Pub Date : 2025-12-11DOI: 10.1016/j.radonc.2025.111328
Dominik Wróbel , Bartosz Wojewoda , Wiktoria Ziółek , Paweł Michał Potocki , Jędrzej Borowczak
Background and purpose
Immunotherapy has redefined the therapeutic paradigm in extensive-stage small cell lung cancer (ES-SCLC). However, the potential role of consolidative thoracic radiotherapy (cTRT) in this context remains unresolved. This study evaluated the efficacy and safety of cTRT in patients with ES-SCLC treated with chemoimmunotherapy, with particular focus on patients with baseline liver and brain metastasis.
Methods
A systematic review and pairwise meta-analysis were conducted per PRISMA guidelines, including studies from PubMed, Embase, and Scopus up to September 1, 2025. Outcomes were reported as hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), and brain metastasis-free survival (BMFS), and odds ratios (OR) for treatment-related adverse events (TRAEs) with 95 % confidence intervals (95 % CI).
Results
Twenty studies involving 5282 patients were included. cTRT combined with chemoimmunotherapy improved OS (HR: 0.57, 95 %CI: 0.48–0.66, p < 0.001) and PFS (HR: 0.53, 95 %CI: 0.45–0.63, p < 0.001). In patients with baseline brain metastasis, cTRT improved both OS (HR:0.57, 95 %CI: 0.39–0.84, p = 0.01) and PFS (HR:0.42, 95 %CI: 0.28–0.64, p < 0.001), whereas in patients with liver metastasis, there was no improvement. Furthermore, cTRT increased BMFS (HR: 0.46, 95 %CI: 0.33–0.64, p < 0.001). Grade ≥ 3 pneumonitis and esophagitis were observed in 3.86 % and 1.27 % of cTRT patients, respectively.
Conclusions
cTRT confers significant improvements in OS and PFS in the general population of patients with ES-SCLC, as well as in patients with baseline brain metastasis. Moreover, cTRT may be associated with prolonged BMFS, potentially reflecting an abscopal effect. The safety profile remains acceptable, given the substantial survival benefit.
{"title":"Consolidative thoracic radiotherapy in the immunotherapy era for extensive-stage small cell lung cancer: a systematic review and meta-analysis with emphasis on brain and liver metastases","authors":"Dominik Wróbel , Bartosz Wojewoda , Wiktoria Ziółek , Paweł Michał Potocki , Jędrzej Borowczak","doi":"10.1016/j.radonc.2025.111328","DOIUrl":"10.1016/j.radonc.2025.111328","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Immunotherapy has redefined the therapeutic paradigm in extensive-stage small cell lung cancer (ES-SCLC). However, the potential role of consolidative thoracic radiotherapy (cTRT) in this context remains unresolved. This study evaluated the efficacy and safety of cTRT in patients with ES-SCLC treated with chemoimmunotherapy, with particular focus on patients with baseline liver and brain metastasis.</div></div><div><h3>Methods</h3><div>A systematic review and pairwise <em>meta</em>-analysis were conducted per PRISMA guidelines, including studies from PubMed, Embase, and Scopus up to September 1, 2025. Outcomes were reported as hazard ratios (HR) for overall survival (OS), progression-free survival (PFS), and brain metastasis-free survival (BMFS), and odds ratios (OR) for treatment-related adverse events (TRAEs) with 95 % confidence intervals (95 % CI).</div></div><div><h3>Results</h3><div>Twenty studies involving 5282 patients were included. cTRT combined with chemoimmunotherapy improved OS (HR: 0.57, 95 %CI: 0.48–0.66, p < 0.001) and PFS (HR: 0.53, 95 %CI: 0.45–0.63, p < 0.001). In patients with baseline brain metastasis, cTRT improved both OS (HR:0.57, 95 %CI: 0.39–0.84, p = 0.01) and PFS (HR:0.42, 95 %CI: 0.28–0.64, p < 0.001), whereas in patients with liver metastasis, there was no improvement. Furthermore, cTRT increased BMFS (HR: 0.46, 95 %CI: 0.33–0.64, p < 0.001). Grade ≥ 3 pneumonitis and esophagitis were observed in 3.86 % and 1.27 % of cTRT patients, respectively.</div></div><div><h3>Conclusions</h3><div>cTRT confers significant improvements in OS and PFS in the general population of patients with ES-SCLC, as well as in patients with baseline brain metastasis. Moreover, cTRT may be associated with prolonged BMFS, potentially reflecting an abscopal effect. The safety profile remains acceptable, given the substantial survival benefit.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111328"},"PeriodicalIF":5.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744207","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 : 2025-12-09DOI: 10.1016/j.radonc.2025.111326
Paul Sargos , Géraldine Pignot , Carine Bellera , Pascal Pommier , Etienne Martin , Pierre Clavere , Christophe Hennequin , Jean-Luc Hoepffner , Gautier Marcq , Mathieu Roumiguié , Sébastien Crouzet , Luc Cormier , Vanessa Schartner , Noémie Huchet , David Pasquier , Jonathan Khalifa
Background and Purpose
Patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy remain at significant risk of pelvic recurrence. We aim to report acute toxicity from a multicentric phase II randomized trial evaluating adjuvant radiotherapy (ART).
Materials and Methods
Patients with pathological high-risk urothelial MIBC, defined as pT3a-4b and/or pN1-2 and/or positive surgical margins, were randomized (3:1) between ART (arm A) and observation (arm B). ART consisted of IMRT (50.4 Gy / 28 fractions) to the pelvic lymph nodes ± cystectomy bed. The primary endpoint was pelvic recurrence-free survival. Herein, we report on acute toxicity (< 6 months after treatment) using the NCI CTCAE 4.0.
Results
From May 2018 to December 2023, 80 eligible patients from 19 centres across France were enrolled: 58 in arm A and 22 in arm B. The present safety analysis focuses on 74 patients: 52 patients in arm A who effectively initiated ART and 22 in arm B. The median age was 66 years. Chemotherapy (mostly neoadjuvant) was given in 62.2 %. All the patients in the arm A completed the treatment. The rate of grade ≥ 2 and grade ≥ 3 acute gastro-intestinal adverse events (AEs) was 28.8 % and 3.8 %, respectively in arm A, and 4.5 % and 0 % respectively in arm B. Of the two grade ≥ 3 GI AE observed in arm A, one was attributed to surgical complications and the other to disease progression. The rate of grade ≥ 2 and grade ≥ 3 acute urinary AEs was 5.8 % and 0 %, respectively in arm A, and 9.1 % and 4.5 % respectively in arm B. As exploratory analyses, when focusing on AE of grade ≥ 2, these proportions were greater for Arm A (28.8 % [n = 15] vs. 4.5 % [n = 1]; p = 0.028, Fisher’s exact test). Overall, no radiotherapy-related grade ≥ 3 AE was observed.
Conclusion
From a randomized multicentric phase II trial, despite a logical higher rate of radiotherapy-related AE in the experimental arm, low rates of moderate to severe acute toxicity suggest the safety of ART for pathological high-risk MIBC. Efficacy end-points results are awaited.
{"title":"Adjuvant radiotherapy in patients with pathological high-risk bladder cancer: Acute toxicity results from a randomized multicentre phase II trial (Bladder-ART/GETUG-AFU30)","authors":"Paul Sargos , Géraldine Pignot , Carine Bellera , Pascal Pommier , Etienne Martin , Pierre Clavere , Christophe Hennequin , Jean-Luc Hoepffner , Gautier Marcq , Mathieu Roumiguié , Sébastien Crouzet , Luc Cormier , Vanessa Schartner , Noémie Huchet , David Pasquier , Jonathan Khalifa","doi":"10.1016/j.radonc.2025.111326","DOIUrl":"10.1016/j.radonc.2025.111326","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy remain at significant risk of pelvic recurrence. We aim to report acute toxicity from a multicentric phase II randomized trial evaluating adjuvant radiotherapy (ART).</div></div><div><h3>Materials and Methods</h3><div>Patients with pathological high-risk urothelial MIBC, defined as pT3a-4b and/or pN1-2 and/or positive surgical margins, were randomized (3:1) between ART (arm A) and observation (arm B). ART consisted of IMRT (50.4 Gy / 28 fractions) to the pelvic lymph nodes ± cystectomy bed. The primary endpoint was pelvic recurrence-free survival. Herein, we report on acute toxicity (< 6 months after treatment) using the NCI CTCAE 4.0.</div></div><div><h3>Results</h3><div>From May 2018 to December 2023, 80 eligible patients from 19 centres across France were enrolled: 58 in arm A and 22 in arm B. The present safety analysis focuses on 74 patients: 52 patients in arm A who effectively initiated ART and 22 in arm B. The median age was 66 years. Chemotherapy (mostly neoadjuvant) was given in 62.2 %. All the patients in the arm A completed the treatment. The rate of grade ≥ 2 and grade ≥ 3 acute gastro-intestinal adverse events (AEs) was 28.8 % and 3.8 %, respectively in arm A, and 4.5 % and 0 % respectively in arm B. Of the two grade ≥ 3 GI AE observed in arm A, one was attributed to surgical complications and the other to disease progression. The rate of grade ≥ 2 and grade ≥ 3 acute urinary AEs was 5.8 % and 0 %, respectively in arm A, and 9.1 % and 4.5 % respectively in arm B. As exploratory analyses, when focusing on AE of grade ≥ 2, these proportions were greater for Arm A (28.8 % [n = 15] vs. 4.5 % [n = 1]; p = 0.028, Fisher’s exact test). Overall, no radiotherapy-related grade ≥ 3 AE was observed.</div></div><div><h3>Conclusion</h3><div>From a randomized multicentric phase II trial, despite a logical higher rate of radiotherapy-related AE in the experimental arm, low rates of moderate to severe acute toxicity suggest the safety of ART for pathological high-risk MIBC. Efficacy end-points results are awaited.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111326"},"PeriodicalIF":5.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736728","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 : 2025-12-09DOI: 10.1016/j.radonc.2025.111311
S R Brown, M Van Hemelrijck, G Price, F B Oppong, J J C Verhoeff, C Faivre-Finn
Background: Traditional randomised controlled trials (RCTs) are foundational to clinical research, yet in radiation oncology, their limitations are increasingly evident. Rapid technological innovation, complex treatment protocols, and diverse patient populations challenge the feasibility, generalisability, and timeliness of RCTs. This has prompted exploration of alternative methodologies that better align with real-world practice and patient-centred care.
Methods: This narrative review was developed following a joint ESTRO-EORTC session at the May 2025 ESTRO meeting. It synthesises expert perspectives and recent literature to examine the limitations of RCTs and the potential of alternative designs, including real-world evidence (RWE), pragmatic trials, and Trials within Cohorts (TwiCs).
Findings: RCTs in radiation oncology face challenges including high cost, recruitment barriers, limited external validity, and ethical constraints. RWE, derived from registries and electronic health records, is increasingly used for regulatory decisions and post-market surveillance, though concerns about data quality and bias remain. Pragmatic trials offer inclusive, flexible designs that reflect routine care, but require robust infrastructure and statistical methods. TwiCs embed randomisation within observational cohorts, improving recruitment and reducing burden, yet raise ethical and methodological concerns. Examples such as OligoCARE, RAPID-RT and SPRINT illustrate how these designs can support scalable, patient-centred research.
Conclusion: To advance societal sustainability and equity in radiation oncology, methodological pluralism is essential. RWE, pragmatic trials, and TwiCs offer promising alternatives to traditional RCTs, enabling more responsive and inclusive research. Their success depends on investment in infrastructure, training, and ethical frameworks that support transparency and trust.
{"title":"Novel methodologies for clinical research in radiation oncology: Time to think outside of the box? A narrative review.","authors":"S R Brown, M Van Hemelrijck, G Price, F B Oppong, J J C Verhoeff, C Faivre-Finn","doi":"10.1016/j.radonc.2025.111311","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111311","url":null,"abstract":"<p><strong>Background: </strong>Traditional randomised controlled trials (RCTs) are foundational to clinical research, yet in radiation oncology, their limitations are increasingly evident. Rapid technological innovation, complex treatment protocols, and diverse patient populations challenge the feasibility, generalisability, and timeliness of RCTs. This has prompted exploration of alternative methodologies that better align with real-world practice and patient-centred care.</p><p><strong>Methods: </strong>This narrative review was developed following a joint ESTRO-EORTC session at the May 2025 ESTRO meeting. It synthesises expert perspectives and recent literature to examine the limitations of RCTs and the potential of alternative designs, including real-world evidence (RWE), pragmatic trials, and Trials within Cohorts (TwiCs).</p><p><strong>Findings: </strong>RCTs in radiation oncology face challenges including high cost, recruitment barriers, limited external validity, and ethical constraints. RWE, derived from registries and electronic health records, is increasingly used for regulatory decisions and post-market surveillance, though concerns about data quality and bias remain. Pragmatic trials offer inclusive, flexible designs that reflect routine care, but require robust infrastructure and statistical methods. TwiCs embed randomisation within observational cohorts, improving recruitment and reducing burden, yet raise ethical and methodological concerns. Examples such as OligoCARE, RAPID-RT and SPRINT illustrate how these designs can support scalable, patient-centred research.</p><p><strong>Conclusion: </strong>To advance societal sustainability and equity in radiation oncology, methodological pluralism is essential. RWE, pragmatic trials, and TwiCs offer promising alternatives to traditional RCTs, enabling more responsive and inclusive research. Their success depends on investment in infrastructure, training, and ethical frameworks that support transparency and trust.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111311"},"PeriodicalIF":5.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744153","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 : 2025-12-08DOI: 10.1016/j.radonc.2025.111320
Siming Zheng , Ting Liu , Jiaxiong Zhou, Ting Wang, Zhen Li, Jianrong Yu, Lei Wen, Minying Li
Background and purpose
To describe the clinical outcomes of patients with metastatic epidural spinal cord compression (MESCC) treated with hypofractionated stereotactic body radiation therapy (SBRT).
Materials and Methods
The outcomes of MESCC patients who underwent SBRT at our institution from January 2021 to September 2023 were retrospectively reviewed. The prescribed dose was 30–35 Gy delivered in five fractions over 7 days. Differences between complete pain relief, local control (LC), overall survival (OS), and adverse reaction rates between the groups were evaluated at different time points.
Results
The study cohort included 63 patients (91 lesions) with a median follow-up of 12 months. Complete pain relief rates at post-treatment months 1, 3, and 6 were 28.6 %, 44.4 %, and 45.3 %, respectively, with no significant difference between patients with low-grade vs. high-grade MESCC. The 1-year LC rate was 91.4 % (32/35) and the 1- and 2-year OS rates were 83.1 % and 46.1 %, respectively, with no significant difference between the low-grade and high-grade MESCC groups. Furthermore, 87.5 % (14/16) of patients with high-grade MESCC exhibited a decrease in Bilsky score at 3 months post-treatment, and the majority remained stabilized at 6 months. However, nine (14.3 %) patients developed new or worsening vertebral compression fractures.
Conclusion
Hypofractionated SBRT presents a feasible option for MESCC. For patients with high-grade MESCC who are unsuitable for surgery or refuse surgical intervention, SBRT can effectively relieve spinal cord compression.
{"title":"Hypofractionated stereotactic body radiation therapy for metastatic epidural spinal cord Compression: A case series study","authors":"Siming Zheng , Ting Liu , Jiaxiong Zhou, Ting Wang, Zhen Li, Jianrong Yu, Lei Wen, Minying Li","doi":"10.1016/j.radonc.2025.111320","DOIUrl":"10.1016/j.radonc.2025.111320","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To describe the clinical outcomes of patients with metastatic epidural spinal cord compression (MESCC) treated with hypofractionated stereotactic body radiation therapy (SBRT).</div></div><div><h3>Materials and Methods</h3><div>The outcomes of MESCC patients who underwent SBRT at our institution from January 2021 to September 2023 were retrospectively reviewed. The prescribed dose was 30–35 Gy delivered in five fractions over 7 days. Differences between complete pain relief, local control (LC), overall survival (OS), and adverse reaction rates between the groups were evaluated at different time points.</div></div><div><h3>Results</h3><div>The study cohort included 63 patients (91 lesions) with a median follow-up of 12 months. Complete pain relief rates at post-treatment months 1, 3, and 6 were 28.6 %, 44.4 %, and 45.3 %, respectively, with no significant difference between patients with low-grade vs. high-grade MESCC. The 1-year LC rate was 91.4 % (32/35) and the 1- and 2-year OS rates were 83.1 % and 46.1 %, respectively, with no significant difference between the low-grade and high-grade MESCC groups. Furthermore, 87.5 % (14/16) of patients with high-grade MESCC exhibited a decrease in Bilsky score at 3 months post-treatment, and the majority remained stabilized at 6 months. However, nine (14.3 %) patients developed new or worsening vertebral compression fractures.</div></div><div><h3>Conclusion</h3><div>Hypofractionated SBRT presents a feasible option for MESCC. For patients with high-grade MESCC who are unsuitable for surgery or refuse surgical intervention, SBRT can effectively relieve spinal cord compression.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111320"},"PeriodicalIF":5.3,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725555","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.2025.111321
Yunxiang Li, Xiao Liang, Jiacheng Xie, Jie Deng, Weiguo Lu, You Zhang
Purpose
We developed a universal image translation model—Translate Any Modality (TAM) model to synthesize MRI sequences and CT for brain and head-and-neck radiotherapy, facilitating downstream clinical tasks including multimodal registration and treatment dose calculation.
Methods and materials
We retrospectively curated multi-modal imaging from 90 patients (43 brain, and 47 head-and-neck), each with up to eight MRI sequences and a paired CT. TAM uses a two-stage translation strategy: a 3D U-Net to firstly segment soft tissues and bones to serve as anatomical anchors; and a conditional diffusion model, guided by these masks, to synthesize the target modality from any available input modalities. We evaluated 46 MRI-to-MRI and MRI-to-CT translation tasks against two comparison methods, CycleGAN and UNIT, using Frechet Inception Distance (FID), peak signal-to-noise-ratio (PSNR), structural similarity index (SSIM), and Hounsfield unit (HU)-based mean absolute error (MAE). Clinical relevance was tested via multi-modality registration with simulated B-spline deformations and dose calculation using clinical plans with Gamma criteria 1 %/1 mm and 2 %/2 mm.
Results
TAM improved image quality (PSNR 30.0 ± 3.7; SSIM 0.973 ± 0.024) versus UNIT (27.0 ± 3.2; 0.958 ± 0.026) and CycleGAN (25.4 ± 4.1; 0.949 ± 0.037). For synthesized CT, TAM-based CT achieved average Gamma indices of 99.1 ± 1.7 % (2 %/2 mm) and 94.1 ± 6.4 % (1 %/1 mm) versus CycleGAN 93.1 ± 7.5 %/84.0 ± 9.5 % and UNIT 93.8 ± 7.0 %/86.3 ± 9.4 %, with dose-volume histograms closely matching real-CT plans.
Conclusion
TAM is a novel any-to-any medical image modality translation model. It provides flexible, anatomically faithful translation among MRI sequences and CT, which subsequently improves the accuracy of downstream tasks, including registration and dose calculation.
{"title":"A universal medical imaging modality translation model in brain and head-and-neck radiotherapy","authors":"Yunxiang Li, Xiao Liang, Jiacheng Xie, Jie Deng, Weiguo Lu, You Zhang","doi":"10.1016/j.radonc.2025.111321","DOIUrl":"10.1016/j.radonc.2025.111321","url":null,"abstract":"<div><h3>Purpose</h3><div>We developed a universal image translation model—Translate Any Modality (TAM) model to synthesize MRI sequences and CT for brain and head-and-neck radiotherapy, facilitating downstream clinical tasks including multimodal registration and treatment dose calculation.</div></div><div><h3>Methods and materials</h3><div>We retrospectively curated multi-modal imaging from 90 patients (43 brain, and 47 head-and-neck), each with up to eight MRI sequences and a paired CT. TAM uses a two-stage translation strategy: a 3D U-Net to firstly segment soft tissues and bones to serve as anatomical anchors; and a conditional diffusion model, guided by these masks, to synthesize the target modality from any available input modalities. We evaluated 46 MRI-to-MRI and MRI-to-CT translation tasks against two comparison methods, CycleGAN and UNIT, using Frechet Inception Distance (FID), peak signal-to-noise-ratio (PSNR), structural similarity index (SSIM), and Hounsfield unit (HU)-based mean absolute error (MAE). Clinical relevance was tested via multi-modality registration with simulated B-spline deformations and dose calculation using clinical plans with Gamma criteria 1 %/1 mm and 2 %/2 mm.</div></div><div><h3>Results</h3><div>TAM improved image quality (PSNR 30.0 ± 3.7; SSIM 0.973 ± 0.024) versus UNIT (27.0 ± 3.2; 0.958 ± 0.026) and CycleGAN (25.4 ± 4.1; 0.949 ± 0.037). For synthesized CT, TAM-based CT achieved average Gamma indices of 99.1 ± 1.7 % (2 %/2 mm) and 94.1 ± 6.4 % (1 %/1 mm) versus CycleGAN 93.1 ± 7.5 %/84.0 ± 9.5 % and UNIT 93.8 ± 7.0 %/86.3 ± 9.4 %, with dose-volume histograms closely matching real-CT plans.</div></div><div><h3>Conclusion</h3><div>TAM is a novel any-to-any medical image modality translation model. It provides flexible, anatomically faithful translation among MRI sequences and CT, which subsequently improves the accuracy of downstream tasks, including registration and dose calculation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111321"},"PeriodicalIF":5.3,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715642","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.2025.111322
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}
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