Technical Innovations and Patient Support in Radiation Oncology最新文献_第2页

Decreased overall survival in patients with brain metastases from non-small cell lung cancer with radiotherapy dose on the neurogenic niches 非小细胞肺癌脑转移患者的总生存率与放射治疗剂量对神经源性壁龛的影响有关。

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI: 10.1016/j.tipsro.2026.100380

Fia Cialdella , Danique E. Bruil , Arthur T.J. van der Boog , Steven H.J Nagtegaal , Filip Y.F.L. de Vos , Joost J.C. Verhoeff , Szabolcs David

Background

Non-small cell lung cancer (NSCLC), the most common type of lung cancer frequently leads to brain metastases (BMs), which are associated with a poor prognosis. Radiotherapy is the main treatment for BMs, but irradiates healthy tissue, including neural stem cells (NSCs). NSCs reside in neurogenic niches, mainly the subventricular zone (SVZ) and the subgranular zone (SGZ) within the hippocampus (HPC), which support neurogenesis and brain repair. Radiation damage to NSCs may influence overall survival (OS). Our study aims to evaluate the impact of any radiotherapy dose on NSCs on OS in patients with BMs from NSCLC, with lesion contact explored as a secondary aim.

Methods

We retrospectively included 138 NSCLC patients with BMs and delineated NSC regions on T1 MR-images. Kaplan-Meier (KM) analysis and Cox regression assessed associations between OS, mean radiotherapy dose to SVZ and HPC, and lesion contact.

Results

Higher radiotherapy dose on the SVZ and HPC were significantly associated with reduced OS, with a hazard ratio (HR) of 1.306 ([95% CI 1.043–1.635], p = 0.019) and 1.222 ([95% CI 1.008–1.483], p = 0.041), respectively. Lesion contact with neurogenic niches was also independently significant (SVZ: HR 1.968 [95% CI 1.094–3.542], p = 0.023 and HPC: HR 5.751 [95% CI 1.733–19.07], p = 0.004), although lesion contact was uncommon.

Conclusion

Unintended radiotherapy dose to neurogenic niches is independently associated with worse OS in NSCLC patients with brain metastases, and tumor contact with these regions also shows an adverse association. These findings support considering the SVZ and hippocampus as organs–at–risk in SRS planning and motivate prospective validation in larger, controlled cohorts.

背景：非小细胞肺癌（NSCLC）是最常见的肺癌类型，常导致脑转移（BMs），其预后较差。放射治疗是脑转移的主要治疗方法，但放射的是健康组织，包括神经干细胞（NSCs）。NSCs存在于神经源性壁龛中，主要是海马（HPC）内的脑室下区（SVZ）和亚颗粒区（SGZ），它们支持神经发生和脑修复。辐射损伤NSCs可能影响总生存期（OS）。我们的研究旨在评估任何放疗剂量的NSCs对非小细胞肺癌脑转移患者OS的影响，并将探讨病变接触作为次要目的。方法：我们回顾性地纳入了138例脑转移的非小细胞肺癌患者，并在T1 mr图像上划定了NSC区域。Kaplan-Meier （KM）分析和Cox回归评估了OS、SVZ和HPC的平均放疗剂量和病变接触之间的关系。结果：SVZ和HPC放疗剂量越大，OS降低的风险比（HR）分别为1.306 （[95% CI 1.043 ~ 1.635], p = 0.019）和1.222 （[95% CI 1.008 ~ 1.483], p = 0.041）。病变与神经源性小生境的接触也具有独立显著性（SVZ: HR 1.968 [95% CI 1.094-3.542], p = 0.023, HPC: HR 5.751 [95% CI 1.733-19.07], p = 0.004），尽管病变接触并不常见。结论：非预期的神经源性小生境放疗剂量与NSCLC脑转移患者更差的OS独立相关，肿瘤与这些区域的接触也显示出不利的关联。这些发现支持将SVZ和海马体作为SRS计划中的高危器官，并激励在更大的对照队列中进行前瞻性验证。

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引用次数: 0

Accuracy and workflow efficiency of surface-guided open-face vs. closed-face masks in SRT/SRS for brain metastases 表面引导的开面面罩与闭面面罩在脑转移的SRT/SRS中的准确性和工作效率。

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-02-01 DOI: 10.1016/j.tipsro.2026.100382

Stephen Obena , Katia Alves , Daniel R. Zwahlen , Alessandro Clivio , Joana C.A. Gomes , Christoph Oehler

Background

Open-face masks (OFMs) provide comparable immobilization or superior accuracy with greater patient comfort than closed-face masks (CFMs), but their impact on workflow efficiency in stereotactic radiotherapy (SRT) and radiosurgery (SRS) for brain metastases remains unclear. This study compared immobilization accuracy, setup-related interruptions, and workflow efficiency of OFM with surface-guided radiotherapy (SGRT) versus CFM.

Methods

We retrospectively analyzed 180 consecutive SRT/SRS courses for brain metastases (March 2020–February 2024) using OFM/SGRT or CFM. Setup accuracy, repeat imaging, repositioning, and session duration were extracted from treatment and CBCT records. Translational and rotational errors were compared using Mann–Whitney U-tests; session times with t-tests.

Results

OFM/SGRT achieved smaller mean x- (1.1 ± 1.0 vs. 1.3 ± 1.1 mm) and z-axis displacements (0.7 ± 0.7 vs. 1.3 ± 1.1 mm) but slightly larger y-axis displacement (2.0 ± 1.7 vs. 1.4 ± 1.4 mm; all p < 0.01). Rotational stability was superior (pitch 0.10° vs. 0.74°, yaw 0.64° vs. 1.10°, roll 0.57° vs. 0.74°; all p < 0.01). Setup-related issues were fewer with OFM/SGRT (2 vs. 7), while patient (5 vs. 3) and technical (2 vs. 1) issues were slightly higher. Mean session times were similar for initial (21.88 vs. 21.87 min; p = 0.98) and subsequent fractions (16.92 vs. 16.74 min; p = 0.47).

Conclusions

OFM combined with SGRT provides improved rotational stability and comparable translational setup accuracy overall compared with CFMs in SRT/SRS, despite inferior longitudinal (y-axis) accuracy. OFM/SGRT was associated with fewer setup-related deviations during initial positioning. While overall session durations were comparable between workflows, reduced setup-related interruptions were observed with OFM/SGRT. These findings support OFM/SGRT as a clinically viable and patient-friendly alternative to conventional CFMs in SRT/SRS.

背景：开放式面罩（OFMs）提供与封闭式面罩（CFMs）相当的固定或更高的准确性，并且患者舒适度更高，但它们对脑转移的立体定向放疗（SRT）和放射外科治疗（SRS）的工作效率的影响尚不清楚。本研究比较了OFM与表面引导放疗（SGRT）与CFM的固定精度、安装相关中断和工作流程效率。方法：我们回顾性分析了180个连续使用OFM/SGRT或CFM治疗脑转移的SRT/SRS疗程（2020年3月- 2024年2月）。从治疗和CBCT记录中提取设置准确性、重复成像、重新定位和疗程持续时间。采用Mann-Whitney u检验比较平移和旋转误差；使用t检验的会话时间。结果：OFM/SGRT的平均x-（1.1±1.0 vs. 1.3±1.1 mm）和z轴位移（0.7±0.7 vs. 1.3±1.1 mm）较小，但y轴位移略大（2.0±1.7 vs. 1.4±1.4 mm）。结论：尽管纵向（y轴）精度较差，但OFM联合SGRT与SRT/SRS的cfm相比，总体上提供了更好的旋转稳定性和相当的平移设置精度。在初始定位时，OFM/SGRT与较少的设置相关偏差相关。虽然工作流之间的总体会话持续时间是相当的，但OFM/SGRT可以减少与设置相关的中断。这些发现支持OFM/SGRT作为SRT/SRS中传统cfm的临床可行且患者友好的替代方案。

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引用次数: 0

Feasibility of transitioning to marker-less immobilisation using optical surface guidance in head and neck cancer treatment: a study at territory state cancer centre in a developing country 在头颈癌治疗中使用光学表面引导过渡到无标记物固定的可行性：一项在发展中国家领土国家癌症中心的研究

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-14 DOI: 10.1016/j.tipsro.2026.100375

Ragul Thirunavukarasu , Sharad Singh , Pramod Kumar Gupta , Sumanta Manna , Vishal Sharma

Purpose/Objective(s)

In countries such as India, where a large share of cancer patients undergoes head and neck radiotherapy, setups still rely primarily on laser alignment with surface markers on the mask. This study explores transitioning from conventional marker-based setup to markerless setups using optical surface guidance (SGRT) to determine if treatment accuracy can be maintained particularly in a territory state cancer centre setting where resources are limited.

Materials/Methods

A prospective study of 80 head-and-neck cancer patients, randomized into two groups was performed: open-face mask group (OM) with optical surface guidance (AlignRT) versus conventional masks with surface-marker setup. All received Volumetric Modulated Arc Therapy VMAT (60–70 Gy in 30–35 fractions). Cone Beam Computed Tomography (CBCT) verified positioning, and translational/rotational shifts were used to calculate systematic (Σ) and random (σ) errors. Group differences were analyzed with an independent t-test.

Results

Translational setup errors in both OM and CM systems were consistently below 0.2 cm across all axes, with no statistically significant differences observed (p > 0.05). Rotational deviations in pitch, roll, and yaw were generally within 1°, with OM showing slightly improved stability trends compared to CM. Weekly error analysis confirmed stable reproducibility better in OM group compared to the CM over the treatment course.

Conclusion

The open-face mask with optical surface guidance is a feasible alternative to conventional closed-face masks in head and neck cancer treatment. It offers comparable accuracy, lateral axis advantage and comparable precision in vertical and longitudinal axes. It enhances patient comfort without increasing imaging frequency or margins and improves treatment outcomes

目的/目标在印度等国家，大部分癌症患者接受头颈部放射治疗，设置仍然主要依靠激光对准面具上的表面标记。本研究探讨了从传统的基于标记物的设置过渡到使用光学表面引导（SGRT）的无标记物设置，以确定治疗准确性是否可以保持，特别是在资源有限的领土国家癌症中心设置。材料/方法对80例头颈癌患者进行前瞻性研究，随机分为两组：采用光学表面引导（AlignRT）的开放式面罩组（OM）和采用表面标记装置的常规面罩组。所有患者均接受体积调节电弧治疗VMAT （60-70 Gy，分30-35份）。锥形束计算机断层扫描（CBCT）验证了定位，并使用平移/旋转位移计算系统（Σ）和随机（Σ）误差。组间差异采用独立t检验分析。结果OM系统和CM系统在各轴上的平移设置误差均小于0.2 CM，差异无统计学意义（p > 0.05）。俯仰、横摇和偏航的旋转偏差一般在1°以内，与CM相比，OM显示出略微改善的稳定性趋势。每周误差分析证实，在整个治疗过程中，与CM组相比，OM组的稳定性重复性更好。结论光学表面引导的开放式面罩是头颈部肿瘤治疗中替代传统封闭面罩的可行方法。它提供了相当的精度，横向轴优势和相当的精度在垂直和纵向轴。它在不增加成像频率或边缘的情况下提高了患者的舒适度，改善了治疗效果

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引用次数: 0

Waiting time interpretations: Complexity and consequences for radiotherapy delays 等待时间解释：放疗延迟的复杂性和后果。

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-02-17 DOI: 10.1016/j.tipsro.2026.100386

Mruga Gurjar , Jesper Lindberg , Caroline E Olsson

引用次数: 0

Impact of variation in voluntary moderate deep inspiration breath hold on the 3D dose distribution in breast cancer radiotherapy 自主适度深吸气憋气变化对乳腺癌放疗三维剂量分布的影响。

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.tipsro.2026.100385

Lotte van der Werf , Lars Murrer , Karolien Verhoeven, Debby Knarren, Kirsten Kremer , Femke Vaassen, Liesbeth Boersma, Michel Öllers

Aim

Determination of impact of variations during voluntary moderately deep inspiration breath hold (vmDIBH) on doses to organs at risk (OAR) and target coverage in patients undergoing radiotherapy (RT) for left-sided breast cancer (BC).

Methods

We recorded vmDIBH-breathing signals using a Surface Guidance system, without visual coaching, in 21 BC patients. In 13 patients, cone-beam CT (CBCT) scans were acquired with vmDIBH, immediately after treatment delivery. A 3D dose recalculation was performed on CBCT, cranio-caudally stitched with the planning CT for full dose evaluation. Mean Heart Dose (MHD), Mean Lung Dose (MLD) and V_95% of the clinical target volume (CTV) were calculated. Relationships between vmDIBH level, stability and differences in Dose-Volume Histogram (DVH) parameters were analysed using linear regression and Mann-Whitney U-tests.

Results

Of 150 recorded vmDIBHs, 39% of the breath-holds were within a predefined 3 mm gating window. The average deviation from this window was 0.6 mm (SD 1.9 mm), with the mean value just outside predefined boundaries. All recalculated CBCTs (n = 95) met predefined DVH criteria for MHD, MLD, and V95% of tumourbed CTV. The V_95% of the whole breast CTV showed minor deviations from the planned dose (mean delta V_95%: −0.8%, SD 1.6%). For patients with excursions beyond the 3 mm window, average differences were 1.43% in V_95%-CTV, 0.02 Gy in MHD, and 0.05 Gy in MLD.

Conclusion

Only small breathing excursions beyond 3 mm were observed during vmDIBH without visual coaching, not resulting in clinically relevant CTV Underdosage with MHD and MLD remaining within tolerance.

目的：确定自愿适度深吸气屏气（vmDIBH）期间的变化对左侧乳腺癌（BC）放射治疗（RT）患者危险器官（OAR）剂量和靶覆盖的影响。方法：我们在没有视觉指导的情况下使用表面引导系统记录21例BC患者的vmdibh呼吸信号。13例患者在治疗后立即使用vmDIBH获得锥束CT （CBCT）扫描。在CBCT上进行三维剂量重新计算，颅尾缝合与计划CT进行全剂量评估。计算平均心脏剂量（MHD）、平均肺剂量（MLD）和临床靶体积（CTV）的V95%。采用线性回归和Mann-Whitney u检验分析vmDIBH水平、稳定性与剂量-体积直方图（DVH）参数差异之间的关系。结果：在记录的150例vmDIBHs中，39%的屏气在预定的3 mm门控窗内。与该窗口的平均偏差为0.6 mm (SD 1.9 mm)，平均值刚好在预定义边界之外。所有重新计算的cbct （n = 95）均符合MHD， MLD和V95%肿瘤CTV的预定义DVH标准。全乳CTV的V95%与计划剂量偏差较小（平均δ V95%: -0.8%, SD 1.6%）。对于偏移超过3mm窗口的患者，V95%-CTV的平均差异为1.43%，MHD为0.02 Gy， MLD为0.05 Gy。结论：在无视觉指导的vmDIBH期间，仅观察到超过3mm的小呼吸偏移，未导致临床相关的CTV剂量不足，MHD和MLD仍在耐受范围内。

{"title":"Impact of variation in voluntary moderate deep inspiration breath hold on the 3D dose distribution in breast cancer radiotherapy","authors":"Lotte van der Werf , Lars Murrer , Karolien Verhoeven, Debby Knarren, Kirsten Kremer , Femke Vaassen, Liesbeth Boersma, Michel Öllers","doi":"10.1016/j.tipsro.2026.100385","DOIUrl":"10.1016/j.tipsro.2026.100385","url":null,"abstract":"<div><h3>Aim</h3><div>Determination of impact of variations during voluntary moderately deep inspiration breath hold (vmDIBH) on doses to organs at risk (OAR) and target coverage in patients undergoing radiotherapy (RT) for left-sided breast cancer (BC).</div></div><div><h3>Methods</h3><div>We recorded vmDIBH-breathing signals using a Surface Guidance system, without visual coaching, in 21 BC patients. In 13 patients, cone-beam CT (CBCT) scans were acquired with vmDIBH, immediately after treatment delivery. A 3D dose recalculation was performed on CBCT, cranio-caudally stitched with the planning CT for full dose evaluation. Mean Heart Dose (MHD), Mean Lung Dose (MLD) and V<sub>95%</sub> of the clinical target volume (CTV) were calculated. Relationships between vmDIBH level, stability and differences in Dose-Volume Histogram (DVH) parameters were analysed using linear regression and Mann-Whitney U-tests.</div></div><div><h3>Results</h3><div>Of 150 recorded vmDIBHs, 39% of the breath-holds were within a predefined 3 mm gating window. The average deviation from this window was 0.6 mm (SD 1.9 mm), with the mean value just outside predefined boundaries. All recalculated CBCTs (n = 95) met predefined DVH criteria for MHD, MLD, and V95% of tumourbed CTV. The V<sub>95%</sub> of the whole breast CTV showed minor deviations from the planned dose (mean delta V<sub>95%</sub>: −0.8%, SD 1.6%). For patients with excursions beyond the 3 mm window, average differences were 1.43% in V<sub>95%</sub>-CTV, 0.02 Gy in MHD, and 0.05 Gy in MLD.</div></div><div><h3>Conclusion</h3><div>Only small breathing excursions beyond 3 mm were observed during vmDIBH without visual coaching, not resulting in clinically relevant CTV Underdosage with MHD and MLD remaining within tolerance.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100385"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mid-ventilation PTV approach for stereotactic ablative body radiotherapy in stage I non-small-cell lung carcinoma: Implementation of a single-system workflow 中通气PTV入路用于I期非小细胞肺癌立体定向消融体放疗：单一系统工作流程的实施

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-10 DOI: 10.1016/j.tipsro.2025.100369

Kendell Shields-Dowton , Joel Poder , Johnson Yuen , Laurel Schmidt , Yaw Sinn Chin

Introduction

The Mid-Ventilation (MidV) approach is an alternative to internal target volume (ITV) for generating a planning target volume (PTV) in lung stereotactic ablative radiotherapy (SABR). It has been shown to reduce PTV and volume of normal lung tissue irradiated, whilst maintaining high local control rates. However, this approach has not been widely adopted due to difficulties in determining the MidV phase in commercially available treatment planning systems. We hypothesised that a fully integrated MidV workflow could be developed and validated within a single vendor platform, producing accurate contours and dosimetric improvements compared with the ITV based method.

Methods

A MidV workflow was implemented using Eclipse/Aria, incorporating deformable image registration (DIR) of 4DCT images, automated 4D contour statistics for MidV phase selection and an embedded PTV margin calculation spreadsheet. Ten patients from a multi-centre Phase II lung SABR study were retrospectively analysed. The following metrics were used to compare the DIR method with the manually contoured iGTV: mean distance to agreement (MDA), dice similarity coefficient (DSC) and accurate selection of the MidV Phase (±10 %). Corresponding ITV and MidV PTV based plans were generated and compared using absolute PTV volumes, mean lung dose (MLD) and V20Gy.

Results

DIR generated iGTVs demonstrated high geometric accuracy (mean MDA 0.86 mm; DSC 0.86). MidV phase selection aligned with manual selection in all patients. MidV based planning produced smaller PTVs than ITV based in 8/10 cases (mean 47.0 cm³ vs 54.6 cm³). Lung dose metrics improved consistently: MLD decreased by 14 % (3.46 Gy to 2.97 Gy) and V20Gy by 16 % (3.78 % to 3.19 %).

Conclusion

A streamlined, vendor integrated MidV workflow was successfully developed and validated, producing accurate DIR based contours and meaningful dosimetric reductions compared with ITV based method. These findings support broader clinical implementation of MidV based lung SABR.

在肺立体定向消融放疗（SABR）中，中期通气（MidV）入路是产生计划靶容积（PTV）的一种替代方法，可替代内部靶容积（ITV）。它已被证明可以降低PTV和正常肺组织的体积，同时保持较高的局部控制率。然而，由于在商业上可用的治疗计划系统中难以确定MidV阶段，这种方法尚未被广泛采用。我们假设完全集成的MidV工作流程可以在单一供应商平台内开发和验证，与基于ITV的方法相比，可以产生准确的轮廓和剂量学改进。方法采用Eclipse/Aria实现MidV工作流程，包括4DCT图像的可变形图像配准（DIR）、用于MidV相位选择的自动4D轮廓统计和嵌入式PTV余量计算电子表格。回顾性分析来自多中心二期肺SABR研究的10例患者。以下指标用于比较DIR方法与手动绘制的iGTV：平均一致距离（MDA），骰子相似系数（DSC）和MidV相的准确选择（±10%）。生成相应的ITV和MidV PTV计划，并使用绝对PTV体积、平均肺剂量（MLD）和V20Gy进行比较。结果dir生成的igtv具有较高的几何精度（平均MDA 0.86 mm, DSC 0.86）。所有患者的中期期选择与人工选择一致。在8/10的情况下，基于MidV的规划比基于ITV的规划产生更小的ptv（平均47.0 cm3 vs 54.6 cm3）。肺剂量指标持续改善：MLD下降14% (3.46 Gy至2.97 Gy)， V20Gy下降16%（3.78%至3.19%）。结论：与基于ITV的方法相比，成功开发并验证了一种简化的、供应商集成的MidV工作流程，可产生准确的基于DIR的轮廓和有意义的剂量降低。这些发现支持基于MidV的肺SABR更广泛的临床应用。

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引用次数: 0

Optimising acute toxicity monitoring in prostate MR-guided radiotherapy workflow: Results from a prospective study using multiple electronic PRO assessments 优化前列腺磁共振引导放射治疗工作流程中的急性毒性监测：一项使用多个电子PRO评估的前瞻性研究的结果

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-10 DOI: 10.1016/j.tipsro.2025.100368

Pia Krause Møller , Helle Pappot , Tine Schytte , Uffe Bernchou , Karin Brochstedt Dieperink

Introduction

Frequent electronic patient-reported outcomes (ePROs) may become an important tool for monitoring outcomes in ultrahypofractionated MRgRT for prostate cancer, enabling real-time remote tracking of toxicity. By integrating weekly ePROs and health-related quality of life (HRQoL) assessments into the early prostate MRgRT workflow, this study aimed to explore real-time acute symptom trajectories and the impact on HRQoL.

Methods

Two cohorts were followed: Patients receiving MRgRT for localised PCa (60Gy/20fx) or low-volume metastatic (M1) PCa (36Gy/6fx) and eligible to complete weekly ePROs and HRQoL measures (EQ-5D-5L, EORTC QLQ-C30) during and up to 24 weeks of follow-up. Linear mixed models were used to evaluate symptom changes over time.

Results

Of 76 included PCa patients, 42 had localised PCa and 34 low-volume M1 PCa. The linear model revealed significant changes in urinary symptoms from treatment week one, persisting 2 weeks post-MRgRT in the 36 Gy cohort, and 3–4 weeks in the 60 Gy cohort. Bowel symptoms increased early post-treatment in both cohorts, with diarrhoea being most frequent. Clinically relevant changes in HRQoL were observed during follow-up: patients in the 60 Gy cohort showed HRQoL improvements after 12 and 24 weeks. In the 36 Gy cohort, patients reported improved self-rated Global health status/QoL and emotional functioning.

Conclusion

Frequent ePROs during and after MRgRT provide critical insights into the timing, fluctuation and severity of acute toxicity, potentially missed with standard follow-up schedules. Integrating real-time ePROs into the MRgRT workflow is a feasible patient-centered method to systematically optimize the outcome assessments of MRgRT.

频繁的电子患者报告结果（ePROs）可能成为监测前列腺癌超低分割MRgRT结果的重要工具，可以实时远程跟踪毒性。通过将每周epro和健康相关生活质量（HRQoL）评估纳入早期前列腺MRgRT工作流程，本研究旨在探索实时急性症状轨迹及其对HRQoL的影响。方法随访两个队列：接受MRgRT治疗局部PCa （60Gy/20fx）或低体积转移性（M1） PCa （36Gy/6fx）的患者，并有资格在长达24周的随访期间完成每周ePROs和HRQoL测量（EQ-5D-5L, EORTC QLQ-C30）。线性混合模型用于评估症状随时间的变化。结果76例PCa患者中，42例为局部PCa， 34例为小体积M1 PCa。线性模型显示，从治疗第一周开始，泌尿系统症状发生了显著变化，在36 Gy队列中持续2周，在60 Gy队列中持续3-4周。两组患者治疗后早期肠道症状均有所增加，腹泻最为常见。随访期间观察HRQoL的临床相关变化：60 Gy队列患者在12周和24周后HRQoL有所改善。在36 Gy队列中，患者报告自我评估的全球健康状况/生活质量和情绪功能有所改善。结论：MRgRT期间和之后频繁的ePROs提供了对急性毒性的时间、波动和严重程度的重要见解，这些可能被标准随访计划遗漏。将实时epro整合到MRgRT工作流程中是一种以患者为中心系统优化MRgRT结果评估的可行方法。

{"title":"Optimising acute toxicity monitoring in prostate MR-guided radiotherapy workflow: Results from a prospective study using multiple electronic PRO assessments","authors":"Pia Krause Møller , Helle Pappot , Tine Schytte , Uffe Bernchou , Karin Brochstedt Dieperink","doi":"10.1016/j.tipsro.2025.100368","DOIUrl":"10.1016/j.tipsro.2025.100368","url":null,"abstract":"<div><h3>Introduction</h3><div>Frequent electronic patient-reported outcomes (ePROs) may become an important tool for monitoring outcomes in ultrahypofractionated MRgRT for prostate cancer, enabling real-time remote tracking of toxicity. By integrating weekly ePROs and health-related quality of life (HRQoL) assessments into the early prostate MRgRT workflow, this study aimed to explore real-time acute symptom trajectories and the impact on HRQoL.</div></div><div><h3>Methods</h3><div>Two cohorts were followed: Patients receiving MRgRT for localised PCa (60Gy/20fx) or low-volume metastatic (M1) PCa (36Gy/6fx) and eligible to complete weekly ePROs and HRQoL measures (EQ-5D-5L, EORTC QLQ-C30) during and up to 24 weeks of follow-up. Linear mixed models were used to evaluate symptom changes over time.</div></div><div><h3>Results</h3><div>Of 76 included PCa patients, 42 had localised PCa and 34 low-volume M1 PCa. The linear model revealed significant changes in urinary symptoms from treatment week one, persisting 2 weeks post-MRgRT in the 36 Gy cohort, and 3–4 weeks in the 60 Gy cohort. Bowel symptoms increased early post-treatment in both cohorts, with diarrhoea being most frequent. Clinically relevant changes in HRQoL were observed during follow-up: patients in the 60 Gy cohort showed HRQoL improvements after 12 and 24 weeks. In the 36 Gy cohort, patients reported improved self-rated Global health status/QoL and emotional functioning.</div></div><div><h3>Conclusion</h3><div>Frequent ePROs during and after MRgRT provide critical insights into the timing, fluctuation and severity of acute toxicity, potentially missed with standard follow-up schedules. Integrating real-time ePROs into the MRgRT workflow is a feasible patient-centered method to systematically optimize the outcome assessments of MRgRT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100368"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparative dosimetric analysis of deep inspiration breath-hold versus free breathing radiotherapy in lung cancer: special emphasis on cardiac and subcardiac structure protection 深吸气屏气与自由呼吸放射治疗肺癌的剂量学比较分析：特别强调心脏和心下结构的保护

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-15 DOI: 10.1016/j.tipsro.2025.100371

Biney Pal Singh , Ahmed Ali Chughtai , Jennifer Stock , Philipp Bruners , Michael J. Eble , Ahmed Allam Mohamed

Background

Radiation therapy (RT) plays a central role in the treatment of lung cancer. However, cardiac and pulmonary toxicities remain major concerns. Deep inspiration breath-hold (DIBH) has been shown to improve target stability and reduce organ-at-risk (OAR) exposure, but data in lung cancer, particularly regarding cardiac substructures, remain limited.

Materials and methods

We retrospectively analysed 32 patients with lung cancer treated with RT at our institution between 2020 and 2021. Each patient underwent planning CTs in both DIBH and free breathing (FB), generating a total of 64 treatment plans using VMAT (60 Gy in 30 fractions). Contouring followed ESTRO ACROP guidelines, including detailed segmentation of cardiac chambers and coronary arteries. Dosimetric endpoints included Dmean, D2%, and VxGy for lung, heart, and subcardiac structures. Statistical comparisons between DIBH and FB plans were performed.

Results

DIBH significantly increased lung volume and improved all lung dosimetric parameters, including Dmean (13.13 vs. 14.49 Gy, p < 0.001) and V20Gy (24.37 % vs. 27.28 %, p < 0.001). Cardiac sparing was evident, with lower heart D2% (39.91 vs. 41.67 Gy, p = 0.012) and V45Gy (2.23 % vs. 2.53 %, p = 0.005). Notably, significant reductions were observed in the LAD (Dmean: 5.59 vs. 6.57 Gy, p = 0.004), LCX, and LV. Subgroup analyses demonstrated consistent dosimetric advantages across tumor laterality and level 7 nodal involvement.

Conclusions

DIBH offers substantial and consistent dosimetric benefits in lung cancer RT, reducing radiation burden to pulmonary, cardiac, and coronary structures. Given the known association between cardiac dose and long-term morbidity, these findings support the broader implementation of DIBH, especially in anatomically challenging cases involving subcarinal nodes or left-sided tumors.

放射治疗（RT）在肺癌的治疗中起着核心作用。然而，心脏和肺毒性仍然是主要问题。深吸气屏气（DIBH）已被证明可以提高靶标稳定性并减少器官风险（OAR）暴露，但肺癌的数据，特别是关于心脏亚结构的数据仍然有限。材料和方法我们回顾性分析了2020年至2021年在我院接受放疗的32例肺癌患者。每位患者在DIBH和自由呼吸（FB）中都进行了计划ct检查，使用VMAT（30份60 Gy）共产生64个治疗计划。轮廓遵循ESTRO ACROP指南，包括心室和冠状动脉的详细分割。剂量学终点包括肺、心脏和心下结构的Dmean、D2%和VxGy。对DIBH方案和FB方案进行统计学比较。结果dibh显著增加肺容量，改善肺剂量学参数，包括Dmean （13.13 vs. 14.49 Gy, p < 0.001）和V20Gy （24.37% vs. 27.28%, p < 0.001）。心脏保留明显，心脏d2降低（39.91比41.67 Gy, p = 0.012）， V45Gy降低（2.23%比2.53%,p = 0.005）。值得注意的是，LAD （Dmean: 5.59 Gy vs. 6.57 Gy, p = 0.004）、LCX和LV显著降低。亚组分析表明，放射剂量学在肿瘤侧边和7级淋巴结受累方面具有一致的优势。结论：dibh在肺癌放射治疗中提供了实质性和一致的剂量学益处，减少了肺、心脏和冠状动脉结构的辐射负担。鉴于心脏剂量与长期发病率之间的已知关联，这些发现支持更广泛地实施DIBH，特别是在涉及隆突下淋巴结或左侧肿瘤的解剖挑战性病例中。

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引用次数: 0

Urgent radiotherapy for superior vena cava syndrome in metastatic non-small cell lung cancer: a case report 转移性非小细胞肺癌上腔静脉综合征的紧急放射治疗一例报告

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-05 DOI: 10.1016/j.tipsro.2025.100365

Arpeet Patel , Nilanjan Haldar , Ida Micaily , Michael Greenberg , Evan Nardone , John A. Lippert , Christopher Fundakowski , Adam C. Mueller

Superior vena cava (SVC) syndrome is a life-threatening complication of thoracic malignancies, requiring rapid management in the setting of airway compromise or hemodynamic instability. We present a 59-year-old male with metastatic non-small cell lung cancer (NSCLC) who developed superior vena cava syndrome (SVCS) due to compression from a large mediastinal mass identified as metastatic lung adenocarcinoma. His declining respiratory status progressed rapidly, necessitating intensive care. After extensive multidisciplinary collaboration, the patient was determined fit for inpatient radiation therapy and 10 fractions of 300 cGy external beam radiotherapy to the obstructing lesion was planned. However, the patient was unable to lay supine for radiation treatment due to dyspnea, so he was transferred to an academic center, where custom immobilization setup was available to accommodate the patient’s inability to tolerate a standardized supine position utilized by most outpatient radiation centers. The patient’s symptoms and oxygen requirement then improved markedly, enabling transition to outpatient care for the remaining two radiotherapy (RT) fractions and chemotherapy. This case highlights the value of hypofractionated radiotherapy and institutional adaptability in managing acute oncologic emergencies such as SVC syndrome.

上腔静脉（SVC）综合征是胸部恶性肿瘤的一种危及生命的并发症，在气道受损或血流动力学不稳定的情况下需要快速治疗。我们报告一位患有转移性非小细胞肺癌（NSCLC）的59岁男性患者，由于被确诊为转移性肺腺癌的大纵隔肿块压迫而发展为上腔静脉综合征（SVCS）。他的呼吸状况恶化得很快，需要重症监护。经过广泛的多学科合作，确定患者适合住院放疗，并计划对梗阻性病变进行10次300 cGy外束放疗。然而，由于呼吸困难，患者无法仰卧进行放射治疗，因此他被转移到一个学术中心，在那里可以定制固定装置，以适应患者无法忍受大多数门诊放射中心使用的标准化仰卧位。患者的症状和氧气需求随后显著改善，可以过渡到门诊治疗，进行剩余的两个放疗（RT）部分和化疗。本病例强调了低分割放疗在处理急性肿瘤紧急情况（如SVC综合征）中的价值和制度适应性。

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引用次数: 0

Advancements in radiation dose reduction for pediatric CT head Imaging: A scoping review of emerging Technologies, Protocols, and optimization strategies 儿童CT头部成像放射剂量降低的进展：对新兴技术、方案和优化策略的范围审查

IF 2.8 Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 10.1016/j.tipsro.2026.100374

Nandini B Patil , Priyanka , Priya P S , Rajagopal Kadavigere , Saikiran Pendem

Computed tomography (CT) is an important imaging modality that provides cross-sectional images, aiding in the detailed visualization of internal structures for accurate diagnosis and treatment. The pediatric population is more sensitive to radiation than adults, making radiation dose (RD) optimization an important concern in pediatric CT imaging. This scoping review emphasizes advanced RD reduction methods used in pediatric CT head imaging for diagnosing various clinical conditions with optimum RD and diagnostic image quality (IQ). A detailed search was conducted across five databases, such as PubMed, Scopus, CINAHL, Web of Science (WOS) and Embase using relevant keywords. A total of 24 articles were included in the final review. RD parameters and IQ related data were extracted from each article. Conventional RD reduction techniques in CT such as reducing the tube voltage, tube current and other scanning parameters, face limitations particularly in the pediatric population. These techniques lead to a trade-off between a lower RD and poor IQ which might obfuscate diagnostic details due to decreased contrast resolution with greater image noise and artifacts. To balance RD and diagnostic IQ, advanced technologies such as iterative reconstruction (IR) and deep learning image reconstruction (DLIR) algorithms with ultra-low dose protocols are increasingly being used. Hence, the review concludes that, compared with conventional dose reduction techniques, artificial intelligence based DLIR algorithms enhance IQ even for ultra-low dose protocols across various clinical domains in pediatric CT imaging.

计算机断层扫描（CT）是一种重要的成像方式，它提供了横断面图像，有助于内部结构的详细可视化，以进行准确的诊断和治疗。儿童人群对辐射的敏感性高于成人，因此辐射剂量（RD）的优化是儿童CT成像的一个重要问题。这篇综述强调了先进的RD降低方法在儿童CT头部成像中用于诊断各种临床疾病，具有最佳的RD和诊断图像质量（IQ）。利用相关关键词在PubMed、Scopus、CINAHL、Web of Science （WOS）和Embase等5个数据库中进行了详细的检索。最终评审共纳入24篇文章。从每篇文章中提取RD参数和IQ相关数据。传统的CT RD降低技术，如降低管电压、管电流和其他扫描参数，尤其在儿童人群中面临局限性。这些技术导致较低的RD和较差的IQ之间的权衡，这可能会混淆诊断细节，因为对比度分辨率降低，图像噪声和伪影更大。为了平衡RD和诊断IQ，迭代重建（IR）和深度学习图像重建（DLIR）算法等先进技术正在越来越多地使用超低剂量协议。因此，该综述得出结论，与传统的剂量减少技术相比，基于人工智能的DLIR算法即使在各种临床领域的超低剂量方案中也能提高儿童CT成像的IQ。

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引用次数: 0