Strahlentherapie und Onkologie最新文献

Radiotherapy for cancer is a local treatment method that uses radiation to treat tumors. It is one of the main approaches for treating malignant tumors. Radiotherapy uses ionizing radiation on living organisms to cause necrosis of tumor cells. However, the DNA damage repair mechanisms of tumor cells and the hypoxic microenvironment of tumors limit the effectiveness of radiotherapy. Tumor cells can also achieve radioresistance through a variety of signaling pathways. The radiation tolerance of adjacent tissues also directly affects the effect of radiotherapy. Stimulation of tumor cells through physical methods such as ultrasound, light, heat, electricity, and magnetic fields can not only improve the hypoxic microenvironment of tumors and directly damage DNA but can also solve the problem of radioresistance by regulating a variety of signaling molecules. Physical stimulation therapy has high specificity and targeted effects, making it widely used in radiosensitization applications. However, the molecular mechanisms underlying the radiosensitizing effects of physical stimulation therapy are not fully understood at a practical level. In this review, we summarize the signaling pathways related to radioresistance as well as the established and potential molecular mechanisms responsible for radiosensitization induced by physical stimulation to provide insights for future radiosensitivity studies on physical stimulation therapies.

Purpose: The early history of radiation and radiation oncology is imprinted by innovative pioneers both in physics and clinical application. Despite the remarkable example of Marie Curie, the contributions of female physicians, physicists, and radiation therapists in the first years of radiation practice are often forgotten or neglected. This analysis aims at a comprehensive review of pivotal female pioneers in the field of radiation oncology and summarizes current and future challenges with regard to gender equality in the radiation oncology workforce.

Methods: The History and Women in Radiation Oncology working groups of the German Society for Radiation Oncology (DEGRO) conducted a selective literature research on Marie Kundt, Marietta Blau, Elisabeth Fleischmann, and Anna Hamann, who were chosen as representative examples of female pioneers. Medical and sociological analyses were selected to illustrate the present situation and point out future challenges.

Results: The review illustrates that women in radiation oncology in the late 19th/early 20th century were hindered in enrolling in educational institutions and in pursuing an equal (and recognized) professional career; they were also subject to discrimination. Thus, great dedication and personal sacrifices were needed to succeed. Despite this, significant contributions were made by women, and the four discussed colleagues contributed to or even enabled the formation of critical aspects of modern radiation oncology, such as X‑ray imaging, radiation physics, different treatment techniques, and the profession of radiation technicians. Lacking adequate radiation protection at the time, their inspirational spirit came at a significant cost, and three of the four presented pioneers (MB, EF, and AH) succumbed to irradiation-induced cancers. Today, modern analyses still show that female professionals tend to drop out during their career before professorship or head of department positions and are therefore underrepresented in these career stages.

Conclusion: The history of women in radiation oncology is marked by discrimination and great personal and professional sacrifices. Despite these challenges, female pioneers contributed to the development of modern radiation oncology in a significant way. Today, gender disparities in the workforce persist and constitute challenges which need to be addressed to enable equal access to leading positions.

Purpose: The initial brain metastasis velocity (iBMV) is a prognostic metric introduced for patients receiving stereotactic radiosurgery (SRS) for brain metastases (BM), reflecting intracranial disease dynamics. This study aimed to assess the applicability of iBMV in a mixed cohort of breast cancer brain metastases (BCBM) patients treated with SRS/fractionated stereotactic radiotherapy (FSRT) and whole-brain radiotherapy (WBRT). Considering disease dynamics, we analyzed the role of biological subtypes in determining the time interval between initial diagnosis and the occurrence of BM.

Methods: We conducted a retrospective, single center cohort study of 126 BCBM patients who received radiotherapy to the brain (SRS/FSRT and WBRT) between 01/2013 and 12/2020. Statistical endpoints included iBMV, time interval between initial diagnosis and the occurrence of BM analyzed per biological subtype, and overall survival (OS).

Results: Median iBMV was 0.48 BM/year. The iBMV independently predicted for mortality in the multivariate model after accounting for WBRT (hazard ratio [HR] = 1.21; 95% confidence interval [CI] 1.04-1.41; p = 0.012). The biologic subtype significantly influenced the time interval between initial diagnosis of breast cancer and occurrence of BM. In a multivariate model, the Karnofsky performance status and HER2 status were strongest predictors of overall survival (HR = 2.60; 95% CI 1.60-4.22; p < 0.001 and HR = 2.26; 95% CI 1.34-3.84; p = 0.002, respectively).

Conclusion: iBMV correlates with overall survival, regardless of whether WBRT was used as part of local treatment. The biological subtype has a profound impact on prognosis and kinetics of BCBM.

Background: High-grade squamous intraepithelial lesions (HSIL) of the anal region are recognized as precursor lesions to squamous cell carcinoma of the anus (SCCA), especially in individuals infected with the human papillomavirus (HPV). Although recent studies indicate that treating HSIL can reduce progression to SCCA, optimal management strategies remain undefined. High recurrence rates and treatment-associated morbidities underscore the need for effective therapeutic options.

Methods: A survey among radiation oncologists in Germany was conducted between September and October 2024, covering clinical practice settings, the frequency of HSIL cases, experience with radiotherapy, reasons for radiotherapy inquiries, treatment indications, and concurrent therapies.

Results: A total of 58 radiation oncologists participated in the survey, with 37 (63.8%) reporting inquiries about radiotherapy for HSIL, primarily for patients with multiple recurrences. Radiotherapy was generally considered an appropriate option, particularly for recurrent cases where other treatments posed risks, especially complications or worsening of anorectal function after local excision. However, only half of the respondents (29) had prior experience with treating anal HSIL and rated radiotherapy outcomes as good or very good. Most respondents indicated a preference for treating only the local area (i.e., excluding lymphatic drainage pathways) to a total dose of 40-50 Gy.

Conclusion: Recurrent anal HSIL presents a major challenge for patients, with no established effective treatment standards available. Radiotherapy is frequently requested and administered, showing promising preliminary outcomes. Clinical studies are warranted to evaluate the effectiveness and tolerability of radiotherapy in patients with anal HSIL.

Purpose: In definitive radiotherapy/radiochemotherapy (RT/RCT) for localized non-small cell lung cancer (NSCLC), the introduction of positron-emission tomography (PET)-CT-based staging/RT planning and dynamic RT techniques (intensity-modulated radiotherapy, IMRT/volumetric modulated arc therapy, VMAT) were important innovations.

Methods: We performed a retrospective study and compared clinical outcomes (1) in patients with PET-CT-based staging (n = 170) vs. conventional staging (n = 103) and (2) in patients with dynamic RT techniques (IMRT/VMAT; n = 99) vs. three-dimensional conformal radiotherapy (3D-CRT; n = 64).

Results: We found improved survival with PET-CT vs. conventional staging. PET-CT patients vs. conventionally staged patients had higher applied RT doses, higher RT completion rates, and a higher rate of patients who received RCT vs. RT only. Additionally, we found higher rates of leukopenia and lung infections in PET-CT patients. When comparing RT techniques (IMRT/VMAT vs. 3D-CRT), there were no differences in survival. IMRT/VMAT patients had higher RT doses and higher rates of intensified concomitant chemotherapy (cisplatin/vinorelbine vs. low-dose cisplatin). IMRT/VMAT was associated with a reduction in pneumonitis and dermatitis.

Conclusion: In summary, refined RT/RCT strategies with PET-CT and IMRT/VMAT enable the intensification of multimodal treatment. Reduction of toxicities with IMRT/VMAT widens the therapeutic window. The coincidence of intensified treatment, improved outcomes, and higher toxicity rates in PET-CT-staged patients emphasizes the need for a detailed risk-benefit assessment during planning and application of treatment modalities.

Purpose: Recent studies indicate that gender plays a role in influencing the side effects and outcomes of radiotherapy (RT), thus highlighting the importance of gender-specific clinical approaches. However, there remains a knowledge gap regarding potential gender differences in the domain of psychosocial profiles during RT. This retrospective analysis examines the psychosocial impact of RT on a cohort of adult and paediatric patients in Italy who received psycho-oncological support during RT from January 2020 to April 2024.

Methods: Medical charts of a total of 750 adult (418 females and 332 males) and 145 paediatric patients (78 male and 67 females) were reviewed. In our radiation oncology department, two psycho-oncological pathways are available for adults: 1) dedicated pathways for patients with head and neck, brain, or rectal and anal cancers, where psychological support is provided automatically; and 2) support for other patients upon request or clinical recommendation. For paediatric patients, psychoeducational/psychotherapeutic interventions tailored to the needs of patients/caregivers are initiated at the start of RT to ensure compliance and promote psychological wellbeing.

Results: Female adult patients reported higher levels of distress, anxiety, and depression than males, with significant predictors including gender and previous psychological disturbances. Notably, patients undergoing RT with palliative or local-control intent exhibited increased anxiety and depression. In contrast, no significant gender differences in psychosocial distress were observed among paediatric patients. Both genders received consistent psychological support, and familial trauma and RT intent did not significantly affect their scores.

Conclusion: In this retrospective analysis, gender is a crucial predictor of psychosocial outcomes in adults undergoing RT, with females experiencing higher distress levels. Prior mental health stability appears protective against anxiety and depression. In paediatric patients, interventions remain effective across genders. Early psychological assessments are essential for both groups to identify patients at risk and enhance coping strategies.

Background: Progression-free (PFS) and overall survival (OS) in UICC stage III non-small cell lung cancer (NSCLC) after definitive concurrent chemoradiotherapy (CRT) can be increased with consolidating immunotherapy. Recent studies have shown a strong predictive value of gross tumor volume (GTV) changes during CRT on OS. The TORCH trial investigated the prognostic impact of GTV changes during CRT as a predictor for a response to immunotherapy.

Methods: This retrospective non-interventional observational multicenter trial included n = 203 patients from 10 German university centers for radiation oncology with confirmed inoperable NSCLC in UICC stage III A-C. Patients had received CRT between 2015 and 2023 as a curative-intent treatment approach. Patient and tumor characteristics were collected anonymously via electronic case report forms. Initial GTVs before CRT (initial planning CT, GTV1) and at 40-50 Gy (re-planning CT for radiation boost, GTV2) were delineated. Absolute and relative GTV changes before/during CRT were correlated with OS to predict the response to CRT with sequential immunotherapy. Hazard ratios (HR) of survival analyses were estimated using adjusted Cox regression models.

Results: The mean GTV1 before radiation therapy (RT) was 145.29 ml with the 25th, 50th, and 75th percentiles being 61.36 ml, 145.29 ml, and 204.93 ml, respectively. Before initiation of the radiation boost, the mean GTV2 was 99.58 ml, with the 25th, 50th, and 75th percentiles at 32.93 ml, 70.45 ml, and 126.85 ml. The HR for the impact of GTV1 on survival was 0.99 per ml (95% confidence interval [CI] 0.99-1.00; p = 0.49). For the absolute volume change between GTV1 and GTV2, the HR was 1.004 per ml (95% CI 0.997-1.011; p = 0.26). In a subgroup analysis of patients who were treated with durvalumab, absolute volume changes between GTV1 and GTV2 were associated with longer OS (HR = 0.955 per ml; 95% CI 0.916-0.996; p = 0.03). Overall, durvalumab treatment was positively associated with OS, demonstrating an HR of 0.454 (95% CI 0.209-0.990; p = 0.047).

Conclusion: Pretreatment GTV and absolute GTV volume changes did not significantly correlate with OS. However, the absolute volume change between the pretreatment and replanning GTV was associated with longer OS in patients treated with durvalumab. Histological subtype, grading, UICC stage, age at onset, pulmonary comorbidities, and smoking status had no significant association with OS. Durvalumab treatment was associated with improved OS.

Artificial intelligence (AI) systems may personalise radiotherapy by assessing complex and multifaceted patient data and predicting tumour and normal tissue responses to radiotherapy. Here we describe three distinct generations of AI systems, namely personalised radiotherapy based on pretreatment data, response-driven radiotherapy and dynamically optimised radiotherapy. Finally, we discuss the main challenges in clinical translation of AI systems for radiotherapy personalisation.

Radiation therapy (RT) is a highly digitized field relying heavily on computational methods and, as such, has a high affinity for the automation potential afforded by modern artificial intelligence (AI). This is particularly relevant where imaging is concerned and is especially so during image-guided RT (IGRT). With the advent of online adaptive RT (ART) workflows at magnetic resonance (MR) linear accelerators (linacs) and at cone-beam computed tomography (CBCT) linacs, the need for automation is further increased. AI as applied to modern IGRT is thus one area of RT where we can expect important developments in the near future. In this review article, after outlining modern IGRT and online ART workflows, we cover the role of AI in CBCT and MRI correction for dose calculation, auto-segmentation on IGRT imaging, motion management, and response assessment based on in-room imaging.