Radiotherapy and Oncology最新文献_第9页

Systemic complement protein levels as biomarkers of chemoradiotherapy response in anal squamous cell carcinoma 全身补体蛋白水平作为肛门鳞状细胞癌放化疗反应的生物标志物。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-12-07 DOI: 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.

背景：确定易于测量的生物标志物，能够预测放化疗（CRT）后的局部区域失败或疾病进展，将实现更个性化的癌症管理。肛门鳞状细胞癌（ASCC）是最常见的肛门癌类型，约占所有病例的90%。虽然CRT是大多数局部晚期肛门癌的标准治疗方法，但高达30%的患者出现治疗失败。然而，目前很难预测哪些患者对治疗没有反应，这突出了对预测性生物标志物的需求。本研究旨在评估血浆补体蛋白水平是否可以作为治疗反应的潜在生物标志物。材料和方法：收集ASCC患者（n = 40）在CRT之前，期间和之后的一系列外周血样本，以及6个月的临床和放射学结果。使用基于多重elisa的技术，我们在基线、CRT期间和CRT后3个 月评估了14种补体蛋白的水平。此外，同样的技术被用于比较ASCC和年龄和性别匹配的无癌症诊断患者的补体分析物水平。结果：我们的数据表明，CRT降低了大多数补体分析物的水平，在治疗后3 个月，特别是在那些获得完全缓解的患者中，完整的C2、完整的C3、完整的C5、C3a、C5a、Ba、Bb、SC5b9、因子D、因子H、因子I和因子P下降（所有P ）。结论：这些发现表明补体系统失调，特别是涉及替代途径，可能在治疗反应较差的患者中更为普遍。完整的C2和因子D可能是治疗失败的潜在标志。

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引用次数: 0

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 聚类剂量谱揭示了寡转移性头颈癌SABR后不同的局部控制概率：来自OMET II期试验质量保证过程的见解

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-12-04 DOI: 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.

背景立体定向消融放疗（SABR）越来越多地用于治疗少转移性疾病。然而，SABR计划的可变性引发了对SABR治疗病变（LC）局部控制影响的疑问。在OMET （GORTEC 2014-04）试验中，我们旨在探讨定量剂量学参数是否可以预测头颈部鳞状细胞癌（HNSCC）患者的LC。方法：somet是一项多中心随机II期试验，比较sabr单用与化疗联合sabr治疗≤3个pet证实的低转移灶患者的疗效。对69例患者的所有辐照病灶（N = 98）进行事后分析。从DICOM文件中提取20个空间和剂量学指标，以及常规指标，包括Dmin、Dmean、Dmax、总靶体积和均匀性/一致性指标。采用分层聚类方法鉴定计划质量表型。Kaplan-Meier分析评估了与LC的关联。结果尽管SABR对每个试验方案进行了标准化，但仍观察到剂量学参数和三个聚类的患者间差异。肿瘤内剂量异质性高且非最佳符合性的病变簇（N = 13）与LC显著改善相关。相比之下，更均匀和适形的表型与较差的LC有关（N = 14）。最大的星团（N = 69）没有明显的特征，具有中度LC。结论：在低转移性HNSCC的SABR中，肿瘤内剂量异质性可能比严格的一致性更能预测LC，特别是在高剂量/分数方案中。在SABR质量保证框架内，除了单独的二元专家审查之外，还可以进一步探索使用复合剂量计量的无监督聚类的定量、基于表型的机器学习方法。

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引用次数: 0

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 ESTRO-ISRS对脊柱转移灶立体定向放射治疗再照射的临床实践建议：系统回顾和荟萃分析支持德尔菲共识。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-12-02 DOI: 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.

背景：立体定向放射治疗（SBRT）是先前未放疗的脊柱转移的一种既定治疗方法；然而，关于SBRT作为再照射补救性治疗的文献有限。我们进行了系统回顾和荟萃分析，作为ESTRO-ISRS联合临床实践推荐的脊髓转移性SBRT的基础。方法：采用PRISMA方法进行系统回顾和荟萃分析，包括2006年1月至2024年9月的出版物，报告 ≥ 5例脊柱SBRT再照射（每分数≥5 Gy）治疗椎体转移的临床结果。这些数据作为ESTRO-ISRS联合临床实践建议的基础。结果：经过最初的文章筛选，20项研究（5项前瞻性研究，15项回顾性研究）符合纳入标准。1284例患者共治疗了1538例脊柱转移瘤。既往常规放疗10次中位再照射剂量为30 Gy，再照射剂量中位为2次24 Gy（范围：16-30 Gy， 1-5次）。椎骨压缩性骨折、神经根损伤和脊髓病事件的合并比例分别为5.0 %、5.6 %和1.7 %。中位随访时间为12 个月，1年和2年总LC率分别为81 %（95 % CI: 77-86 %）和70 %（95 % CI: 61-79 %）。尽管证据水平较低，但在第一轮投票后，对11项实践建议达成了共识，这表明专家之间达成了相当程度的一致。结论：在先前的常规放疗或SBRT之后再用SBRT治疗脊柱转移是有效、安全的，并且在适当选择的患者中是一种推荐的治疗选择。代表ESTRO和ISRS提供联合实践建议，以指导临床实践。

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引用次数: 0

Acute toxicity and quality of life after 5-fraction versus 15-fraction adjuvant radiotherapy following conventional or oncoplastic breast-conserving surgery − a real-world prospective cohort study 常规或癌性保乳手术后5分次和15分次辅助放疗的急性毒性和生活质量——一项现实世界前瞻性队列研究

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-30 DOI: 10.1016/j.radonc.2025.111310

Dieuwke R. Mink van der Molen , Marilot C.T. Batenburg , Tanja van ’t Westeinde , Antonetta C. Houweling , Wies Maarse , Karolien Verhoeven , Jennifer Strijbos , Lars Murrer , Sabine Siesling , Evelyn M. Monninkhof , Helena M. Verkooijen , Liesbeth J. Boersma , Femke van der Leij , UMBRELLA study group

Background and purpose

The FAST-Forward trial demonstrated that 26 Gy in 5 fractions for whole breast irradiation (WBI) has similar outcomes as 40 Gy in 15 fractions. Since radiation treatment plans in the Netherlands in general deliver higher target doses, we aimed to compare acute toxicity and quality of life of the adjuvant 26 Gy and the 40 Gy schedules in a real-world setting, including after oncoplastic surgery.

Materials and methods

Eligible were women ≥50 years with breast cancer receiving WBI or partial breast irradiation (PBI) between 2018 and 2023 in two Dutch centres, with either 26 Gy/5 fractions in 1 week or 40 Gy/15 fractions in 3 weeks. Acute toxicity was assessed using CTCAE v5.0 during and ≤ 4 weeks following radiotherapy. Patient-reported outcomes were evaluated using EORTC-QLQ-C30/BR23 prior to radiotherapy, at 3 months and 1 year post-radiotherapy.

Results

In total, 832 patients received 26 Gy/5 fractions (70.2% WBI, 12.9% oncoplastic surgery) and 845 patients 40 Gy/15 fractions (81.9% WBI, 14.2% oncoplastic surgery). For WBI and PBI, grade ≥ 1 dermatitis and fatigue were less common after 26 Gy than 40 Gy: 61–67 % versus 86–91% and 42–43% versus 56% respectively (p < 0.001–0.005). After oncoplastic surgery, 26 Gy patients less often experienced grade ≥ 1 dermatitis than 40 Gy patients (77% vs 94%, p < 0.001). At 3 months and 1-year post-radiotherapy, 26 Gy and 40 Gy patients reported comparable patient-reported outcomes.

Conclusion

We confirmed the safety of the 26 Gy/5 fractions schedule in terms of acute toxicity and quality of life compared to the 40 Gy/15 fractions schedule, also when treated with higher target coverage and following oncoplastic breast-conserving surgery.

背景和目的：FAST-Forward试验表明，全乳照射（WBI）的5次剂量26 Gy与15次剂量40 Gy的效果相似。由于荷兰的放射治疗计划通常提供更高的目标剂量，我们的目的是在现实环境中，包括肿瘤整形手术后，比较26 Gy和40 Gy辅助方案的急性毒性和生活质量。材料和方法：符合条件的是在2018年至2023年期间在两个荷兰中心接受WBI或部分乳房照射（PBI）的≥50 岁乳腺癌妇女，在1 周内接受26 Gy/5分数或在3 周内接受40 Gy/15分数。放疗期间及放疗后 ≤ 4周采用CTCAE v5.0评价急性毒性。在放疗前，放疗后3 个月和1 年，使用EORTC-QLQ-C30/BR23评估患者报告的结果。结果：832例患者接受了26次 Gy/5（70.2 % WBI， 12.9 %肿瘤整形手术），845例患者接受了40次 Gy/15（81.9 % WBI， 14.2 %肿瘤整形手术）。WBI和PBI 年级≥1 皮炎和疲劳后被不太常见的26比40 Gy Gy: 86 - 91 61 - 67 %与 %和42-43 分别%和56 % (p 结论:我们确认26 Gy / 5分数的安全安排的急性毒性和生活质量相比40 Gy / 15分数时间表,也当处理更高目标覆盖率和oncoplastic后手术。

{"title":"Acute toxicity and quality of life after 5-fraction versus 15-fraction adjuvant radiotherapy following conventional or oncoplastic breast-conserving surgery − a real-world prospective cohort study","authors":"Dieuwke R. Mink van der Molen , Marilot C.T. Batenburg , Tanja van ’t Westeinde , Antonetta C. Houweling , Wies Maarse , Karolien Verhoeven , Jennifer Strijbos , Lars Murrer , Sabine Siesling , Evelyn M. Monninkhof , Helena M. Verkooijen , Liesbeth J. Boersma , Femke van der Leij , UMBRELLA study group","doi":"10.1016/j.radonc.2025.111310","DOIUrl":"10.1016/j.radonc.2025.111310","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The FAST-Forward trial demonstrated that 26 Gy in 5 fractions for whole breast irradiation (WBI) has similar outcomes as 40 Gy in 15 fractions. Since radiation treatment plans in the Netherlands in general deliver higher target doses, we aimed to compare acute toxicity and quality of life of the adjuvant 26 Gy and the 40 Gy schedules in a real-world setting, including after oncoplastic surgery.</div></div><div><h3>Materials and methods</h3><div>Eligible were women ≥50 years with breast cancer receiving WBI or partial breast irradiation (PBI) between 2018 and 2023 in two Dutch centres, with either 26 Gy/5 fractions in 1 week or 40 Gy/15 fractions in 3 weeks. Acute toxicity was assessed using CTCAE v5.0 during and ≤ 4 weeks following radiotherapy. Patient-reported outcomes were evaluated using EORTC-QLQ-C30/BR23 prior to radiotherapy, at 3 months and 1 year post-radiotherapy.</div></div><div><h3>Results</h3><div>In total, 832 patients received 26 Gy/5 fractions (70.2% WBI, 12.9% oncoplastic surgery) and 845 patients 40 Gy/15 fractions (81.9% WBI, 14.2% oncoplastic surgery). For WBI and PBI, grade ≥ 1 dermatitis and fatigue were less common after 26 Gy than 40 Gy: 61–67 % versus 86–91% and 42–43% versus 56% respectively (p < 0.001–0.005). After oncoplastic surgery, 26 Gy patients less often experienced grade ≥ 1 dermatitis than 40 Gy patients (77% vs 94%, p < 0.001). At 3 months and 1-year post-radiotherapy, 26 Gy and 40 Gy patients reported comparable patient-reported outcomes.</div></div><div><h3>Conclusion</h3><div>We confirmed the safety of the 26 Gy/5 fractions schedule in terms of acute toxicity and quality of life compared to the 40 Gy/15 fractions schedule, also when treated with higher target coverage and following oncoplastic breast-conserving surgery.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111310"},"PeriodicalIF":5.3,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Quality of life and late toxicity after total neoadjuvant treatment for locally advanced rectal cancer – LARCT-US 局部晚期直肠癌新辅助治疗后的生活质量和晚期毒性——LARCT-US

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-28 DOI: 10.1016/j.radonc.2025.111318

Israa Imam , Tanweera Khan , Per J Nilsson , Bengt Glimelius

Introduction

Total neoadjuvant therapy (TNT) is increasingly used to treat locally advanced rectal cancer (LARC) due to more complete responses and fewer systemic recurrences. However, its impact on quality-of-life (QoL) or late toxicity remains under-investigated. This study evaluates this in a large real-world Swedish cohort treated with an abbreviated RAPIDO-TNT-protocol (LARCT-US).

Material and methods

In the prospective LARCT-US study, 273 LARC patients from 16 Swedish hospitals received short-course radiotherapy (5x5 Gy) followed by four cycles of CAPOX (or six cycles of mFOLFOX-6). An additional 189 patients who received similar treatment were included (ad modum LARCT-US, AdmL). QoL was assessed three years post-treatment using EORTC QLQ-C30, QLQ-CR29 and bowel function using the LARS-score. Physician-reported grade 3+ late toxicity was recorded at three- and five-years follow-up.

Results

Of curatively treated recurrence-free LARCT-US patients, 144/176 (82%) were included in the QoL assessment. Global health score (GHS) and all functioning scores were high (mean 73 and ∼86, respectively). Flatulence, urinary frequency, and fatigue were the most commonly reported symptoms. LARS was present in 79% of patients (n = 42/53), with 47% experiencing major LARS. Grade 3+ late toxicity occurred in 12% (n = 33/265) of LARCT-US/AdmL patients after three years and in 8% (n = 16/254) after five years. Patients with late toxicity reported worse scores for GHS, fatigue, dysuria, financial difficulties, and role and social functioning.

Conclusions

An abbreviated TNT schedule, compared with the RAPIDO-study, used in LARCT-US, achieves favourable oncological outcomes with low risk of late toxicity, and an acceptable QoL similar to other less effective neoadjuvant treatments.

全新辅助治疗（TNT）越来越多地用于局部晚期直肠癌（LARC）的治疗，因为其更完全的反应和更少的全身复发。然而，其对生活质量（QoL）或晚期毒性的影响仍未得到充分研究。本研究在一个大型现实世界瑞典队列中进行了简短的rapido - tnt协议（LARCT-US）的评估。材料和方法：在前瞻性LARCT-US研究中，来自瑞典16家医院的273名LARC患者接受了短期放疗（5x5 Gy），随后接受了4个周期的CAPOX（或6个周期的mFOLFOX-6）。另外189名接受类似治疗的患者被纳入研究（LARCT-US, AdmL）。使用EORTC QLQ-C30、QLQ-CR29评估治疗后3年的生活质量，使用lars评分评估肠道功能。医生报告的3级 + 晚期毒性在3年和5年随访中记录。结果：在治愈无复发的LARCT-US患者中，144/176（82% %）被纳入QoL评估。总体健康评分（GHS）和所有功能评分都很高（平均分别为73分和 ~ 86分）。肠胃胀气、尿频和疲劳是最常见的症状。79% %的患者出现LARS (n = 42/53)，其中47% %的患者出现重度LARS。3级 + 晚期毒性发生在12 % （n = 33/265）的LARCT-US/AdmL患者中，5年后发生在8 % （n = 16/254）的患者中。晚期毒性患者报告GHS、疲劳、排尿困难、经济困难、角色和社会功能评分较差。结论：与LARCT-US中使用的rapido研究相比，缩短的TNT计划获得了良好的肿瘤学结果，晚期毒性风险低，生活质量与其他效果较差的新辅助治疗相似。

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引用次数: 0

Impact of dose and dose-averaged linear energy transfer on oro-pharyngeal-mucosal toxicity in patients with non-squamous head and neck cancers treated with carbon-ion radiotherapy 剂量和剂量平均线性能量转移对接受碳离子放疗的非鳞状头颈癌患者口咽粘膜毒性的影响

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-28 DOI: 10.1016/j.radonc.2025.111314

Ankita Nachankar , Joanna Gora , Mansure Schafasand , Martina Fuß , Eugen Hug , Antonio Carlino , Carola Lütgendorf-Caucig , Markus Stock , Piero Fossati

Background

In head and neck carbon-ion radiotherapy (CIRT), high dose-averaged LET (LETd) and relative biological effectiveness weighted dose (D_RBE) often overlap the oro-pharyngeal-mucosa (mucosa of oral cavity, oro-pharynx, nasopharynx, pharynx) beyond the target, resulting in serious complications. We investigated clinical and dosimetric predictors for late severe mucosal-toxicity/ oro-antral fistula (OAF) post-CIRT.

Materials and methods

CIRT plans for 51 patients with non-squamous head and neck cancers (NSHNCs) were evaluated and correlated with clinical outcome. Prescription was D_RBE of 68.8 Gy (65.6–76.8)/16 fractions optimized using Local Effect Model-I (LEM-I). After the first 21 patients a mucosa-sparing approach (MS-CIRT) was adopted, delineating healthy mucosa-to-spare within the high-dose PTV and applying D_RBE constraints (D_RBE|0.1cm₃ < 70 Gy), maintaining target coverage. For the present analysis, D_RBE was recomputed also with the modified microdosimetric kinetic model (mMKM) and LETd was calculated. Several clinical and dosimetric parameters including DLV-parameters (61 Gy ≤ D_RBE ≤ 70 Gy, LETd ≥ 50 keV/µm, volume) that may be predictors of OAF were analyzed.

Results

MS-CIRT reduced mucosal doses to < 70 Gy, preserving local control (preliminary results in limited number of patients). Seven patients developed late G3 OAF after median follow-up of 23 months, including 2 with MS-CIRT. Doses to oro-pharyngeal mucosa > 70 Gy were predictive of OAF development. Even moderate-high doses correlated with OAF if they coincided with high-LETd. For instance, when more than 1 cm³ of mucosa-to-spare was exposed to D_RBE|mMKM ≥ 63 Gy and LETd ≥ 75 keV/µm, 2-yr OAF-free survival probability was 38 % versus 100 % in cases where these thresholds were not exceeded (p < 0.001). Sino-nasal primary and HD–CTV ≥ 100 cm³ also influenced OAF development.

Conclusion

Besides MS-CIRT strategy, optimizing DLV-parameters for oro-pharyngeal-mucosa may be a promising strategy in preventing late G3 OAF post-CIRT.

背景：在头颈部碳离子放疗（CIRT）中，高剂量平均LET （LETd）和相对生物有效性加权剂量（DRBE）经常重叠超出靶标的口腔-咽-粘膜（口腔、口腔-咽、鼻咽、咽粘膜），导致严重并发症。我们研究了cirt后晚期严重粘膜毒性/口-心房瘘（OAF）的临床和剂量学预测因素。材料和方法：对51例非鳞状头颈癌（NSHNCs）患者的CIRT计划进行评估，并与临床结果相关联。处方DRBE为68.8 Gy(65.6-76.8)/16个分数，采用局部效应模型i （LEM-I）优化。在前21例患者后，采用粘膜保留入路（MS-CIRT），划定高剂量PTV内的健康粘膜，并应用DRBE约束（DRBE|0.1 1cm3 ），并使用改进的微剂量动力学模型（mMKM）重新计算RBE，并计算LETd。一些临床和剂量测定的参数包括DLV-parameters(61 Gy ≤ DRBE ≤ 70 Gy, LETd ≥50  keV /µm,卷),可能是畸形儿的预测进行了分析。结果：MS-CIRT将黏膜剂量降低至70  Gy可预测OAF的发展。即使是中高剂量也与OAF相关，如果它们与高led同时发生的话。例如,当超过1 立方厘米的mucosa-to-spare被暴露在DRBE | mMKM ≥63  Gy和LETd ≥ 75 keV /µm, OAF-free时颁发新加坡莱佛士学院集团与生存概率是38 %与100 %在这些阈值的情况下不超过(p 3也影响畸形儿的发展。结论：除了MS-CIRT策略外，优化口腔-咽-粘膜dlv参数可能是预防cirt后晚期G3 OAF的一种有希望的策略。

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引用次数: 0

Patterns of lymphatic spread in hypopharyngeal squamous cell carcinoma – Findings from a multicenter study 下咽鳞状细胞癌的淋巴扩散模式——来自一项多中心研究的发现。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-28 DOI: 10.1016/j.radonc.2025.111319

Esmée L. Looman , Tineke W.H. van Zon-Meijer , Alexander Rühle , Henning Schäfer , Roman Ludwig , Yoel Pérez Haas , Johannes A Langendijk , Matthias Guckenberger , Panagiotis Balermpas , Jan Unkelbach

Introduction

Aiming for personalization of the elective nodal irradiation (ENI) in hypopharyngeal squamous cell carcinoma (SCC) patients, we describe the regional lymphatic spread patterns and risk of lymph node metastases, considering not only T-stage, location and lateralization of the primary tumor, but also involvement of adjacent lymph node levels (LNLs).

Materials and methods

Patients with newly diagnosed hypopharyngeal SCC diagnosed at University Hospital Zurich between 2013–2021, UMCG Groningen between 2006–2023 and University Medical Center Freiburg between 2011–2019 were analyzed. Lymphatic involvement per level was assessed based on imaging and, if available, pathology. The dataset is made publicly available and can be visualized on https://lyprox.org/.

Results

390 patients with hypopharyngeal SCC were included, 81 % had one or more cervical lymph node metastases. Overall prevalence of involvement in LNLs II, III, IV, V was consistent with literature: ipsilateral 65 %, 54 %, 23 %, 11 %; contralateral 25 %, 16 %, 6 %, 3 %. For lateralized tumors not affecting the midline (N = 143), contralateral involvement was 11 %, 4 %, 1 % 1 %. When contralateral LNL II was negative (N = 291), involvement of downstream LNLs III, IV, V was 5 %, 3 %, 1 %. Ipsilateral LNL IV involvement was reduced to 7 % in patients with negative LNL II and III. Ipsilateral level I and VII involvement was 6 % and 13 % in T4-tumors, but only 2 % and 3 % in T1–T3 tumors.

Conclusion

We provide detailed information about lymphatic spread patterns of hypopharyngeal SCC, where subgroups of patients may be identified in whom the ENI may be reduced. For lateralized tumors, contralateral irradiation may be limited to LNL II in patients without contralateral involvement.

简介：针对下咽鳞状细胞癌（SCC）患者择期淋巴结照射（ENI）的个体化，我们描述了区域淋巴扩散模式和淋巴结转移的风险，不仅考虑了原发肿瘤的t分期、位置和侧化，还考虑了邻近淋巴结水平（LNLs）的累及。材料与方法：分析2013-2021年苏黎世大学医院、2006-2023年格罗宁根UMCG和2011-2019年弗莱堡大学医学中心诊断的新诊断下咽鳞状细胞癌患者。每个级别的淋巴受累情况是根据影像学和病理来评估的。该数据集是公开的，可以在https://lyprox.org/.Results上看到：390名下咽SCC患者被纳入，81% %有一个或多个颈部淋巴结转移。LNLs II、III、IV、V受累的总体患病率与文献一致：同侧65 %，54 %,23 %,11 %；对侧25 %，16 %,6 %,3 %。对于不影响中线的侧边肿瘤（N = 143），对侧受累为11 %，4 %,1 % 1 %。当对侧LNL II阴性时（N = 291），下游LNL III、IV、V受累分别为5 %、3 %、1 %。LNL II和III阴性患者的同侧LNL IV受累减少到7% %。同侧I和VII级受累在t4级肿瘤中分别为6 %和13 %，而在T1-T3级肿瘤中仅为2 %和3 %。结论：我们提供了关于下咽鳞状细胞癌淋巴传播模式的详细信息，其中可以确定患者亚组，其中ENI可能会降低。对于偏侧肿瘤，对侧照射可能仅限于对侧未受援的LNL II。

{"title":"Patterns of lymphatic spread in hypopharyngeal squamous cell carcinoma – Findings from a multicenter study","authors":"Esmée L. Looman , Tineke W.H. van Zon-Meijer , Alexander Rühle , Henning Schäfer , Roman Ludwig , Yoel Pérez Haas , Johannes A Langendijk , Matthias Guckenberger , Panagiotis Balermpas , Jan Unkelbach","doi":"10.1016/j.radonc.2025.111319","DOIUrl":"10.1016/j.radonc.2025.111319","url":null,"abstract":"<div><h3>Introduction</h3><div>Aiming for personalization of the elective nodal irradiation (ENI) in hypopharyngeal squamous cell carcinoma (SCC) patients, we describe the regional lymphatic spread patterns and risk of lymph node metastases, considering not only T-stage, location and lateralization of the primary tumor, but also involvement of adjacent lymph node levels (LNLs).</div></div><div><h3>Materials and methods</h3><div>Patients with newly diagnosed hypopharyngeal SCC diagnosed at University Hospital Zurich between 2013–2021, UMCG Groningen between 2006–2023 and University Medical Center Freiburg between 2011–2019 were analyzed. Lymphatic involvement per level was assessed based on imaging and, if available, pathology. The dataset is made publicly available and can be visualized on <span><span>https://lyprox.org/</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>390 patients with hypopharyngeal SCC were included, 81 % had one or more cervical lymph node metastases. Overall prevalence of involvement in LNLs II, III, IV, V was consistent with literature: ipsilateral 65 %, 54 %, 23 %, 11 %; contralateral 25 %, 16 %, 6 %, 3 %. For lateralized tumors not affecting the midline (N = 143), contralateral involvement was 11 %, 4 %, 1 % 1 %. When contralateral LNL II was negative (N = 291), involvement of downstream LNLs III, IV, V was 5 %, 3 %, 1 %. Ipsilateral LNL IV involvement was reduced to 7 % in patients with negative LNL II and III.Ipsilateral level I and VII involvement was 6 % and 13 % in T4-tumors, but only 2 % and 3 % in T1–T3 tumors.</div></div><div><h3>Conclusion</h3><div>We provide detailed information about lymphatic spread patterns of hypopharyngeal SCC, where subgroups of patients may be identified in whom the ENI may be reduced. For lateralized tumors, contralateral irradiation may be limited to LNL II in patients without contralateral involvement.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111319"},"PeriodicalIF":5.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A prospective study using a spirometry-based system on the positional reproducibility of anatomical landmarks and tumour-tracking accuracy 一项前瞻性研究，使用基于肺活量计的系统对解剖标志的位置再现性和肿瘤跟踪准确性。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-27 DOI: 10.1016/j.radonc.2025.111315

Noriko Kishi , Yukinori Matsuo , Mitsuhiro Nakamura , Tomohiro Ono , Nobutaka Mukumoto , Hiraku Iramina , Yuta Sakurai , Norimasa Matsushita , Yusuke Tsuruta , Hideaki Hirashima , Makoto Sasaki , Takahiro Fujimoto , Yusuke Iizuka , Michio Yoshimura , Takashi Mizowaki

Purpose

This prospective study evaluated the positional reproducibility of anatomical landmarks and estimated planning target volume (PTV) margins using a spirometry-based system during deep inspiration breath-hold (DIBH), and evaluated the system’s potential as a surrogate for dynamic tumour tracking (DTT).

Patients and Methods

The study comprised two components, each involving 10 patients and utilising a spirometry-based system. Part A evaluated inter- and intra-fractional variations at 12 bronchial bifurcation landmarks and estimated PTV margins based on vertebral- and carina-based registrations. Part B assessed six 4D tumour position prediction models using varying ratios of spirometry- and surface-based inputs. The root-mean-square error (RMSE) was used to evaluate the prediction accuracy over two time intervals. For short-term evaluation, 20 s of data were used for model training, and the subsequent 50 s for validation. For long-term evaluation, a separate 70-second dataset was used.

Results

In Part A, mean inter- and intra-fractional variations across the 12 landmarks were 4.2 ± 2.0 mm and 2.9 ± 2.0 mm, respectively. PTV margins remained < 5 mm for both registrations, except in the superior-inferior direction of the left anteromedial segment. In Part B, no significant RMSE differences were observed in short-term predictions. For long-term predictions, the spirometry-only and combined-input models showed significantly lower RMSE than the surface-only model (P = 0.049 and P = 0.021, respectively).

Conclusions

Spirometry-based DIBH demonstrated acceptable positional reproducibility; however, individualised PTV margins may be necessary for specific regions. Spirometry-based prediction remained robust during free breathing, supporting its utility as a surrogate for DTT.

目的：本前瞻性研究评估了在深度吸气屏气（DIBH）期间使用基于肺活量计的系统的解剖标志和估计计划靶体积（PTV）边缘的位置可重复性，并评估了该系统作为动态肿瘤跟踪（DTT）替代品的潜力。患者和方法：该研究包括两个部分，每个部分涉及10名患者，并使用基于肺活量计的系统。A部分评估了12个支气管分支标志的分数间和分数内变化，并基于椎体和隆突的配准估计了PTV边缘。B部分评估了六个4D肿瘤位置预测模型，使用不同比例的肺活量测定和基于表面的输入。采用均方根误差（RMSE）对两个时间区间内的预测精度进行评价。对于短期评价，20 s的数据用于模型训练，随后的50 s用于验证。为了进行长期评估，我们使用了一个单独的70秒数据集。结果：在A部分中，12个地标的平均分数间和分数内变化分别为4.2 ± 2.0 mm和2.9 ± 2.0 mm。结论：基于肺活量计的DIBH具有可接受的位置重复性；然而，个别地区可能需要个性化的PTV边际。基于肺活量计的预测在自由呼吸期间保持稳健，支持其作为DTT替代品的实用性。

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引用次数: 0

Cumulative dose evaluation in clinical reirradiation – Consensus guidance on technical considerations by the ESTRO reirradiation focus group 临床再照射中的累积剂量评估。ESTRO再照射焦点小组关于技术考虑的共识指南。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-27 DOI: 10.1016/j.radonc.2025.111313

Ane L Appelt , Piotr Andrzejewski , Lone Hoffmann , Colin Kelly , Chrysanthi Michailidou , Donna H. Murrell , Christopher JH Pagett , Daniel Portik , Heidi S. Rønde , Monica Serban , Natasa Solomou , Christopher Thompson , Eliana Vasquez Osorio , Nicholas S West , Ali Zaila , Marija Popovic

Reirradiation is increasingly used, but its safe application requires accurate evaluation of cumulative doses to organs at risk. Methods of cumulative dose evaluation vary widely, from simple summation of prescription doses to complex three-dimensional (3D) dose summation methodologies, yet best practices remain undefined. This guidance, endorsed by the ESTRO Reirradiation Focus Group, provides detailed recommendations on the technical aspects of 3D dose summation; appropriate alternatives when it is unfeasible, suboptimal, or requires special considerations; and general guidance on uncertainty evaluation, resource management, and implications for treatment delivery. The writing group (n = 15) analysed scenarios ranging from full 3D dose summation to situations with incomplete data and unacceptable image registration, and developed recommendations through structured expert discussion and a two-step voting process. Key discussion points included: dose mapping (with rigid and deformable image registration), radiobiological corrections (particularly equieffective dose rescaling, such as EQD2Gy and BED), uncertainties, role of documentation, quality control, and peer review. Thirty-five statements reached consensus within both the writing group and the full ESTRO Physics Reirradiation Working Group (n = 34, 66 % response rate). Altogether, this guidance offers a practical framework for standardizing the technical aspects of cumulative dose evaluation to support clinical decision making and improve safety and effectiveness of reirradiation, while reducing institutional variability. It also highlights ongoing needs for research into advanced dose mapping, image registration, and integration of uncertainty analyses.

再照射的使用越来越多，但其安全应用需要对有危险器官的累积剂量进行准确评估。累积剂量评估方法差异很大，从简单的处方剂量总和到复杂的三维剂量总和方法，但最佳做法仍未确定。该指南经ESTRO再照射焦点小组批准，就3D剂量总和的技术方面提供了详细建议；当不可行、次优或需要特别考虑时，适当的替代方案；以及关于不确定性评估、资源管理和对治疗交付的影响的一般指导。撰写小组（n = 15）分析了从全3D剂量求和到数据不完整和图像配准不可接受的情况，并通过有组织的专家讨论和两步投票过程提出了建议。主要讨论点包括：剂量测绘（具有刚性和可变形的图像配准）、放射生物学校正（特别是等有效剂量重新标度，如EQD2Gy和BED）、不确定性、文件的作用、质量控制和同行评审。35份声明在写作小组和整个ESTRO物理再照射工作组达成了共识（n = 33,66 %响应率）。总之，本指南为标准化累积剂量评估的技术方面提供了一个实用框架，以支持临床决策，提高再照射的安全性和有效性，同时减少制度差异。它还强调了对高级剂量测绘、图像配准和不确定性分析集成研究的持续需求。

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引用次数: 0

International guidelines for the delineation of the postoperative clinical target volumes (CTV) for parotid and submandibular gland cancers 描述腮腺和颌下腺癌术后临床靶体积（CTV）的国际指南。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology

Pub Date : 2025-11-27 DOI: 10.1016/j.radonc.2025.111317

J. Biau , C. Nutting , J.A. Langendijk , J. Thariat , B. O’Sullivan , J. Cacicedo , P. Blanchard , N.Y. Lee , S. McBride , J.J. Caudell , D.I. Rosenthal , S.S. Yom , L. McDowell , M.L.K. Chua , J. Bourhis , V. Grégoire , M. Lapeyre

Background and purpose

Post-operative radiotherapy (PORT) for major salivary gland cancers increasingly relies on highly conformal techniques, making rigorous and reproducible clinical target volume (CTV) delineation essential. There are currently limited data to guide radiation oncologists with CTV delineation for PORT of parotid and submandibular gland cancers in the era of IMRT or IMPT.

Materials and methods

We formed an international panel to develop practical, consensus-based guidelines for peritumoral CTVs around the primary site (CTV-P) and for low-risk nodal CTVs (CTV-N-LR) in parotid and submandibular gland cancers. These guidelines are based on the natural history and extension pathways of these cancers, including local tumor spread, perineural invasion (PNI) risks and regional spread. We reviewed radiographic anatomy, natural history, and routes of tumor extension, including PNI. Agreement levels were categorized as high (≥85 %), moderate (70–84 %), or low (<70 %).

Results

Areas of variation and uncertainty in postoperative CTV delineation for parotid and submandibular gland cancers were identified. Through structured discussion and iterative voting, the panel converged on consensus statements that translate available evidence and expert practice into practical, harmonized recommendations.

Conclusion

These consensus guidelines offer a pragmatic framework for PORT CTV selection in parotid and submandibular gland cancers. They should be implemented with careful imaging-pathology correlation and multidisciplinary judgment, and adapted to patient-specific risk factors; areas of uncertainty warrant further study.

背景与目的：大涎腺癌的术后放疗（PORT）越来越依赖于高适形技术，这使得严格和可重复的临床靶体积（CTV）描绘至关重要。目前，在IMRT或IMPT时代，指导放射肿瘤学家对腮腺和颌下腺癌的PORT进行CTV划定的数据有限。材料和方法：我们成立了一个国际小组，为腮腺和颌下腺癌原发部位周围瘤周ctv （CTV-P）和低风险淋巴结ctv （CTV-N-LR）制定实用的、基于共识的指南。这些指南是基于这些癌症的自然病史和扩展途径，包括局部肿瘤扩散、神经周围浸润（PNI）风险和区域扩散。我们回顾了放射学解剖、自然病史和肿瘤扩展途径，包括PNI。一致性水平分为高（≥85 %）、中（70-84 %）和低（结果：确定了腮腺癌和颌下腺癌术后CTV划定的变异和不确定区域）。通过有组织的讨论和反复的投票，小组达成了共识声明，将现有证据和专家实践转化为实际的、协调一致的建议。结论：这些共识指南为腮腺和颌下腺癌的PORT CTV选择提供了实用的框架。在实施时应仔细考虑影像学与病理学的相关性和多学科的判断，并适应患者特定的危险因素；不确定的领域值得进一步研究。

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引用次数: 0