Strahlentherapie und Onkologie最新文献

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.

Purpose: The aim of this study was to evaluate the outcome, especially disease-free survival (DFS) and recurrence patterns, in patients with a maximum age of 45 years at first diagnosis of head and neck squamous cell carcinoma (HNSCC).

Methods: We retrospectively reviewed data from 79 patients with newly diagnosed HNSCC aged 45 or younger without distant metastasis who underwent postoperative or definitive radio(chemo)therapy in either the Department of Radiation Oncology at the University Hospital of Erlangen or the Department of Radiation Oncology at the University Hospital of Mainz between September 2006 and December 2023. The Kaplan-Meier method was used to calculate survival and recurrence rates. In univariate analysis, the log-rank test was used to correlate patient-/tumour- and treatment-related parameters to survival and recurrence rates.

Results: The overall survival rate was 79.7% at 2 years and 67.1% at 5 years. The DFS rate was 73.4% at 2 years and 67.1% at 5 years. Cumulatively, 14.6% of patients in the postoperative arm had locoregional recurrences at 2 years and 23.0% at 5 years, while 25.7% of patients in the definitive arm had local recurrences at 2 years and 33.1% at 5 years (p = 0.36). The rate of distant metastasis was 19.2% in the postoperative arm at 2 years and 21.6% at 5 years. In the definitive arm, the distant metastasis rate was 20.7% at 2 years and 28.6% at 5 years (p = 0.49). Disease-free survival was significantly improved in patients who drank little or no alcohol (p = 0.005) and in patients with a low UICC stage (p < 0.001). No differences in DFS were observed for different primary tumour locations or treatment modalities.

Conclusion: Locoregional recurrences were the most common site of recurrence, regardless of tumour location and treatment modality. Therefore, future study designs in this patient cohort should potentially investigate intensified treatment approaches.

Background: Enteric-type adenocarcinoma of the lung (lung-ETAC) is an exceptionally rare variant of lung adenocarcinoma, often presenting diagnostic challenges due to its histological resemblance to colorectal adenocarcinoma. This rarity has hindered the development of standardized treatment protocols, with most management approaches being empirical. Radiotherapy is used infrequently for lung-ETAC, predominantly reserved for palliative care in metastatic cases. Recent studies, however, suggest that lung-ETAC may have a better prognosis than other lung cancer subtypes, thus raising the need to explore alternative therapeutic strategies, including radiotherapy.

Case report: We present the case of a 73-year-old female with stage IIIA lung-ETAC who was treated with curative-intent radiotherapy (60 Gy in 30 fractions) in combination with platinum-based chemotherapy. Despite transient pulmonary complications, the patient exhibited an almost complete response to treatment after 2 months, achieving sustained clinical remission with no further antitumor therapies.

Conclusion: This case underscores the potential role of high-dose radiotherapy as a curative treatment for locally advanced lung-ETAC. Given the limited evidence, further research is needed to better define the role of chemoradiotherapy in the management of this rare histological subtype.

Objectives: This systematic review assessed the efficacy and safety of preoperative stereotactic radiotherapy (PreopSRT) in the treatment of resectable brain metastases (BM).

Methods: A PRISMA systematic review was conducted using Web of Science, Scopus, and PubMed. The search terms included "(brain or cerebral) and (metastasis or metastases) and (radiotherapy or radiosurgery or radiation) and (neoadjuvant or preoperative)." Of the 2061 articles identified, 12 studies met the inclusion criteria: patients with resectable BM who received PreopSRT in single or multiple fractions. Literature reviews, protocols, and studies on salvage resections were excluded.

Results: Local control at 6 months ranged from 81.8 to 100%, with over 95% control reported in 4 studies, reaching 100% in 3 series. At 12 months, local control ranged from 49.1 to 95%. Data for 24-month local control were available for only 3 studies, ranging from 73 to 97.1%. Multiple fractions appeared to be more effective. PreopSRT showed a rate of leptomeningeal recurrence between 0 and 17% and a rate of radionecrosis from 3.5 to 10.5% at 1 year.

Conclusion: This PRISMA review highlights the growing interest in preoperative stereotactic radiotherapy, which appears at least as effective and potentially less toxic than postoperative treatment. Phase III trials are needed to confirm its clinical use.

Objective: The study we describe focuses on evaluating the effectiveness of linear accelerator (LINAC) stereotactic radiosurgery (SRS) in the treatment of cerebral arteriovenous malformations (AVMs). This treatment option is gaining interest due to the uncertainties associated with combined radiosurgical and endovascular treatments and the significant technological advancements in SRS. The primary goals of the study are to assess rates of obliteration (successful closure of the AVM) and rebleeding (the recurrence of bleeding posttreatment), as well as to identify factors influencing obliteration rates and to document any adverse effects associated with the procedure.

Materials and methods: The study retrospectively analyzed data from 134 patients treated with LINAC-based SRS for cerebral AVMs. The patients were categorized based on their prior treatments: 50 had undergone partial embolization, 8 had received a combination of embolization and surgery and 1 patient had a surgical intervention. Furthermore, 75 patients had received no prior treatment. Kaplan-Meier survival analysis and log-rank tests were employed to calculate actuarial obliteration rates and annual cumulative bleeding rates following SRS treatment.

Results: The study found that obliteration rates after SRS treatment increased over time, with 5‑year obliteration rates of 85.2% for grades I-II, 76.4% for grade III, and 62.1% for grades IV-V. Annual cumulative bleeding rates post-SRS were 1.5% for the first year and 0.7% for the second year. Interestingly, prior embolization did not affect the obliteration rate. The median time to obliteration was 36 months (range 7-162 months). Obliteration rates were significantly better in Spetzler-Martin (SM) grade I-II (85% at 5 years) compared to grade III-V (68% at 5 years, p = 0.01). Age, sex, and pediatric status had no statistically significant influence on AVM response to SRS. No radiation necrosis was observed in our cohort.

Conclusion: This study contributes to the body of evidence supporting the effectiveness of SRS in treating cerebral AVMs and provides valuable insights into factors affecting treatment outcomes. The findings suggest that patients can expect a high chance of successful obliteration of the AVM with minimal adverse effects, making SRS a compelling option for those affected by this condition.

Purpose: This study evaluated survival outcomes and chronic side effects in adult medulloblastoma patients treated with craniospinal irradiation (CSI).

Methods: We performed a retrospective analysis of 30 adult medulloblastoma patients treated with postoperative craniospinal radiotherapy (RT; 30-36 Gy) combined with a posterior fossa/tumor bed boost (54 Gy). Kaplan-Meier methods were used to analyze local control (LC) and survival. Long-term quality of life was assessed using the 12-Item Short Form Health Survey (SF-12) questionnaire and the telephone cognitive evaluation (T-Cog) test.

Results: With a median follow-up of 87 months, 10 patients (33.3%) died, 6 due to craniospinal fluid (CSF) recurrence and 4 from distant metastases. The 5‑year local control (LC) and overall survival (OS) rates were 85% and 71%, respectively. Alopecia (64.7%), cognitive decline (41.1%), and ototoxicity (41.1%) were common long-term toxicities, with 5 of 7 ototoxicity cases linked to cisplatin. Secondary tumors occurred in 2 patients. Cognitive impairment was indicated by a mean T‑Cog score of 24, while SF-12 physical and mental health scores were 47.8 and 44.4, both below the cutoff of 50.

Conclusion: Craniospinal RT is a safe and effective treatment for adult patients with medulloblastoma. Future treatment strategies should aim to deintensify therapy by limiting radiation to the local tumor bed in selected low-risk patients and by identifying favorable molecular subgroups for observation after surgery. Advanced techniques and targeted therapies can further reduce toxicity while maintaining strong oncologic outcomes and enhancing quality of life.

Purpose: The goal is to investigate the best time point for assessing radiological complete response after exclusive chemoradiation in locally advanced cervical cancer (LACC). This is a retrospective single-center study.

Materials and methods: Seventy-nine patients with LACC, stage IB3-IVA FIGO 2018 treated between January and December 2020 were retrospectively analyzed. All patients received external beam radiotherapy (45 Gy in 25 daily fractions ± simultaneous boost to lymph nodes), and interventional radiotherapy (IRT, 28 Gy/twice/weekly) with concurrent chemotherapy. The radiological complete response evaluation was examined using magnetic resonance imaging (MRI) at three timepoints: (i) before IRT, at the end of external beam radiotherapy, (ii) 3 months following the completion of IRT and (iii) 6 months after IRT. Seventy-nine patients were included.

Results: At the three timepoints, the complete response rate increased with 21, 53, and 59 patients reporting a complete response at MRI scan, respectively. Seven patients with partial response at the second assessment had complete response 6 months after treatment completion, overall resulting in 80% clinical complete response.

Conclusions: Our findings suggest that 6 months following the end of exclusive treatment for LACC patients is the best time to detect complete radiological response (measured by MRI scan) after chemoradiation. Waiting this period of time before conclusively assessing response would allow for the inclusion of patients who have not yet fully responded at 3 months, while avoiding the performance of salvage therapies too early.

Background: Single-fraction stereotactic body radiotherapy (SBRT) is an effective treatment option for patients with non-small cell lung cancer (NSCLC) who are ineligible for surgery. This study investigates long-term clinical outcomes, prognostic factors, and toxicity associated with high-dose single-fraction SBRT.

Materials and methods: We retrospectively analyzed 110 patients with 116 NSCLC lesions treated with single-fraction SBRT between 2000 and 2023. Histologic subtypes included adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and CT-defined suspicious lesions without histological confirmation. Local control (LC), progression-free survival (PFS), and overall survival (OS) were assessed using Kaplan-Meier and Cox regression models. Toxicity was evaluated using CTCAE v4.0.

Results: The most common dose was 30 Gy, prescribed in 76.7% of lesions. Among patients who received ≥ 30 Gy, LC at 2, 3, and 5 years was 78%, 74%, and 68%; PFS was 63%, 49%, and 37%; and OS was 84%, 83%, and 60%, respectively. LC and PFS were significantly higher in patients treated with ≥ 30 Gy (p < 0.05). Acute pneumonitis occurred in 2 patients (1.8%), and 22 patients (20.0%) developed late-onset pneumonitis. Pneumonitis incidence was 26.8% in patients planned with 3D-CT, compared to 12.8% with DIBH or 4D-CT. No grade ≥ 3 toxicity was observed.

Conclusion: High-dose (≥ 30 Gy) single-fraction SBRT provides excellent long-term tumor control with minimal toxicity with NSCLC. Advanced motion management techniques were associated with reduced pulmonary toxicity. A ≥ 30 Gy dose significantly improved LC, PFS, and OS. Higher Charlson Comorbidity Index (CCI) was associated with worse OS. These findings support the use of high-dose SF-SBRT in selected patients and highlight the need for individualized treatment planning. Prospective validation is warranted.