Strahlentherapie und Onkologie最新文献

Purpose: To evaluate genitourinary (GU) toxicity in patients with prostate cancer receiving conventional radiotherapy (RT) with a simultaneous integrated boost (SIB) to intraprostatic lesions (IPL), with a specific focus on those with a history of transurethral resection of the prostate (TURP).

Methods: This retrospective study initially included 606 patients with localized prostate cancer treated with definitive image-guided external beam RT between 2012 and 2023. Of these, 79 patients (13%) had a history of TURP. To reduce potential bias and balance baseline characteristics, 1:1 propensity score matching (PSM) was performed based on age, cardiac disease, diabetes mellitus, RT field, and androgen deprivation therapy (ADT) use. After matching, 158 patients (79 TURP vs. 79 no-TURP) were included in the final analysis. SIB was delivered to IPLs up to 86 Gy in 39 fractions. Toxicities were recorded according to CTCAE v4.03, and logistic regression was used to identify predictors of late GU toxicity.

Results: In the matched cohort, baseline urinary function, α‑blocker use, prostate and IPL volumes, and IPL localisation were well balanced between groups. After a median follow-up of 78 months, late Grade ≥ 2 GU toxicity occurred in 21.5% of TURP vs. 7.6% of non-TURP patients (p = 0.02). The median time to late toxicity was significantly shorter among TURP patients (16 vs. 47 months, p = 0.007). On multivariable analysis, prior TURP and diabetes mellitus were independently associated with increased risk of late grade ≥ 2 GU toxicity.

Conclusion: Prior TURP is independently associated with higher and earlier-onset late GU toxicity in patients with prostate cancer receiving modern SIB-based RT. These results suggest that TURP status should be incorporated into personalized RT planning.

Purpose: The healthcare sector is a large greenhouse gas producer. Especially in radiotherapy (RT), a lot of electricity is consumed by the medical linear accelerator (linac) and associated patient travel. Our aim was to ascertain by how much electrical energy consumption and patient travel can be reduced by replacing normofractionated (NF) with emerging moderately hypofractionated (UF) or ultra-hypofractionated (UHF) concepts.

Methods: We connected an energy meter to our linac (VersaHD, Elekta©, Stockholm, Sweden) and evaluated different fractionation concepts (NF, HF, UHF) for 30 patients with target volumes of the prostate, breast, and spine. In addition to the energy measurements, we also conducted an analysis of the carbon dioxide (CO₂) emissions associated with the variations in patient travel.

Results: This study measured the energy consumption of a linac (in kWh) and its impact on CO₂ emissions for various radiotherapy fractionation concepts. Ultra-hypofractionated regimens consistently showed the lowest energy consumption and variability across prostate, breast, and bone metastasis treatment courses, while NF regimens had significantly higher energy consumption and variability. Transitioning from NF to UHF regimens reduced CO₂ emissions by up to 75%, driven by fewer patient visits and lower electricity consumption. These findings highlight the environmental and logistical benefits of HF and UHF treatment protocols.

Conclusion: The adoption of HF and UHF treatment concepts can significantly reduce energy consumption and CO₂ emissions, achieving an up to 75% reduction per treatment course. This is primarily due to decreased patient travel and electricity consumption at the linac. Extrapolated globally, these changes offer further potential to mitigate climate change.

Purpose: The TARGIT BQR (boost quality registry) phase IV trial investigates clinical outcomes of breast cancer patients with standard external-beam radiotherapy (EBRT) of the whole breast and intraoperative radiotherapy (IORT) with low-kV x‑rays as an anticipated tumor bed boost in a real-world setting.

Methods: Intraoperative radiotherapy was performed immediately after breast-conserving surgery in one fraction. External-beam radiotherapy and systemic treatment were given according to the German S3 guideline for breast cancer and local tumor board recommendations. Outcome parameters were death, local recurrence, metastasis, local lymph node recurrence, and ipsilateral and contralateral invasive breast cancer. Kaplan-Meier estimates were used to calculate overall survival, metastasis-free survival, local recurrence-free survival, and disease-free survival.

Results: From 10 centers, 1133 patients were recruited. This analysis included 871 patients with 879 cancers, with a median follow-up of 36 months (up to 12 years). An IORT boost was performed in 82% and whole-breast irradiation in 84%. Overall survival was 98.4% after 3 years, 96.8% after 5 years, and 95.4% after 10 years (16 deaths; 1.8%). Metastasis and local recurrence occurred in 11 patients each (1.3%). At 5 years, the local control rate was 97.4% and local recurrence-free survival was 94.4%. Ipsilateral breast cancer occurred in 2 patients, contralateral breast cancer in 3 patients, and local lymph node recurrence in 2 patients. Disease-free survival was 92.9% after 5 years and 82.6% after 10 years.

Conclusion: This phase IV trial confirms previously reported outcomes on upfront IORT boost, with excellent disease-control outcomes.

Purpose: Evidence on the use of definitive radiotherapy (RT) in younger prostate cancer (PCa) patients is limited, with no national-level studies systematically evaluating oncologic outcomes and treatment-related toxicity in this population. This study aimed to assess oncologic outcomes and toxicity of definitive prostate RT in patients aged 55 years or younger.

Methods: Records of 180 PCa patients aged ≤ 55 years treated with definitive RT ± androgen deprivation therapy across 12 cancer centers were retrospectively reviewed. Primary endpoints included freedom from biochemical failure (FFBF) and PCa-specific survival (PCSS). Secondary endpoints were overall survival (OS), acute/late genitourinary (GU) and gastrointestinal (GI) toxicities, local recurrence (LR), and distant metastasis (DM).

Results: Median age was 54 years; median PSA at diagnosis was 10.4 ng/mL. Risk group distribution was 29% low-, 29% intermediate-, and 42% high-risk. Median RT dose was 76 Gy delivered in 38 fractions. After a median follow-up of 106.2 months, local recurrence (9%), distant metastasis (7%), and isolated PSA progression (3%) were noted. The 8‑year FFBF, PCSS, and OS were 85.7%, 93.8%, and 90.3%, respectively. Univariate analysis identified PSA, clinical T stage, Gleason score (GS), and risk group as significant prognostic factors for FFBF and PCSS. Multivariate analysis showed advanced stage and high GS independently predicted worse FFBF and PCSS. Acute and late grade ≥ 2 GU toxicity occurred in 12% and 6%, and GI toxicity in 11% and 3%.

Conclusion: Definitive radiotherapy is a safe and effective treatment for prostate cancer patients aged ≤ 55 years. Prospective studies are needed to confirm these findings.

Chemo-/radiotherapy-induced cardiomyopathy is a clinical challenge for patients with cancer, characterized by detrimental effects on cardiac structure and function. To date, numerous experimental and clinical investigations have revealed that numerous mechanisms, such as oxidative damage, contribute to chemo-/radiotherapy-induced cardiomyopathy. Chronic oxidative stress and reactive oxygen species (ROS) production following damage to mitochondria and the endoplasmic reticulum (ER) play a fundamental role in the progression of cell death, inflammation, and fibrosis, leading to heart failure and unusual changes in the heart structure. This review delves into the mechanisms of cardiotoxicity induced by chemotherapy and radiotherapy, highlighting the pivotal role of mitochondrial dysfunction and subsequent oxidative stress and cell death. The interplay between mitochondrial and ER dysfunction can also be offered as a paramount factor in the development of cardiomyopathy. We review how damage to these organelles may trigger cardiac injury through crosstalk with other mechanisms such as activation of pro-oxidant enzymes, inflammation, fibrosis, and other important processes.

Background: Isolated nodal recurrence (INR) after localized breast cancer is rare, with an incidence of less than 1%. Curative management typically includes surgical resection, often with axillary lymph node dissection (ALND), followed by regional nodal radiotherapy. However, evidence-based guidelines remain limited due to the rarity of this clinical scenario. The aim of this study was to evaluate survival determinants and the acute and long-term toxicities associated with second-course regional nodal irradiation as part of curative strategies for INR after localized breast cancer.

Materials and methods: This retrospective study included 11 patients with localized breast cancer who developed ipsilateral, nonmetastatic INR between 2003 and 2019. All patients were treated with curative intent, including regional nodal irradiation. Overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), local control, and treatment toxicities were analyzed. Survival probabilities were calculated using the Kaplan-Meier method, and Cox regression was used to assess prognostic factors.

Results: The 5‑year OS and CSS were 71.6%, while MFS was 62.3%. Inclusion of internal mammary chain (IMC) irradiation significantly improved OS, CSS, and MFS (p < 0.01). Triple-negative breast cancer (TNBC) INRs were associated with worse survival outcomes. Acute grade 2 toxicities included radiodermatitis (36.4%), and late grade 2 toxicities were limited to fibrosis (18.2%). No cardiac, pulmonary, or grade 3 or higher toxicities were reported.

Conclusion: This study highlights the favorable survival outcomes and safety profile of contemporary curative strategies for INRs following localized breast cancer, with a 5-year OS rate exceeding historical benchmarks. Internal mammary chain irradiation appears to improve survival without increased toxicity. However, the poor prognosis associated with TNBC INR underscores the need for effective systemic therapies. Prospective multicenter trials are essential to validate these findings and optimize treatment protocols.

Background: Cardiac tumors are exceedingly rare with metastatic involvement representing the most frequent form of malignancy within the heart. In patients presenting with inoperable primary or recurrent malignant cardiac sarcomas or cardiac/epicardial/pericardial metastases, stereotactic body radiotherapy (SBRT) serves as an alternative local treatment to surgery or may, in some cases, constitute the sole viable local treatment modality. To date, there are only case reports or small retrospective studies assessing SBRT dose and toxicity for cardiac SBRT. The goal of this prospective multicentric observational study is to systematically evaluate the feasibility, toxicity and outcome of magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) in the management of primary and secondary cardiac malignancies.

Methods: The treatment is performed using MR-guided SBRT in five fractions on non-consecutive days (6-8 Gy per fraction prescribed to the 80% isodose). Four study centers participate in this prospective phase II trial (Heidelberg, Munich, Rome, Zurich). Eligible patients who consent to participate in the study will undergo treatment as indicated and approved by an interdisciplinary tumor board. Primary objective is to assess the feasibility and safety of online adaptive MRgSBRT; secondary endpoints are local control and survival outcome, acute and late toxicity, patient-reported outcome as well as technical feasibility of treatment.

Discussion: The findings from this study may serve as a foundation for the future integration of cardiac SBRT into clinical practice guidelines for the management of cardiac malignancies.

Melanoma presents significant challenges to treatment due to its complex tumor microenvironment (TME) and the development of various resistance mechanisms in cancer cells. Radiotherapy is one of the main treatment modalities for melanoma. It acts by generating reactive oxygen species (ROS) and inducing DNA damage in melanoma cancer cells. However, these malignant cells develop DNA damage responses (DDRs) to resist ionizing radiation (IR). In addition, tumor cells engage in constant dialogue with surrounding stromal cells, immune cells, and extracellular matrix (ECM) components. These interactions shape tumor progression, metastasis, and resistance to different antitumor agents, including radiotherapy. Key players in this cellular orchestra include stromal cells, macrophages, myeloid cells, and different subsets of T cells. In addition, a unique vascular system and subsequent hypoxia in some regions of the tumor can further stimulate resistance to radiotherapy. Emerging research highlights the role of immune checkpoints, hypoxia, growth factors, and growth factor receptors in modulating tumor responses to radiation. Recent studies have uncovered promising molecular targets such as DNA repair inhibitors, immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), and hypoxia modulators to sensitize melanoma to radiotherapy. This review aims to synthesize current knowledge on melanoma tumor interactions, providing a comprehensive overview of promising targets for improving radiotherapy outcomes in melanoma patients.