Strahlentherapie und Onkologie最新文献

Purpose: Patient care in radiation oncology is challenging. Interface problems can arise, particularly when transitioning from the inpatient to home environment. Inpatients' perception of safety regarding the upcoming discharge and their satisfaction with care were addressed in the project.

Methods: "Bridging the gaps" was an optional course for medical students in their 5th year. The study consisted of two arms-one with a home visit by medical students and the other without such a visit. Before discharge, inpatient radiation oncology patients were offered a home visit by medical students. A survey was conducted before (time point 1) and 3-5 days after discharge (time point 2) using questionnaires concerning satisfaction with care, current health status, and perception of safety. Outcome changes between time points 1 and 2 in both groups (with vs. without home visit) were compared.

Results: A total of 60 patients were interviewed. Patients which received a home visit expressed improved perception of safety after discharge, whereas patients without a home visit showed decreased perception of safety (p = 0.024 for group-difference). Both groups showed a high level of satisfaction with care, which varied between the time points. In patients without a home visit, satisfaction decreased significantly after discharge, whereas satisfaction slightly increased in patients with a home visit (p = 0.001 for group-difference).

Conclusion: Radiation oncology patients may benefit from home visits by increasing their perception of safety. Continuation and expansion of the project could strengthen the role of radiation oncology in the cross-sectoral care system.

Purpose: This study investigates objective long-term cosmetic outcomes in patients with breast cancer after intraoperative radiotherapy applied as a boost (IORT boost) from a pooled international cohort.

Methods: A pooled analysis of two prospective studies with IORT boost (low-energy X‑rays, 20 Gy; inclusion criteria: 3.5 cm maximum tumor size and preoperative indication for a boost according to local criteria) during breast-conserving surgery followed by whole-breast radiotherapy (46-50 Gy). The analysis included photos from a subgroup of the prospective phase IV TARGeted Intraoperative radioTherapy (TARGIT) Boost Quality Registry (BQR) study (NCT01440010) with a follow-up of up to 10 years as well as patients from a Swiss study (ROKSM; Spital Thurgau AG; NCT02114086) with a follow-up of 5 years. The pooled analysis included photos from both trials taken at the same timepoints (6 weeks, 6 months, 1 year, 2 years, and 5 years after completion of whole-breast radiotherapy). Cosmetic results were evaluated with the validated BCCT.core software (BCCT.core 2.0, INESC Porto, Portugal) to assess symmetry, color, and scars. A generalized estimating equation (GEE) regression model was used to compare the two cohorts over time.

Results: The pooled analysis included 777 cosmetic assessments from 276 patients. Across all follow-ups in the pooled analysis, the majority of cosmetic results were rated as excellent or good (61.9%). Patients from TARGIT-BQR had significantly more excellent or good ratings than patients from ROKSM (p < 0.0001). The proportion of patients receiving "excellent" and "good" ratings remained higher in TARGIT-BQR than in ROKSM at every timepoint during follow-up. Overall, for up to 10 years, the majority of ratings in the whole cohort were "excellent" or "good."

Conclusion: In this international pooled analysis, the cosmetic outcome after IORT boost followed by whole-breast irradiation shows a good esthetic long-term outcome. Further studies should explore factors that influence cosmetic outcomes and consider additional treatment-related parameters.

Purpose: Magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) combines high-precision SBRT with superior soft tissue visualization and daily adaptive planning. While prospective studies suggest reduced toxicity compared to CT-based SBRT, data on oncologic outcomes and PSA kinetics in the MR-guided setting remain limited.

Methods: We retrospectively reviewed 150 prostate cancer patients treated with MRgSBRT (ViewRay MRIdian) between September 2018 and April 2024. Patients received 36.25 Gy radiotherapy in 5 fractions with or without androgen deprivation therapy (ADT). Outcomes included biochemical recurrence free survival (bRFS), local progression free survival (LPFS), regional recurrence free survival (RRFS), distant metastases free survival (DMFS), event-free survival (EFS), PSA kinetics, and toxicity (CTCAE v5.0).

Results: The median follow-up was 27.2 months (range: 4-73 months). The estimated 5‑year bRFS, LPFS, RRFS, DMFS and EFS rates were 81.8%, 91.4%, 99.2%, 98.3% and 77.3% respectively. All patients were alive at the time of analysis. The estimated EFS was lowest for the very high-risk group (2-year EFS: 55.6%). The median time to nadir PSA (nPSA) was 12 months (range: 3-54 months), with a median value of 0.46 ng/mL, for all cohort. PSA bounce occurred in 15.3% of patients and was associated with numerically higher 5‑year EFS (95% vs. 73.8%). No acute or late grade ≥ 3 GU or GI toxicities were observed.

Conclusion: MRgSBRT for localized prostate cancer provides favorable tumor control with minimal toxicity. Although not statistically significant, PSA bounce was associated with improved outcomes, warranting further investigation as a potential prognostic marker.

Purpose: Lymphedema of the arm and reduced shoulder mobility are common complications of breast cancer treatment. We aim to establish whether the radiation dose received by the area of the axillary lateral thoracic artery vessel juncture (ALTJ) and the shoulder joint-affect the development of the mentioned side effects.

Methods: In this retrospective study, 298 patients with early breast cancer treated surgically and with adjuvant radiation therapy, were included. Clinical data from the prospective database were used. Physiotherapists evaluated lymphedema and shoulder mobility at diagnosis, 6 and 12 months afterwards. The ALTJ, humeral head, and humeral head with a safety margin were delineated on a CT scan, and irradiation parameters were obtained from dose-volume histograms.

Results: Multivariate analysis confirmed a correlation between higher mean (Dmean) and near-minimum (D98) radiation doses received by ALTJ and the incidence of lymphedema 12 months post-diagnosis (p = 0.016 and p = 0.002, respectively). No significant association was found between the radiation dose to the humeral head and reduced mobility.

Conclusion: In our cohort of patients, irradiation of the ALTJ region is associated with the occurrence of clinically-assessed lymphedema, while irradiation of the humeral head is not linked to limited mobility of the shoulder after breast cancer treatment.

Purpose: Outcomes of adjuvant (aRT) or salvage radiation therapy (sRT) after radical prostatectomy are under investigation regarding cancer-control outcomes.

Methods: Relying on the University Cancer Center database elaborating differences in metastasis-free (MFS), cancer-specific (CSS) and overall survival (OS) of aRT vs. sRT-treated patients between 2014-2024. Sensitivity analyses addressed high-risk patients with pN1 and/or Gleason score 8-10 and/or pT3-4 stage.

Results: Of 1862 patients, 7.1% underwent aRT and 93% were in the sRT group. Median PSA at sRT was 0.33 ng/ml. Patients with aRT harbored significantly worse baseline tumor and pathological characteristics such as PSA level (12.0 vs. 7.6 ng/ml), Gleason score 9-10 (30% vs. 9.8%), D'Amico high risk prostate cancer (97% vs. 56%), as well as pT3-4, pN1 and positive surgical margins rates (all p < 0.001). Similar observations were made for high-risk patients. No differences were observed for aRT vs. sRT with 60-month MFS rates of 85.1% vs. 95.4% (hazard ratio [HR] 0.60, p = 0.18). 60-months CSS-rates of 96.8% vs. 99.1% and 60-month OS-rates of 91.0% vs. 89.1% respectively (all p ≥ 0.15). Neither sensitivity analyses of high-risk patients nor multivariable adjusted Cox regression models revealed significant differences regarding MFS, CSS or OS in aRT vs. SRT comparison (all p ≥ 0.05), despite aRT showing qualitatively better OS results.

Conclusion: Within real-world setting, patients undergoing aRT harbor wore tumor characteristics. However, these differences did not translate into significant differences of mid-term oncological outcomes, relative to sRT patients. Similar observations were made within analyses of high-risk patients with pT3-4 and/or Gleason 8-10 and/or pN1 stage, nevertheless aRT showed slightly higher OS rates within this subgroup.

Purpose: Locally advanced breast cancer in frail and inoperable patients often causes tumor-associated pain, bleeding, or discharge. These patients may not be suitable for therapeutic options like surgery or potentially toxic systemic treatment. Local radiotherapy with little impact on treatment time may be beneficial in this patient subgroup. We evaluated an ultra-hypofractionated definitive irradiation concept in five fractions (5 × 5 Gy with a simultaneous integrated boost of 5 × 6 Gy) for these patients, focusing on tolerability and clinical outcome.

Methods: A total of 29 patients were retrospectively sampled. They were treated by irradiation to the breast with 25 Gy in five fractions with a simultaneous integrated boost (SIB) of 6 Gy per fraction. Tumor response and clinical outcome were evaluated by clinical examination.

Results: In total, 27 patients with a median age of 82 years were assessed. Median follow-up was 7.4 months. All patients completed radiotherapy with 25 Gy in five fractions with a simultaneous integrated boost of 30 Gy (6 Gy per fraction) without any high-grade toxicity (≥ grade 2). Within the first 90 days after irradiation, 15 patients (56%) exhibited a clinical response and 12 showed stable disease. Only 7 patients reported low-grade acute dermatotoxicity grade 1 (CTCAE) within the first 90 days, and only one experienced toxicity later (fibrosis grade 1, LENT-SOMA).

Conclusion: Radiotherapy in five consecutive daily fractions is sufficient. The studied regimen proved to be a safe, effective palliative treatment in inoperable and frail patients not suitable for surgery or toxic systemic therapy.