Pub Date : 2025-11-28DOI: 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.
{"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}
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.
{"title":"A prospective study using a spirometry-based system on the positional reproducibility of anatomical landmarks and tumour-tracking accuracy","authors":"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","doi":"10.1016/j.radonc.2025.111315","DOIUrl":"10.1016/j.radonc.2025.111315","url":null,"abstract":"<div><h3>Purpose</h3><div>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).</div></div><div><h3>Patients and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111315"},"PeriodicalIF":5.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638131","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 : 2025-11-27DOI: 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.
{"title":"Cumulative dose evaluation in clinical reirradiation – Consensus guidance on technical considerations by the ESTRO reirradiation focus group","authors":"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","doi":"10.1016/j.radonc.2025.111313","DOIUrl":"10.1016/j.radonc.2025.111313","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111313"},"PeriodicalIF":5.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638126","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 : 2025-11-27DOI: 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.
{"title":"International guidelines for the delineation of the postoperative clinical target volumes (CTV) for parotid and submandibular gland cancers","authors":"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","doi":"10.1016/j.radonc.2025.111317","DOIUrl":"10.1016/j.radonc.2025.111317","url":null,"abstract":"<div><h3>Background and purpose</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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 %).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111317"},"PeriodicalIF":5.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638112","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 : 2025-11-27DOI: 10.1016/j.radonc.2025.111301
Szeyi Ng , Anna M. Kirby , Lucy S. Kilburn , Clare Griffin , Mark Sydenham , Lisa Lloyd , Cliona C. Kirwan , Monica Jefford , Isabel Syndikus , Judith M. Bliss , Charlotte E. Coles
Background and purpose
Long-term patient reported outcomes (PROs) from questionnaires are important to capture late adverse effects in breast cancer treatment. Declining return rates over time may introduce selection bias and reduce robustness of results. Using data from two trials which had collected data prospectively, we investigated factors associated with non-return of PROs at 5 years. We also investigated which questions were more likely missed in PROs.
Materials and methods
IMPORT HIGH (ISRCTN47437448) and IMPORT LOW (ISRCTN12852634) investigated different radiotherapy treatments for breast cancer patients with high and low ipsilateral breast tumour relapse risk respectively. Both trials had PRO sub-studies with similar design, using questionnaires such as EORTC QLQ-C30, QLQ-BR23 and Body Image Scale. We used univariable and multivariable logistic regressions for the analysis.
Results
The return rate for PROs was 99.5 % (1034/1039) at baseline and 81.4 % (766/941) at year 5, 100 % (1257/1257) and 84 % (974/1165) for IMPORT HIGH/LOW respectively. Participants with moderate/severe depression/anxiety at baseline were more likely to miss year-5 response: IMPORT HIGH 16 % with depression/anxiety, OR = 1.60, CI = [1.03–2.49]; IMPORT LOW 9 % with depression/anxiety, OR = 2.62, CI = [1.66–4.14]. In multivariable analysis, age, smoking status, depression/anxiety, and ethnicity were significant predictors of missing PRO returns in IMPORT HIGH while depression/anxiety, relationship status and deprivation in IMPORT LOW. Participants who missed sexual functioning questions initially were more likely to continue missing them (OR = 1.02, CI = [1.00–1.03] IMPORT HIGH; OR = 1.02, CI = [1.01–1.02] IMPORT LOW).
Conclusion
Participants who were younger, more deprived, smoked at baseline, had depression/anxiety may require targeted support to return PRO during follow-up. Sensitive questions need ‘Prefer not to say’ or ‘Not applicable’ options available and require further work to optimise wording.
{"title":"Baseline characteristics predicting lower return rates of missing patient-reported quality of life data over 5 years: evidence from the IMPORT HIGH and IMPORT LOW breast cancer radiotherapy trials","authors":"Szeyi Ng , Anna M. Kirby , Lucy S. Kilburn , Clare Griffin , Mark Sydenham , Lisa Lloyd , Cliona C. Kirwan , Monica Jefford , Isabel Syndikus , Judith M. Bliss , Charlotte E. Coles","doi":"10.1016/j.radonc.2025.111301","DOIUrl":"10.1016/j.radonc.2025.111301","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Long-term patient reported outcomes (PROs) from questionnaires are important to capture late adverse effects in breast cancer treatment. Declining return rates over time may introduce selection bias and reduce robustness of results. Using data from two trials which had collected data prospectively, we investigated factors associated with non-return of PROs at 5 years. We also investigated which questions were more likely missed in PROs.</div></div><div><h3>Materials and methods</h3><div>IMPORT HIGH (ISRCTN47437448) and IMPORT LOW (ISRCTN12852634) investigated different radiotherapy treatments for breast cancer patients with high and low ipsilateral breast tumour relapse risk respectively. Both trials had PRO sub-studies with similar design, using questionnaires such as EORTC QLQ-C30, QLQ-BR23 and Body Image Scale. We used univariable and multivariable logistic regressions for the analysis.</div></div><div><h3>Results</h3><div>The return rate for PROs was 99.5 % (1034/1039) at baseline and 81.4 % (766/941) at year 5, 100 % (1257/1257) and 84 % (974/1165) for IMPORT HIGH/LOW respectively. Participants with moderate/severe depression/anxiety at baseline were more likely to miss year-5 response: IMPORT HIGH 16 % with depression/anxiety, OR = 1.60, CI = [1.03–2.49]; IMPORT LOW 9 % with depression/anxiety, OR = 2.62, CI = [1.66–4.14]. In multivariable analysis, age, smoking status, depression/anxiety, and ethnicity were significant predictors of missing PRO returns in IMPORT HIGH while depression/anxiety, relationship status and deprivation in IMPORT LOW. Participants who missed sexual functioning questions initially were more likely to continue missing them (OR = 1.02, CI = [1.00–1.03] IMPORT HIGH; OR = 1.02, CI = [1.01–1.02] IMPORT LOW).</div></div><div><h3>Conclusion</h3><div>Participants who were younger, more deprived, smoked at baseline, had depression/anxiety may require targeted support to return PRO during follow-up. Sensitive questions need ‘Prefer not to say’ or ‘Not applicable’ options available and require further work to optimise wording.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111301"},"PeriodicalIF":5.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638163","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 : 2025-11-26DOI: 10.1016/j.radonc.2025.111312
C. Bang , H. Gautier , W.T. Le , A. Lalonde , G. Bernard , D. Markel , F. Nguyen-Tan , E. Filion , B. O’Sullivan , T. Ayad , A. Christopoulos , E. Bissada , L. Guertin , D. Soulières , L. Létourneau-Guillon , S. Kadoury , H. Bahig
Background and purpose
Head and neck cancer (HNC) radiotherapy (RT) is effective but causes significant toxicity. We aimed to develop a dynamic deep learning model to predict three major HNC RT toxicities—nasogastric (NG) tube placement, hospitalization, and radionecrosis—by integrating clinical data and daily cone-beam computed tomography (CBCTs), assessing whether serial imaging or dosimetry features improve early prediction.
Materials and methods
We retrospectively analyzed 1,012 HNC patients treated with RT between 2017 and 2022. A multibranch 3D ResNet50 and multilayer perceptron model was trained using 5-fold cross-validation. Inputs included anatomical deformations from daily CBCTs (converted to Jacobian determinant matrices, Jf), radiomics, and clinical variables (demographics, tumor and treatment details, early weight loss). Each toxicity was modeled using weighted binary cross-entropy loss to address class imbalance. Prediction at the 10th RT fraction was compared with and without Jf integration.
Results
The cohort was 78% male, median age was 63 years (range 35–84). Primary sites were mainly oropharynx (47%), larynx (19%), and oral cavity (16%). Concurrent chemoradiation was given to 57%, induction chemotherapy to 7%, and postoperative RT to 18% of patients. Incidences of NG tube, hospitalization, and radionecrosis were 16.6%, 4.2%, and 4.6%, respectively. Clinical features alone yielded highest predictive accuracy: 70% for NG tube, 67.3% for hospitalization, and 74.2% for radionecrosis. Early weight loss was the strongest predictor. Early Jf or radiomics did not improve performance. NG tube prediction accuracy improved with later RT fractions (up to 75% at fraction 25).
Conclusion
Clinical data combined with weight loss remains the most reliable early predictor of toxicity without added benefit from imaging data.
{"title":"Dynamic prediction of Radiotherapy toxicities in Head and neck cancer using clinical and imaging data","authors":"C. Bang , H. Gautier , W.T. Le , A. Lalonde , G. Bernard , D. Markel , F. Nguyen-Tan , E. Filion , B. O’Sullivan , T. Ayad , A. Christopoulos , E. Bissada , L. Guertin , D. Soulières , L. Létourneau-Guillon , S. Kadoury , H. Bahig","doi":"10.1016/j.radonc.2025.111312","DOIUrl":"10.1016/j.radonc.2025.111312","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Head and neck cancer (HNC) radiotherapy (RT) is effective but causes significant toxicity. We aimed to develop a dynamic deep learning model to predict three major HNC RT toxicities—nasogastric (NG) tube placement, hospitalization, and radionecrosis—by integrating clinical data and daily cone-beam computed tomography (CBCTs), assessing whether serial imaging or dosimetry features improve early prediction.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 1,012 HNC patients treated with RT between 2017 and 2022. A multibranch 3D ResNet50 and multilayer perceptron model was trained using 5-fold cross-validation. Inputs included anatomical deformations from daily CBCTs (converted to Jacobian determinant matrices, J<sub>f</sub>), radiomics, and clinical variables (demographics, tumor and treatment details, early weight loss). Each toxicity was modeled using weighted binary cross-entropy loss to address class imbalance. Prediction at the 10th RT fraction was compared with and without J<sub>f</sub> integration.</div></div><div><h3>Results</h3><div>The cohort was 78% male, median age was 63 years (range 35–84). Primary sites were mainly oropharynx (47%), larynx (19%), and oral cavity (16%). Concurrent chemoradiation was given to 57%, induction chemotherapy to 7%, and postoperative RT to 18% of patients. Incidences of NG tube, hospitalization, and radionecrosis were 16.6%, 4.2%, and 4.6%, respectively. Clinical features alone yielded highest predictive accuracy: 70% for NG tube, 67.3% for hospitalization, and 74.2% for radionecrosis. Early weight loss was the strongest predictor. Early J<sub>f</sub> or radiomics did not improve performance. NG tube prediction accuracy improved with later RT fractions (up to 75% at fraction 25).</div></div><div><h3>Conclusion</h3><div>Clinical data combined with weight loss remains the most reliable early predictor of toxicity without added benefit from imaging data.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111312"},"PeriodicalIF":5.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638184","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}
We aimed to analyze the data from the Japan Association for Radiation Oncology Particle Beam Therapy Committee’s prospective registration database to evaluate the clinical efficacy and safety of concurrent chemo-proton therapy (CCPT) for unresectable stage III non-small cell lung cancer (NSCLC).
Materials and methods
The data of patients with histologically confirmed unresectable stage III NSCLC who received CCPT between May 2016 and June 2020 were extracted. Dose fractionation within the unified standard of 60–74 Gy relative biological effectiveness over 30–37 fractions and irradiation range to lymph node regions was determined at the discretion of the attending radiation oncologists. Immune checkpoint inhibitor (ICI) as adjuvant therapy was mostly administered after the provision of insurance coverage in August 2018. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0.
Results
A total of 170 patients were enrolled, of whom 156 met the eligibility criteria, including 10 patients (6.4 %) with interstitial pneumonia and 31 patients (20 %) who were ineligible for definitive chemo-radiation using x-rays due to exceeding normal dose constraints. Sixty-six patients (42 %) received ICI as adjuvant therapy. The median follow-up duration was 49.0 months, 2 and 5-year overall survivals were 72.9 % (95 % confidence interval: 66.2–80.4) and 43.7 % (35.8–53.3), and 2 and 5-year progression-free survivals were 35.4 % (28.5–43.8) and 21.3 % (15.0–30.1), respectively. Grade 2 or 3 radiation pneumonitis was observed in 19.9 % and 3.2 % of the patients, respectively, and there were no grade ≥ 4 late toxicities. In the 31 patients who were not eligible for definitive chemo-radiation using x-rays, the 2 and 5-year overall survivals were 58.1 % (43.1–78.3) and 27.5 % (14.2–53.4), respectively.
Conclusion
CCPT for unresectable stage III NSCLC is considered safe and effective. Definitive treatment was possible even in patients who were not eligible for photon thoracic radiotherapy.
{"title":"Long-term outcomes of concurrent chemo-proton therapy for unresectable stage III non-small cell lung cancer: a Japanese national registry study","authors":"Hiromitsu Iwata , Masao Murakami , Kazushi Maruo , Masaki Nakamura , Takahiro Waki , Masatoshi Nakamura , Hiroshi Taguchi , Kazuya Inoue , Masayuki Araya , Hitoshi Tatebe , Miyako Satouchi , Kimihiro Shimizu , Takayuki Hashimoto , Hideyuki Harada","doi":"10.1016/j.radonc.2025.111307","DOIUrl":"10.1016/j.radonc.2025.111307","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We aimed to analyze the data from the Japan Association for Radiation Oncology Particle Beam Therapy Committee’s prospective registration database to evaluate the clinical efficacy and safety of concurrent chemo-proton therapy (CCPT) for unresectable stage III non-small cell lung cancer (NSCLC).</div></div><div><h3>Materials and methods</h3><div>The data of patients with histologically confirmed unresectable stage III NSCLC who received CCPT between May 2016 and June 2020 were extracted. Dose fractionation within the unified standard of 60–74 Gy relative biological effectiveness over 30–37 fractions and irradiation range to lymph node regions was determined at the discretion of the attending radiation oncologists. Immune checkpoint inhibitor (ICI) as adjuvant therapy was mostly administered after the provision of insurance coverage in August 2018. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0.</div></div><div><h3>Results</h3><div>A total of 170 patients were enrolled, of whom 156 met the eligibility criteria, including 10 patients (6.4 %) with interstitial pneumonia and 31 patients (20 %) who were ineligible for definitive chemo-radiation using x-rays due to exceeding normal dose constraints. Sixty-six patients (42 %) received ICI as adjuvant therapy. The median follow-up duration was 49.0 months, 2 and 5-year overall survivals were 72.9 % (95 % confidence interval: 66.2–80.4) and 43.7 % (35.8–53.3), and 2 and 5-year progression-free survivals were 35.4 % (28.5–43.8) and 21.3 % (15.0–30.1), respectively. Grade 2 or 3 radiation pneumonitis was observed in 19.9 % and 3.2 % of the patients, respectively, and there were no grade ≥ 4 late toxicities. In the 31 patients who were not eligible for definitive chemo-radiation using x-rays, the 2 and 5-year overall survivals were 58.1 % (43.1–78.3) and 27.5 % (14.2–53.4), respectively.</div></div><div><h3>Conclusion</h3><div>CCPT for unresectable stage III NSCLC is considered safe and effective. Definitive treatment was possible even in patients who were not eligible for photon thoracic radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111307"},"PeriodicalIF":5.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638134","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 : 2025-11-26DOI: 10.1016/j.radonc.2025.111309
Marcus Tyyger , Zsuzsanna Iyizoba-Ebozue , Emma Nicklin , Florien Boele , John Lilley , Louise Murray , Eliana Vasquez Osorio
Background
Radiotherapy is standard of care for oropharyngeal cancer (OPC) but it has been associated with neurocognitive issues, fatigue, and mood disturbances. Voxel-based analysis (VBA) was used to correlate dose and late radiotherapy effects on a fine-grained, voxel-level, without pre-defined regions.
Method
A multicentre cross-sectional study, including patients from two tertiary radiotherapy centres: Leeds Cancer Centre (Centre A) and The Christie NHS Foundation Trust, Manchester (Centre B). Patient-reported outcomes for cognitive complaints (Medical Outcomes Study Cognitive Functioning Scale), fatigue (Multidimensional Fatigue Inventory), and mood (Profile of Mood States short form) were administered at least 2 years after treatment. VBA using cross-centre validated software, and three publically available reference CTs, was performed on: single centre only subgroups, and one combined cohort. Regions of significance were clinically reviewed and investigated using dose-volume histogram (DVH) analysis.
Results
273 patients treated for OPC (Centre A: 118, Centre B: 155) were included, with significant inter-centre differences observed in age, T-stage, N-stage, and dose/fractionation. Dose to the identified cerebellar region differed between centres, with median equivalent dose in 2 Gy fractions (α/β = 3 Gy) of 6.8 Gy for Centre A and 10.2 Gy for Centre B. Correlations of dose with mood disturbance and fatigue within regions of the right-posterior cerebellum were identified for centre B only.
Conclusion
There are potential positive associations between right-posterior cerebellum dose with late mood disturbance and fatigue, including potential dose–effect thresholds and cerebella sensitivity to dose per fraction. Further research is needed to clarify these findings, and to establish causality.
{"title":"Associations between patient-reported neurocognition, mood, and fatigue and radiation dose in oropharyngeal cancer survivors","authors":"Marcus Tyyger , Zsuzsanna Iyizoba-Ebozue , Emma Nicklin , Florien Boele , John Lilley , Louise Murray , Eliana Vasquez Osorio","doi":"10.1016/j.radonc.2025.111309","DOIUrl":"10.1016/j.radonc.2025.111309","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy is standard of care for oropharyngeal cancer (OPC) but it has been associated with neurocognitive issues, fatigue, and mood disturbances. Voxel-based analysis (VBA) was used to correlate dose and late radiotherapy effects on a fine-grained, voxel-level, without pre-defined regions.</div></div><div><h3>Method</h3><div>A multicentre cross-sectional study, including patients from two tertiary radiotherapy centres: Leeds Cancer Centre (Centre A) and The Christie NHS Foundation Trust, Manchester (Centre B). Patient-reported outcomes for cognitive complaints (Medical Outcomes Study Cognitive Functioning Scale), fatigue (Multidimensional Fatigue Inventory), and mood (Profile of Mood States short form) were administered at least 2 years after treatment. VBA using cross-centre validated software, and three publically available reference CTs, was performed on: single centre only subgroups, and one combined cohort. Regions of significance were clinically reviewed and investigated using dose-volume histogram (DVH) analysis.</div></div><div><h3>Results</h3><div>273 patients treated for OPC (Centre A: 118, Centre B: 155) were included, with significant inter-centre differences observed in age, T-stage, N-stage, and dose/fractionation. Dose to the identified cerebellar region differed between centres, with median equivalent dose in 2 Gy fractions (α/β = 3 Gy) of 6.8 Gy for Centre A and 10.2 Gy for Centre B. Correlations of dose with mood disturbance and fatigue within regions of the right-posterior cerebellum were identified for centre B only.</div></div><div><h3>Conclusion</h3><div>There are potential positive associations between right-posterior cerebellum dose with late mood disturbance and fatigue, including potential dose–effect thresholds and cerebella sensitivity to dose per fraction. Further research is needed to clarify these findings, and to establish causality.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111309"},"PeriodicalIF":5.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638172","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 : 2025-11-25DOI: 10.1016/j.radonc.2025.111308
Robert Poel , Lucas Mose , Philipp Reinhardt , Michael Müller , Silvan Meuller , Mauricio Reyes , Sarah Brueningk , Peter Manser , Daniel M. Aebersold , Ekin Ermiş
Background and purpose
Manual delineation of target volumes in glioblastoma (GBM) radiotherapy (RT) is time-consuming and variable. This study evaluates the clinical applicability of a preliminary deep learning model (Neosoma Glioma) for automating gross tumor volume (GTV) segmentation in postoperative GBM per ESTRO-EANO guidelines.
Materials and methods
We retrospectively analyzed 100 GBM cases treated at Inselspital University Hospital, Bern (2016–2020) with standardized multi-modal MRI. Auto-segmented GTVs were compared to expert-defined contours using geometric metrics. Radiation oncologists reviewed and adjusted the best-performing configuration. Time savings, geometric similarity, and dosimetric impact were assessed.
Results
Optimal auto-segmentation (resection cavity plus enhancing tumor with 1 mm margin) achieved a mean Dice similarity coefficient of 0.79 (SD = 0.14) vs. ground truth. Manual adjustment took 5.9 (SD = 4.6) minutes vs. 12.3 (SD = 6.8) minutes for manual contouring (>50 % time reduction). The mean Dice between auto-segmented and adjusted GTVs was 0.84 (SD = 0.18). Dosimetric evaluation showed plans from adjusted auto-segmentations were equivalent to those based on consensus contours, with no clinically relevant differences in target coverage or organ-at-risk sparing.
Conclusion
The Neosoma Glioma model generates clinically useful postoperative GTV segmentations, with geometric performance comparable to expert variability and dosimetric equivalence to consensus contours. It reduces contouring time by over 50%, enabling faster RT workflows. Its consistency across diverse GBM presentations supports its practical value. AI-based segmentation can help standardize GBM target definition when integrated into RT planning with proper quality assurance.
{"title":"Evaluation of compartmentalized automatic segmentation for definition of the GTV in glioblastoma radiotherapy","authors":"Robert Poel , Lucas Mose , Philipp Reinhardt , Michael Müller , Silvan Meuller , Mauricio Reyes , Sarah Brueningk , Peter Manser , Daniel M. Aebersold , Ekin Ermiş","doi":"10.1016/j.radonc.2025.111308","DOIUrl":"10.1016/j.radonc.2025.111308","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Manual delineation of target volumes in glioblastoma (GBM) radiotherapy (RT) is time-consuming and variable. This study evaluates the clinical applicability of a preliminary deep learning model (Neosoma Glioma) for automating gross tumor volume (GTV) segmentation in postoperative GBM per ESTRO-EANO guidelines.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 100 GBM cases treated at Inselspital University Hospital, Bern (2016–2020) with standardized multi-modal MRI. Auto-segmented GTVs were compared to expert-defined contours using geometric metrics. Radiation oncologists reviewed and adjusted the best-performing configuration. Time savings, geometric similarity, and dosimetric impact were assessed.</div></div><div><h3>Results</h3><div>Optimal auto-segmentation (resection cavity plus enhancing tumor with 1 mm margin) achieved a mean Dice similarity coefficient of 0.79 (SD = 0.14) vs. ground truth. Manual adjustment took 5.9 (SD = 4.6) minutes vs. 12.3 (SD = 6.8) minutes for manual contouring (>50 % time reduction). The mean Dice between auto-segmented and adjusted GTVs was 0.84 (SD = 0.18). Dosimetric evaluation showed plans from adjusted auto-segmentations were equivalent to those based on consensus contours, with no clinically relevant differences in target coverage or organ-at-risk sparing.</div></div><div><h3>Conclusion</h3><div>The Neosoma Glioma model generates clinically useful postoperative GTV segmentations, with geometric performance comparable to expert variability and dosimetric equivalence to consensus contours. It reduces contouring time by over 50%, enabling faster RT workflows. Its consistency across diverse GBM presentations supports its practical value. AI-based segmentation can help standardize GBM target definition when integrated into RT planning with proper quality assurance.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111308"},"PeriodicalIF":5.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621158","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 : 2025-11-25DOI: 10.1016/j.radonc.2025.111306
Lukas Zimmermann, Barbara Knäusl, Johannes Knoth, Alina Sturdza, Vincent Dick, Tatevik Mrva-Ghukasyan, Inga-Malin Simek, Nicole Eder-Nesvacil, Dietmar Georg, Maximilian Schmid
Background and purpose:
Accurate gross tumor volume (GTV) delineation is critical for successful radiochemotherapy and image-guided adaptive brachytherapy (BT) in cervical cancer. This study investigated whether diffusion-weighted imaging (DWI) improves GTV delineation accuracy compared to T2-weighted (T2w) MRI alone, across different physician experience levels.
Materials and Methods:
Twenty-seven patients with locally advanced cervical carcinoma undergoing primary radiochemotherapy were analyzed. Six physicians (three experts, three residents) delineated GTVs at three time points: diagnosis (init), pre-brachytherapy (preBT), and pre-brachytherapy with applicator in situ (BT). Segmentations were performed using T2w images alone and T2w plus DWI (b=800 s mm-2) guidance. Expert consensus served as reference standard using STAPLE algorithm. Inter-observer agreement was assessed using conformity index, Dice-Sørensen coefficient, and Hausdorff distance.
Results:
DWI guidance significantly improved inter-observer agreement among experts at init (conformity index: 0.62 0.70, ) and BT (0.33 0.39, ) time points. For residents, DWI guidance enhanced agreement with expert consensus, particularly during BT, with significant improvements in Dice coefficient (median increase 9%, ) and reduced Hausdorff distance (median decrease 1.3 mm, ). Tumor volume correlation between preBT and BT time points improved with DWI guidance for both groups.
Conclusion:
Incorporating DWI into the segmentation workflow reduces inter-observer variability for both expert and resident radiation oncologists. DWI guidance particularly benefits less experienced physicians, enabling them to achieve contours closer to expert consensus standards through additional functional information.
背景与目的：准确的肿瘤总体积（GTV）描绘是宫颈癌放化疗和图像引导适应性近距离治疗（BT）成功的关键。本研究调查了不同医师经验水平下，与单独的T2w MRI相比，弥散加权成像（DWI）是否能提高GTV描绘的准确性。材料与方法：对27例局部晚期宫颈癌患者行原发性放化疗的临床资料进行分析。六名医生（三名专家，三名住院医师）在三个时间点划定了gtv：诊断（init），近距离治疗前（preBT）和近距离原位应用器治疗前（BT）。分别使用T2w图像和T2w + DWI （b=800 s mm-2）引导进行分割。采用STAPLE算法以专家共识为参考标准。使用一致性指数、dice - s - ørensen系数和Hausdorff距离来评估观察者间的一致性。结果：DWI指导显著提高了初始（一致性指数：0.62→0.70,p<0.05）和BT（一致性指数：0.33→0.39,p<0.05）时间点专家间的一致性。对于居民来说，DWI指导增强了与专家共识的一致性，特别是在BT期间，Dice系数（中位数增加9%，p<0.05）和Hausdorff距离（中位数减少1.3 mm, p<0.05）显著改善。在DWI指导下，两组的preBT和BT时间点的肿瘤体积相关性均有所改善。结论：将DWI纳入分割工作流程可以减少专家和住院放射肿瘤学家之间的观察者差异。DWI指导特别有利于经验不足的医生，使他们能够通过额外的功能信息实现更接近专家共识标准的轮廓。
{"title":"Diffusion weighted imaging for gross tumor volume delineation in primary radiochemotherapy and image guided adaptive brachytherapy for cervical cancer","authors":"Lukas Zimmermann, Barbara Knäusl, Johannes Knoth, Alina Sturdza, Vincent Dick, Tatevik Mrva-Ghukasyan, Inga-Malin Simek, Nicole Eder-Nesvacil, Dietmar Georg, Maximilian Schmid","doi":"10.1016/j.radonc.2025.111306","DOIUrl":"10.1016/j.radonc.2025.111306","url":null,"abstract":"<div><h3>Background and purpose:</h3><div>Accurate gross tumor volume (GTV) delineation is critical for successful radiochemotherapy and image-guided adaptive brachytherapy (BT) in cervical cancer. This study investigated whether diffusion-weighted imaging (DWI) improves GTV delineation accuracy compared to T2-weighted (T2w) MRI alone, across different physician experience levels.</div></div><div><h3>Materials and Methods:</h3><div>Twenty-seven patients with locally advanced cervical carcinoma undergoing primary radiochemotherapy were analyzed. Six physicians (three experts, three residents) delineated GTVs at three time points: diagnosis (<em>init</em>), pre-brachytherapy (<em>preBT</em>), and pre-brachytherapy with applicator in situ (<em>BT</em>). Segmentations were performed using T2w images alone and T2w plus DWI (b=800<!--> <!-->s<!--> <!-->mm<sup>-2</sup>) guidance. Expert consensus served as reference standard using STAPLE algorithm. Inter-observer agreement was assessed using conformity index, Dice-Sørensen coefficient, and Hausdorff distance.</div></div><div><h3>Results:</h3><div>DWI guidance significantly improved inter-observer agreement among experts at <em>init</em> (conformity index: 0.62<span><math><mo>→</mo></math></span> 0.70, <span><math><mrow><mi>p</mi><mo><</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>) and <em>BT</em> (0.33<span><math><mo>→</mo></math></span> 0.39, <span><math><mrow><mi>p</mi><mo><</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>) time points. For residents, DWI guidance enhanced agreement with expert consensus, particularly during <em>BT</em>, with significant improvements in Dice coefficient (median increase 9%, <span><math><mrow><mi>p</mi><mo><</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>) and reduced Hausdorff distance (median decrease 1.3 mm, <span><math><mrow><mi>p</mi><mo><</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>). Tumor volume correlation between <em>preBT</em> and <em>BT</em> time points improved with DWI guidance for both groups.</div></div><div><h3>Conclusion:</h3><div>Incorporating DWI into the segmentation workflow reduces inter-observer variability for both expert and resident radiation oncologists. DWI guidance particularly benefits less experienced physicians, enabling them to achieve contours closer to expert consensus standards through additional functional information.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111306"},"PeriodicalIF":5.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621254","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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