,0.15]、0.01[-0.20,0.29]和-0.02 [-0.27,0.27]%-point。剂量预测时间约为1.2 s。结论：尽管对于1000名训练患者，所得到的预测精度还没有收敛，但对于1000名训练患者的6级模型，其精度可能足以满足所追求的瞬时计划，有待进一步研究。

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引用次数: 0

Prediction of the need of enteral nutrition during radiation therapy for head and neck cancers 头颈癌放疗期间肠内营养需求的预测。

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110693

Paul Giraud , Sebastien Guihard , Sebastien Thureau , Philippe Guilbert , Amandine Ruffier , Remi Eugene , Assia Lamrani-Ghaouti , Cyrus Chargari , Xavier Liem , Jean Emmanuel Bibault

Introduction

Patients with a head and neck (HN) cancer undergoing radiotherapy risk critical weight loss and oral intake reduction leading to enteral nutrition. We developed a predictive model for the need for enteral nutrition during radiotherapy in this setting. Its performances were reported on a real-world multicentric cohort.

Material and Methods

Two models were trained on a prospective monocentric cohort of 230 patients. The first model predicted an outcome combining severe or early fast weight loss, or severe oral intake impairment (grade 3 anorexia or dysphagia or the prescription of enteral nutrition). The second outcome only combined oral intake impairment criteria. We trained a gradient boosted tree with a nested cross validation for Bayesian optimization on a prospective cohort and predictive performances were reported on the external multicentric real-world cohort of 410 patients from 3 centres. Predictions were explainable for each patient using Shapley values.

Results

For the first and second outcome, the model yielded a ROC curve AUC of 81 % and 80%, an accuracy of 77 % and 77 %, a positive predictive value of 77 % and 72 %, a specificity of 78 % and 79 % and a sensitivity of 75 % and 73 %. The negative predictive value was 80 % and 80 %. For each patient, the underlying Shapley values of each clinical predictor to the prediction could be displayed. Overall, the most contributing predictor was concomitant chemotherapy.

Conclusion

Our predictive model yielded good performance on a real life multicentric validation cohort to predict the need for enteral nutrition during radiotherapy for HN cancers.

头颈部（HN）癌患者接受放射治疗有严重体重减轻和口服摄入量减少导致肠内营养的风险。我们开发了一个预测模型，预测在这种情况下放疗期间肠内营养的需求。它的表现是在一个真实的多中心队列中报告的。材料和方法：两个模型在230例患者的前瞻性单中心队列中进行训练。第一个模型预测的结果是合并严重或早期快速体重减轻，或严重的口服摄入障碍（3级厌食症或吞咽困难或肠内营养处方）。第二个结果仅结合了口服摄入障碍标准。我们在前瞻性队列中训练了一个梯度增强树，并对贝叶斯优化进行了嵌套交叉验证，并在来自3个中心的410名外部多中心现实队列中报告了预测性能。使用Shapley值可以解释每个患者的预测。结果:第一次和第二次的结果,81年的模型产生了ROC曲线AUC %和80%,准确性为77 77 %和%,阳性预测值77 72 %和%,78 % 79 %的特异性和灵敏度75 % 73 %。阴性预测值分别为80 %和80 %。对于每个患者，可以显示每个临床预测因子对预测的潜在Shapley值。总的来说，最重要的预测因素是伴随化疗。结论：我们的预测模型在现实生活中的多中心验证队列中表现良好，可以预测HN癌症放疗期间肠内营养的需求。

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引用次数: 0

Corrigendum to “Parallel explorations in LA-NSCLC: Chemoradiation dose-response optimisation considering immunotherapy and cardiac toxicity sparing” [Radiother. Oncol. 200 (2024) 110477] 对 "LA-NSCLC 的平行探索：化疗剂量反应优化考虑免疫治疗和心脏毒性疏导" [Radiother.

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.radonc.2024.110666

Huei-Tyng Huang

引用次数: 0