Pub Date : 2024-11-22DOI: 10.1016/j.radonc.2024.110641
Cristian Udovicich , Kendrick Koo , John Michael Bryant , Alejandro Bugarini , Michael Huo , Kyung Hwan Kim , Yuping Derek Li , Daniel E. Oliver , Samir Patel , Susanne Rogers , Michael R. Chicoine , Matthew C. Foote , Seon-Hwan Kim , Anand Mahadevan , Mark B. Pinkham , Joseph Sia , Neda Haghighi , INTERNEO Investigators
Background and Purpose
Neoadjuvant stereotactic radiosurgery (NaSRS) is an emerging treatment option for brain metastases (BrM) planned for resection. The aim of this study was to report on the efficacy and safety of NaSRS in an individual patient data pooled analysis.
Materials and Methods
Patients undergoing single- and multi-fraction NaSRS for BrM at nine institutions in five countries (Australia, Canada, South Korea, Switzerland and USA) were included. Eligibility criteria included BrM from any primary malignancy and no prior local therapy. The primary endpoint was a composite of local recurrence (LR), any grade radionecrosis (RN), and/or nodular leptomeningeal disease (nLMD). Secondary endpoints included these endpoints and Grade ≥ 2 RN. Endpoints were evaluated using cumulative incidence functions.
Results
NaSRS was delivered to 179 patients with 189 BrM. Median follow-up was 28.4 months. Primary malignancies included non-small cell lung carcinoma (44 %) and melanoma (17 %). The median BrM diameter was 29 mm (IQR 21–36 mm). Single- and multi-fraction NaSRS was utilised in 100 (53 %) and 89 BrM (47 %) respectively. The median single-fraction dose was 18 Gy (IQR 16–20 Gy). Multi-fraction doses included 24 Gy in three fractions (55 %) and 27 Gy in three fractions (25 %). The 12-month incidence for the composite endpoint was 8.0 %. The 12-month incidence of LR was 4.6 %, any grade RN was 3.6 %, Grade ≥ 2 RN was 1.8 % and nLMD was 1.2 %.
Conclusion
Neoadjuvant SRS results in favourable rates of LR, RN and nLMD. We provide a global experience of this treatment approach with long-term data and the largest cohort of patients undergoing multi-fraction SRS.
{"title":"International collaboration of neoadjuvant stereotactic radiosurgery for brain metastases: The INTERNEO individual patient data pooled analysis","authors":"Cristian Udovicich , Kendrick Koo , John Michael Bryant , Alejandro Bugarini , Michael Huo , Kyung Hwan Kim , Yuping Derek Li , Daniel E. Oliver , Samir Patel , Susanne Rogers , Michael R. Chicoine , Matthew C. Foote , Seon-Hwan Kim , Anand Mahadevan , Mark B. Pinkham , Joseph Sia , Neda Haghighi , INTERNEO Investigators","doi":"10.1016/j.radonc.2024.110641","DOIUrl":"10.1016/j.radonc.2024.110641","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Neoadjuvant stereotactic radiosurgery (NaSRS) is an emerging treatment option for brain metastases (BrM) planned for resection. The aim of this study was to report on the efficacy and safety of NaSRS in an individual patient data pooled analysis.</div></div><div><h3>Materials and Methods</h3><div>Patients undergoing single- and multi-fraction NaSRS for BrM at nine institutions in five countries (Australia, Canada, South Korea, Switzerland and USA) were included. Eligibility criteria included BrM from any primary malignancy and no prior local therapy. The primary endpoint was a composite of local recurrence (LR), any grade radionecrosis (RN), and/or nodular leptomeningeal disease (nLMD). Secondary endpoints included these endpoints and Grade ≥ 2 RN. Endpoints were evaluated using cumulative incidence functions.</div></div><div><h3>Results</h3><div>NaSRS was delivered to 179 patients with 189 BrM. Median follow-up was 28.4 months. Primary malignancies included non-small cell lung carcinoma (44 %) and melanoma (17 %). The median BrM diameter was 29 mm (IQR 21–36 mm). Single- and multi-fraction NaSRS was utilised in 100 (53 %) and 89 BrM (47 %) respectively. The median single-fraction dose was 18 Gy (IQR 16–20 Gy). Multi-fraction doses included 24 Gy in three fractions (55 %) and 27 Gy in three fractions (25 %). The 12-month incidence for the composite endpoint was 8.0 %. The 12-month incidence of LR was 4.6 %, any grade RN was 3.6 %, Grade ≥ 2 RN was 1.8 % and nLMD was 1.2 %.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant SRS results in favourable rates of LR, RN and nLMD. We provide a global experience of this treatment approach with long-term data and the largest cohort of patients undergoing multi-fraction SRS.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110641"},"PeriodicalIF":4.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695643","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 : 2024-11-21DOI: 10.1016/j.radonc.2024.110646
Lauren C. Nassour-Caswell , Manoj Kumar , Christian T. Stackhouse , Hasan Alrefai , Taylor L. Schanel , Benjamin M. Honan , Andee M. Beierle , Patricia H. Hicks , Joshua C. Anderson , Christopher D. Willey , Jeffrey S. Peacock
Purpose
Current radiotherapy (RT) in glioblastoma (GBM) is delivered as constant dose fractions (CDF), which do not account for intratumoral-heterogeneity and radio-selection in GBM. These factors contribute to differential treatment response complicating the therapeutic efficacy of this principle. Our study aims to investigate an alternative dosing strategy to overcome radio-resistance using a novel longitudinal radiation cytotoxicity assay.
Methods
Theoretical In-silico mathematical assumptions were combined with an in-vitro experimental strategy to investigate alternative radiation regimens. Patient-derived xenograft (PDX) brain tumor-initiating cells (BTICs) with differential radiation-sensitivities were tested individually with sham control and three regimens of the same nominal and average dose of 16 Gy (over four fractions), but with altered doses per fraction. Fractions were delivered conventionally (CDF: 4, 4, 4, 4 Gy), or as dynamic dose fractions (DDF) “ramped down” (RD: 7, 5, 3, 1 Gy), or DDF “ramped up” (RU: 1, 3, 5, 7 Gy), every 4 days. Interfraction-longitudinal data were collected by imaging cells every 5 days, and endpoint viability was taken on day 20.
Results
The proposed method of radiosensitivity assessment allows for longitudinal-interfraction investigation in addition to endpoint analysis. Delivering four-fraction doses in an RD manner proves to be most effective at overcoming acquired radiation resistance in BTICs (Relative cell viability: CDF vs. RD: P < 0.0001; Surviving fraction: CDF: vs. RD: P < 0.0001).
Conclusions
Using in-silico cytotoxicity prediction modeling and an altered radiosensitivity assessment, we show DDF-RD is effective at inducing cytotoxicity in three BTIC lines with differential radiosensitivity.
{"title":"Altering fractionation during radiation overcomes radio-resistance in patient-derived glioblastoma cells assessed using a novel longitudinal radiation cytotoxicity assay","authors":"Lauren C. Nassour-Caswell , Manoj Kumar , Christian T. Stackhouse , Hasan Alrefai , Taylor L. Schanel , Benjamin M. Honan , Andee M. Beierle , Patricia H. Hicks , Joshua C. Anderson , Christopher D. Willey , Jeffrey S. Peacock","doi":"10.1016/j.radonc.2024.110646","DOIUrl":"10.1016/j.radonc.2024.110646","url":null,"abstract":"<div><h3>Purpose</h3><div>Current radiotherapy (RT) in glioblastoma (GBM) is delivered as constant dose fractions (CDF), which do not account for intratumoral-heterogeneity and radio-selection in GBM. These factors contribute to differential treatment response complicating the therapeutic efficacy of this principle. Our study aims to investigate an alternative dosing strategy to overcome radio-resistance using a novel longitudinal radiation cytotoxicity assay.</div></div><div><h3>Methods</h3><div>Theoretical In-silico mathematical assumptions were combined with an in-vitro experimental strategy to investigate alternative radiation regimens. Patient-derived xenograft (PDX) brain tumor-initiating cells (BTICs) with differential radiation-sensitivities were tested individually with sham control and three regimens of the same nominal and average dose of 16 Gy (over four fractions), but with altered doses per fraction. Fractions were delivered conventionally (CDF: 4, 4, 4, 4 Gy), or as dynamic dose fractions (DDF) “ramped down” (RD: 7, 5, 3, 1 Gy), or DDF “ramped up” (RU: 1, 3, 5, 7 Gy), every 4 days. Interfraction-longitudinal data were collected by imaging cells every 5 days, and endpoint viability was taken on day 20.</div></div><div><h3>Results</h3><div>The proposed method of radiosensitivity assessment allows for longitudinal-interfraction investigation in addition to endpoint analysis. Delivering four-fraction doses in an RD manner proves to be most effective at overcoming acquired radiation resistance in BTICs (Relative cell viability: CDF vs. RD: P < 0.0001; Surviving fraction: CDF: vs. RD: P < 0.0001).</div></div><div><h3>Conclusions</h3><div>Using in-silico cytotoxicity prediction modeling and an altered radiosensitivity assessment, we show DDF-RD is effective at inducing cytotoxicity in three BTIC lines with differential radiosensitivity.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110646"},"PeriodicalIF":4.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695455","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 : 2024-11-19DOI: 10.1016/j.radonc.2024.110644
John Michael Bryant , Matthew N. Mills , Casey Liveringhouse , Russell Palm , Mihaela Druta , Andrew Brohl , Damon R. Reed , Peter A. Johnstone , Justin T. Miller , Kujtim Latifi , Vladimir Feygelman , George Q. Yang , Arash O. Naghavi
Soft tissue sarcomas (STS) are radioresistant with a low α/β, which may have a biologic benefit with hypofractionation. For unresectable STS, the dose escalation required to achieve durable control is often limited by long-term toxicity risk. We sought to compare an isotoxic approach utilizing hypofractionated accelerated radiation dose-painting (HARD) versus standard fractionated radiation therapy (SFT) in patients with unresected STS.
We conducted a retrospective analysis of patients with unresected STS who received either HARD (n = 49) or SFT (n = 43) with photon-based therapy between 1990 and 2022. The 2 HARD regimens each use 3 dose levels based on risk of disease burden. The gross disease, intermediate risk, and low-risk clinical target volumes were treated with either 20–22 fractions of 3/2.5/2–2.2 Gy or 28 fractions of 2.5/2.2/1.8 Gy. SFT included patients treated with definitive intent, receiving ≥ 50 Gy in 1.8–2 Gy per fraction. Clinical endpoints included 3-year local control (LC), overall survival (OS), and progression-free survival (PFS), along with treatment-related toxicity.
With a median age of 67 and tumor size of 7 cm, most patients were stage IV (37 %), grade 3 (67 %), had no concurrent systemic therapy (70 %), and were lower extremity tumors (24 %). HARD cohort consisted of higher age, stage, recurrent disease, and median BED4 (p < 0.05), when compared to SFT. With a median follow-up of 35.9 months, HARD demonstrated significant improvement in 3-year LC (96.4 % vs. 48.4 %, p < 0.001), compared to SFT overall, with a median PFS benefit (16 vs. 10 months, p = 0.037) for non-distantly metastatic patients at baseline. On multivariate analysis, HARD was significantly associated with improved LC (HR 0.058, 95 % CI 0.005–0.682, p = 0.024). The HARD regimen found no significant increase in toxicity, with limited acute grade 3 (24 %, all dermatitis) and late grade 3 toxicity (6 %) observed, with no grade 4 or 5 events.
HARD regimen significantly improves LC for unresectable STS without a significant increase in toxicity, when compared to a standard fractionated approach, supporting further prospective investigation of this treatment approach.
{"title":"Hypofractionated accelerated radiation dose-painting (HARD) improves outcomes in unresected soft-tissue sarcoma","authors":"John Michael Bryant , Matthew N. Mills , Casey Liveringhouse , Russell Palm , Mihaela Druta , Andrew Brohl , Damon R. Reed , Peter A. Johnstone , Justin T. Miller , Kujtim Latifi , Vladimir Feygelman , George Q. Yang , Arash O. Naghavi","doi":"10.1016/j.radonc.2024.110644","DOIUrl":"10.1016/j.radonc.2024.110644","url":null,"abstract":"<div><div>Soft tissue sarcomas (STS) are radioresistant with a low α/β, which may have a biologic benefit with hypofractionation. For unresectable STS, the dose escalation required to achieve durable control is often limited by long-term toxicity risk. We sought to compare an isotoxic approach utilizing hypofractionated accelerated radiation dose-painting (HARD) versus standard fractionated radiation therapy (SFT) in patients with unresected STS.</div><div>We conducted a retrospective analysis of patients with unresected STS who received either HARD (n = 49) or SFT (n = 43) with photon-based therapy between 1990 and 2022. The 2 HARD regimens each use 3 dose levels based on risk of disease burden. The gross disease, intermediate risk, and low-risk clinical target volumes were treated with either 20–22 fractions of 3/2.5/2–2.2 Gy or 28 fractions of 2.5/2.2/1.8 Gy. SFT included patients treated with definitive intent, receiving ≥ 50 Gy in 1.8–2 Gy per fraction. Clinical endpoints included 3-year local control (LC), overall survival (OS), and progression-free survival (PFS), along with treatment-related toxicity.</div><div>With a median age of 67 and tumor size of 7 cm, most patients were stage IV (37 %), grade 3 (67 %), had no concurrent systemic therapy (70 %), and were lower extremity tumors (24 %). HARD cohort consisted of higher age, stage, recurrent disease, and median BED<sub>4</sub> (<em>p</em> < 0.05), when compared to SFT. With a median follow-up of 35.9 months, HARD demonstrated significant improvement in 3-year LC (96.4 % vs. 48.4 %, <em>p</em> < 0.001), compared to SFT overall, with a median PFS benefit (16 vs. 10 months, <em>p =</em> 0.037) for non-distantly metastatic patients at baseline. On multivariate analysis, HARD was significantly associated with improved LC (HR 0.058, 95 % CI 0.005–0.682, <em>p</em> = 0.024). The HARD regimen found no significant increase in toxicity, with limited acute grade 3 (24 %, all dermatitis) and late grade 3 toxicity (6 %) observed, with no grade 4 or 5 events.</div><div>HARD regimen significantly improves LC for unresectable STS without a significant increase in toxicity, when compared to a standard fractionated approach, supporting further prospective investigation of this treatment approach.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110644"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688670","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 : 2024-11-19DOI: 10.1016/j.radonc.2024.110645
Sherif Ramadan , Adam Mutsaers , Po-Hsuan Cameron Chen , Glenn Bauman , Vikram Velker , Belal Ahmad , Andrew J. Arifin , Timothy K. Nguyen , David Palma , Christopher D. Goodman
Purpose
Artificial intelligence (AI) and machine learning present an opportunity to enhance clinical decision-making in radiation oncology. This study aims to evaluate the competency of ChatGPT, an AI language model, in interpreting clinical scenarios and assessing its oncology knowledge.
Methods and Materials
A series of clinical cases were designed covering 12 disease sites. Questions were grouped into domains: epidemiology, staging and workup, clinical management, treatment planning, cancer biology, physics, and surveillance. Royal College-certified radiation oncologists (ROs) reviewed cases and provided solutions. ROs scored responses on 3 criteria: conciseness (focused answers), completeness (addressing all aspects of the question), and correctness (answer aligns with expert opinion) using a standardized rubric. Scores ranged from 0 to 5 for each criterion for a total possible score of 15.
Results
Across 12 cases, 182 questions were answered with a total AI score of 2317/2730 (84 %). Scores by criteria were: completeness (79 %, range: 70–99 %), conciseness (92 %, range: 83–99 %), and correctness (81 %, range: 72–92 %). AI performed best in the domains of epidemiology (93 %) and cancer biology (93 %) and reasonably in staging and workup (89 %), physics (86 %) and surveillance (82 %). Weaker domains included treatment planning (78 %) and clinical management (81 %). Statistical differences were driven by variations in the completeness (p < 0.01) and correctness (p = 0.04) criteria, whereas conciseness scored universally high (p = 0.91). These trends were consistent across disease sites.
Conclusions
ChatGPT showed potential as a tool in radiation oncology, demonstrating a high degree of accuracy in several oncologic domains. However, this study highlights limitations with incorrect and incomplete answers in complex cases.
{"title":"Evaluating ChatGPT’s competency in radiation oncology: A comprehensive assessment across clinical scenarios","authors":"Sherif Ramadan , Adam Mutsaers , Po-Hsuan Cameron Chen , Glenn Bauman , Vikram Velker , Belal Ahmad , Andrew J. Arifin , Timothy K. Nguyen , David Palma , Christopher D. Goodman","doi":"10.1016/j.radonc.2024.110645","DOIUrl":"10.1016/j.radonc.2024.110645","url":null,"abstract":"<div><h3>Purpose</h3><div>Artificial intelligence (AI) and machine learning present an opportunity to enhance clinical decision-making in radiation oncology. This study aims to evaluate the competency of ChatGPT, an AI language model, in interpreting clinical scenarios and assessing its oncology knowledge.</div></div><div><h3>Methods and Materials</h3><div>A series of clinical cases were designed covering 12 disease sites. Questions were grouped into domains: epidemiology, staging and workup, clinical management, treatment planning, cancer biology, physics, and surveillance. Royal College-certified radiation oncologists (ROs) reviewed cases and provided solutions. ROs scored responses on 3 criteria: conciseness (focused answers), completeness (addressing all aspects of the question), and correctness (answer aligns with expert opinion) using a standardized rubric. Scores ranged from 0 to 5 for each criterion for a total possible score of 15.</div></div><div><h3>Results</h3><div>Across 12 cases, 182 questions were answered with a total AI score of 2317/2730 (84 %). Scores by criteria were: completeness (79 %, range: 70–99 %), conciseness (92 %, range: 83–99 %), and correctness (81 %, range: 72–92 %). AI performed best in the domains of epidemiology (93 %) and cancer biology (93 %) and reasonably in staging and workup (89 %), physics (86 %) and surveillance (82 %). Weaker domains included treatment planning (78 %) and clinical management (81 %). Statistical differences were driven by variations in the completeness (p < 0.01) and correctness (p = 0.04) criteria, whereas conciseness scored universally high (p = 0.91). These trends were consistent across disease sites.</div></div><div><h3>Conclusions</h3><div>ChatGPT showed potential as a tool in radiation oncology, demonstrating a high degree of accuracy in several oncologic domains. However, this study highlights limitations with incorrect and incomplete answers in complex cases.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110645"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688667","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 : 2024-11-19DOI: 10.1016/j.radonc.2024.110639
Marcin Kubeczko , Dorota Gabryś , Justyna Rembak-Szynkiewicz , Donata Gräupner , Anna Polakiewicz-Gilowska , Michał Jarząb
Background
In patients diagnosed with estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, bone metastases emerge as the primary site of significant tumor burden. Cyclin-dependent kinase 4/6 (CDK4/6i) inhibitors are the gold standard in this clinical scenario, while radiotherapy (RT) represents a valuable addition. However, data on the efficacy of this combination remain scarce. We aimed to evaluate efficacy of RT in bone metastatic breast cancer patients treated with CDK4/6 inhibitors.
Materials and methods
398 patients (pts) with ER-positive HER2-negative breast cancer with bone metastases treated with CDK4/6i between 2018–2024 were analyzed. A total of 114 pts received 177 bone RT concurrently with CDK4/6i or within 6 months before CDK4/6i initiation, including 34 courses of stereotactic-body RT and 143 courses of conventional RT.
Results
The median progression-free survival (PFS) in pts who received bone RT was 31.0 months, compared to 26.3 months in pts without bone RT. The 2-y PFS for pts with bone RT was 57.1 % [95 % CI: 46.3–66.6 %] vs. 53.2 % [95 % CI: 46.3–59.6 %] for patients without bone RT (p = 0.51). The median overall survival (OS) for pts who received bone RT was 49.1 months, compared to 40.5 months for pts without bone RT. The 3-y OS for pts with bone RT was 63.7 % [95 % CI: 51.5–73.5 %] vs. 55.0 % [95 % CI 46.6–62.6 %] for pts without bone RT (p = 0.50). The 3-y local control for irradiated patients was 86.9 % [95 % CI 72.2–94.1 %].
Conclusions
In this study, we present the largest cohort published to date of breast cancer patients who received CDK4/6i alongside bone-directed RT. Although the observed differences in survival were not statistically significant, RT remains a viable treatment modality in metastatic breast cancer in some patients.
{"title":"Efficacy of radiotherapy for bone metastasis in breast cancer patients treated with cyclin-dependent kinase 4/6 inhibitors","authors":"Marcin Kubeczko , Dorota Gabryś , Justyna Rembak-Szynkiewicz , Donata Gräupner , Anna Polakiewicz-Gilowska , Michał Jarząb","doi":"10.1016/j.radonc.2024.110639","DOIUrl":"10.1016/j.radonc.2024.110639","url":null,"abstract":"<div><h3>Background</h3><div>In patients diagnosed with<!--> <!-->estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, bone metastases<!--> <!-->emerge as the<!--> <!-->primary site<!--> <!-->of<!--> <!-->significant tumor burden. Cyclin-dependent kinase 4/6 (CDK4/6i) inhibitors<!--> <!-->are the<!--> <!-->gold standard in this clinical scenario, while radiotherapy (RT) represents a valuable addition. However, data on the efficacy of this combination remain scarce. We aimed to evaluate efficacy of RT in bone metastatic breast cancer patients treated with CDK4/6 inhibitors.</div></div><div><h3>Materials and methods</h3><div>398 patients (pts) with ER-positive HER2-negative breast cancer with bone metastases treated with CDK4/6i between 2018–2024 were analyzed. A total of 114 pts received 177 bone RT concurrently with CDK4/6i or within 6 months before CDK4/6i initiation, including 34 courses of stereotactic-body RT and 143 courses of conventional RT.</div></div><div><h3>Results</h3><div>The median progression-free survival (PFS) in pts who received bone RT was 31.0 months, compared to 26.3 months in pts without bone RT. The 2-y PFS for pts with bone RT was 57.1 % [95 % CI: 46.3–66.6 %] vs. 53.2 % [95 % CI: 46.3–59.6 %] for patients without bone RT (p = 0.51). The median overall survival (OS) for pts who received bone RT was 49.1 months, compared to 40.5 months for pts without bone RT. The 3-y OS for pts with bone RT was 63.7 % [95 % CI: 51.5–73.5 %] vs. 55.0 % [95 % CI 46.6–62.6 %] for pts without bone RT (p = 0.50). The 3-y local control for irradiated patients was 86.9 % [95 % CI 72.2–94.1 %].</div></div><div><h3>Conclusions</h3><div>In this study, we present the largest cohort published to date of breast cancer patients who received CDK4/6i alongside bone-directed RT. Although the observed differences in survival were not statistically significant, RT remains a viable treatment modality in metastatic breast cancer in some patients.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110639"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.radonc.2024.110642
Cas Stefaan Dejonckheere , Lara Caglayan , Andrea Renate Glasmacher , Shari Wiegreffe , Julian Philipp Layer , Younèss Nour , Davide Scafa , Gustavo Renato Sarria , Simon Spohn , Markus Essler , Stefan Hauser , Manuel Ritter , Marit Bernhardt , Glen Kristiansen , Anca-Ligia Grosu , Constantinos Zamboglou , Eleni Gkika
Purpose
Stereotactic body radiotherapy (SBRT) is emerging as a valuable treatment modality for localized prostate cancer, with promising biochemical progression-free survival rates. Longitudinal assessment of prostate-specific antigen (PSA) is the mainstay of follow-up after treatment. PSA kinetics and dynamics are well-established in the context of brachytherapy and conventionally fractionated radiotherapy, yet little is known in the context of prostate SBRT.
Methods
A review of available literature in MEDLINE, Scopus, and Embase was performed, focusing on studies reporting PSA slope, nadir, bounce, and biochemical failure after prostate SBRT.
Results
Thirty-three records (45 % prospective) encompassing 9949 patients were included. SBRT dose ranged from 32–50 Gy in 4–5 fractions and overall median follow-up time (range) was 41 (15–74) months. Use of androgen deprivation therapy ranged from 0–38 %. SBRT was characterized by a steep initial decline of PSA, slowing down over time and ultimately yielding a lower nadir in comparison with conventional radiotherapy, with a median value (range) of 0.24 (0.1–0.6) ng/mL after a median time (range) of 33.1 (6–54) months. There was an inverse correlation between the highest SBRT dose in a trial and PSA nadir (r = − 0.59; p < 0.001). Benign PSA bounce occurred in 30 % of patients across all studies, after a median time (range) of 14.8 (9–36) months and with a median size (range) of 0.5 (0.3–1.1) ng/mL. There was no significant correlation between bounce and dose, nadir nor biochemical failure. There was, however, a significant inverse correlation between ADT use and PSA bounce frequency (r = −0.49; p = 0.046).
Conclusion
PSA kinetics and dynamics after SBRT for localized prostate cancer are different from those in other established radiotherapy modalities. Benign PSA bounce is very common. Clinicians should be aware of these factors and patients should be counseled accordingly, preventing unnecessary distress or salvage treatment.
{"title":"Prostate-specific antigen kinetics after stereotactic body radiotherapy for localized prostate cancer: A scoping review and meta-analysis","authors":"Cas Stefaan Dejonckheere , Lara Caglayan , Andrea Renate Glasmacher , Shari Wiegreffe , Julian Philipp Layer , Younèss Nour , Davide Scafa , Gustavo Renato Sarria , Simon Spohn , Markus Essler , Stefan Hauser , Manuel Ritter , Marit Bernhardt , Glen Kristiansen , Anca-Ligia Grosu , Constantinos Zamboglou , Eleni Gkika","doi":"10.1016/j.radonc.2024.110642","DOIUrl":"10.1016/j.radonc.2024.110642","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic body radiotherapy (SBRT) is emerging as a valuable treatment modality for localized prostate cancer, with promising biochemical progression-free survival rates. Longitudinal assessment of prostate-specific antigen (PSA) is the mainstay of follow-up after treatment. PSA kinetics and dynamics are well-established in the context of brachytherapy and conventionally fractionated radiotherapy, yet little is known in the context of prostate SBRT.</div></div><div><h3>Methods</h3><div>A review of available literature in MEDLINE, Scopus, and Embase was performed, focusing on studies reporting PSA slope, nadir, bounce, and biochemical failure after prostate SBRT.</div></div><div><h3>Results</h3><div>Thirty-three records (45 % prospective) encompassing 9949 patients were included. SBRT dose ranged from 32–50 Gy in 4–5 fractions and overall median follow-up time (range) was 41 (15–74) months. Use of androgen deprivation therapy ranged from 0–38 %. SBRT was characterized by a steep initial decline of PSA, slowing down over time and ultimately yielding a lower nadir in comparison with conventional radiotherapy, with a median value (range) of 0.24 (0.1–0.6) ng/mL after a median time (range) of 33.1 (6–54) months. There was an inverse correlation between the highest SBRT dose in a trial and PSA nadir (<em>r</em> = − 0.59; <em>p</em> < 0.001). Benign PSA bounce occurred in 30 % of patients across all studies, after a median time (range) of 14.8 (9–36) months and with a median size (range) of 0.5 (0.3–1.1) ng/mL. There was no significant correlation between bounce and dose, nadir nor biochemical failure. There was, however, a significant inverse correlation between ADT use and PSA bounce frequency (<em>r</em> = −0.49; <em>p</em> = 0.046).</div></div><div><h3>Conclusion</h3><div>PSA kinetics and dynamics after SBRT for localized prostate cancer are different from those in other established radiotherapy modalities. Benign PSA bounce is very common. Clinicians should be aware of these factors and patients should be counseled accordingly, preventing unnecessary distress or salvage treatment.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110642"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.radonc.2024.110643
Emma Skarsø Buhl , Lasse Hindhede Refsgaard , Sami Aziz-Jowad Al-Rawi , Karen Andersen , Martin Berg , Kristian Boye , Ingelise Jensen , Ebbe Laugaard Lorenzen , Else Maae , Maja Vestmø Maraldo , Louise Wichmann Matthiessen , Marie Louise Milo , Mette Holck Nielsen , Abhilasha Saini , Esben Yates , Birgitte Vrou Offersen , Stine Sofia Korreman
Background and purpose
In this study, we conducted a population-based retrospective audit of heart doses for high-risk breast cancer (BC) over a nine-year period in patients treated with adjuvant CT-based radiotherapy in a comprehensive and homogenized national BC cohort. Additionally, this serves as a demonstration of performing large scale audits with consistent delineations created by an auto-segmentation tool.
Materials and methods
High-risk BC patients treated with adjuvant radiotherapy in the period 2008–2016 from all seven radiotherapy centres in Denmark were included. A homogenized cohort was created using an inhouse developed auto-segmentation tool. The homogenized cohort volume and planned doses (mean heart dose (MHD), V20Gy and V40Gy) were evaluated. Volumes and dose metrics were compared for clinical and homogenized heart volumes.
Results
Among 6925 patients, 5589(81 %) had a clinical heart delineation. The median delineated heart volume increased from 531.9 ml (2008) to 638.5 ml (2016) (p < 0.01). The median MHD for the homogenized cohort was 1.58 Gy (2008–2016) with an overall decreasing trend, 2.14 Gy in left- and 1.08 Gy in right-sided patients. The median MHD in the clinically delineated hearts was 0.01 Gy lower than the planned median MHD in the homogenized cohort.
Conclusion
During 2008–2016 the planned heart dose has been low across the population. A volume increase was observed in the clinically delineated hearts, however the median MHD in the homogenized cohort was low, with 1.58 Gy. The study demonstrated the possibilities for full population-based and consistent dose audit by using auto-segmentation tools.
{"title":"Population based audit of heart radiation doses in 6925 high-risk breast cancer patients from the Danish breast cancer group RT Nation study","authors":"Emma Skarsø Buhl , Lasse Hindhede Refsgaard , Sami Aziz-Jowad Al-Rawi , Karen Andersen , Martin Berg , Kristian Boye , Ingelise Jensen , Ebbe Laugaard Lorenzen , Else Maae , Maja Vestmø Maraldo , Louise Wichmann Matthiessen , Marie Louise Milo , Mette Holck Nielsen , Abhilasha Saini , Esben Yates , Birgitte Vrou Offersen , Stine Sofia Korreman","doi":"10.1016/j.radonc.2024.110643","DOIUrl":"10.1016/j.radonc.2024.110643","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In this study, we conducted a population-based retrospective audit of heart doses for high-risk breast cancer (BC) over a nine-year period in patients treated with adjuvant CT-based radiotherapy in a comprehensive and homogenized national BC cohort. Additionally, this serves as a demonstration of performing large scale audits with consistent delineations created by an auto-segmentation tool.</div></div><div><h3>Materials and methods</h3><div>High-risk BC patients treated with adjuvant radiotherapy in the period 2008–2016 from all seven radiotherapy centres in Denmark were included. A homogenized cohort was created using an inhouse developed auto-segmentation tool. The homogenized cohort volume and planned doses (mean heart dose (MHD), V20Gy and V40Gy) were evaluated. Volumes and dose metrics were compared for clinical and homogenized heart volumes.</div></div><div><h3>Results</h3><div>Among 6925 patients, 5589(81 %) had a clinical heart delineation. The median delineated heart volume increased from 531.9 ml (2008) to 638.5 ml (2016) (p < 0.01). The median MHD for the homogenized cohort was 1.58 Gy (2008–2016) with an overall decreasing trend, 2.14 Gy in left- and 1.08 Gy in right-sided patients. The median MHD in the clinically delineated hearts was 0.01 Gy lower than the planned median MHD in the homogenized cohort.</div></div><div><h3>Conclusion</h3><div>During 2008–2016 the planned heart dose has been low across the population. A volume increase was observed in the clinically delineated hearts, however the median MHD in the homogenized cohort was low, with 1.58 Gy. The study demonstrated the possibilities for full population-based and consistent dose audit by using auto-segmentation tools.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110643"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-16DOI: 10.1016/j.radonc.2024.110640
Martin C. Tom , Seema Nagpal , Joshua D. Palmer , William G. Breen , Erqi L. Pollom , Eric J. Lehrer , Tresa M. McGranahan , Kevin Shiue , Anupama Chundury , Shearwood McClelland III , Hina Saeed , Eric L. Chang , Veronica L.S. Chiang , Tony J.C. Wang , Jonathan P.S. Knisely , Samuel T. Chao , Michael T. Milano
The ARS brain committee recommends that vorasidenib may be appropriate for recurrent or residual IDH-mutant grade 2 oligodendroglioma or astrocytoma. Vorasidenib is usually not appropriate for completely resected grade 2 oligodendroglioma or astrocytoma, any grade 3 oligodendroglioma or astrocytoma, or combined with radiotherapy and/or chemotherapy for any grade 2–3 glioma.
{"title":"An update to the American Radium Society’s appropriate use criteria of lower grade gliomas: Integration of IDH inhibitors","authors":"Martin C. Tom , Seema Nagpal , Joshua D. Palmer , William G. Breen , Erqi L. Pollom , Eric J. Lehrer , Tresa M. McGranahan , Kevin Shiue , Anupama Chundury , Shearwood McClelland III , Hina Saeed , Eric L. Chang , Veronica L.S. Chiang , Tony J.C. Wang , Jonathan P.S. Knisely , Samuel T. Chao , Michael T. Milano","doi":"10.1016/j.radonc.2024.110640","DOIUrl":"10.1016/j.radonc.2024.110640","url":null,"abstract":"<div><div>The ARS brain committee recommends that vorasidenib <em>may be appropriate</em> for recurrent or residual IDH-mutant grade 2 oligodendroglioma or astrocytoma. Vorasidenib is <em>usually not appropriate</em> for completely resected grade 2 oligodendroglioma or astrocytoma, any grade 3 oligodendroglioma or astrocytoma, or combined with radiotherapy and/or chemotherapy for any grade 2–3 glioma.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110640"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668786","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 : 2024-11-16DOI: 10.1016/j.radonc.2024.110626
Jennifer Le Guévelou , Luca Nicosia , Pierre Blanchard , Flavien Ralite , Xavier Durand , Vincent Marchesi , Guilhem Roubaud , Paul Sargos
Seminoma is a highly curable disease; therefore, long-term morbidity of oncological treatment represents a crucial stake. In view of the considerable advances made in radiotherapy in the past decade, we aim to shed light on current and future strategies that hold promises for the management of stage II seminoma.
精原细胞瘤是一种高度可治愈的疾病；因此，肿瘤治疗的长期发病率关系重大。鉴于放射治疗在过去十年中取得了长足的进步，我们旨在阐明目前和未来有望治疗 II 期精索瘤的策略。
{"title":"Radiation therapy for stage IIA/IIB seminomas: Back to the future?","authors":"Jennifer Le Guévelou , Luca Nicosia , Pierre Blanchard , Flavien Ralite , Xavier Durand , Vincent Marchesi , Guilhem Roubaud , Paul Sargos","doi":"10.1016/j.radonc.2024.110626","DOIUrl":"10.1016/j.radonc.2024.110626","url":null,"abstract":"<div><div>Seminoma is a highly curable disease; therefore, long-term morbidity of oncological treatment represents a crucial stake. In view of the considerable advances made in radiotherapy in the past decade, we aim to shed light on current and future strategies that hold promises for the management of stage II seminoma.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110626"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668800","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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