Seminars in Radiation Oncology最新文献

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Biological Effects of Low-Dose Radiation Therapy: From Mechanistic Aspects to Translational Approaches and Challenges 低剂量放射治疗的生物学效应：从机制方面到转化方法和挑战

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-12-12 DOI: 10.1016/j.semradonc.2025.10.001

Anna-Jasmina Donaubauer PhD , Lia Mogge MSc , Philipp Schubert PhD , Rainer Fietkau PhD , Oliver J. Ott PhD , Benjamin Frey PhD , Udo S. Gaipl PhD

Low dose radiation therapy (LDRT) is commonly applied for its pain and symptom-relieving effects in the treatment of different benign diseases, such as chronic degenerative and inflammatory, or hyperproliferative disorders. Most clinical trials report a beneficial therapeutic effect of LDRT and further, robust preclinical evidence on the biological modes of action of LDRT is existent. In chronic degenerative and inflammatory diseases such as osteoarthritis, LDRT can ameliorate inflammatory processes and impacts positively on the bone metabolism. A key mechanism is the modulation of the endothelium and the phenotype of macrophages. In the bone, the deposition of new bone matrix is supported, while bone degradation is diminished. In hyperproliferative disorders, the main mode of action is the inhibition of the differentiation and proliferation of fibroblasts and myofibroblasts, along with a modulation of inflammatory mediators, such as cytokines. Even though comprehensive preclinical evidence supports the use of LDRT, biological mechanistic insights from randomized clinical trials is mostly missing for LDRT and indicates a significant translational gap. Apart from preclinical data, the evidence for LDRT is based largely on observational clinical trials, with only limited randomized and placebo-controlled trials available. In the future, rigorously designed randomized disease-specific studies with standardized protocols, translational research programs and objectifiable clinical and biological endpoints are needed to establish LDRT as precise and evidence-based therapy.

低剂量放射治疗（LDRT）通常用于治疗不同的良性疾病，如慢性退行性和炎症性疾病或增生性疾病，因为它具有疼痛和缓解症状的作用。大多数临床试验报告了LDRT的有益治疗效果，并且存在关于LDRT作用的生物学模式的强有力的临床前证据。在慢性退行性和炎症性疾病如骨关节炎中，LDRT可以改善炎症过程并对骨代谢产生积极影响。一个关键的机制是调节内皮细胞和巨噬细胞的表型。在骨中，新骨基质的沉积得到支持，同时骨降解减少。在增生性疾病中，主要的作用方式是抑制成纤维细胞和肌成纤维细胞的分化和增殖，同时调节炎症介质，如细胞因子。尽管全面的临床前证据支持LDRT的使用，但LDRT的随机临床试验的生物学机制见解大多缺失，这表明存在重大的转化差距。除了临床前数据，LDRT的证据主要基于观察性临床试验，只有有限的随机和安慰剂对照试验。在未来，需要严格设计随机疾病特异性研究，标准化方案，转化研究计划和客观的临床和生物学终点，以建立LDRT作为精确和循证治疗。

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引用次数: 0

Functional Radiotherapy for Non-Malignant Diseases: The Potential of Ionizing Radiation Beyond Cancer Treatment 非恶性疾病的功能放疗：电离辐射在癌症治疗之外的潜力

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-12-12 DOI: 10.1016/j.semradonc.2025.11.002

Alexander Rühle MD, MHBA , Thomas F. DeLaney MD

This special issue, “Functional Radiotherapy for Non-Malignant Diseases – The Potential of Ionizing Radiation Beyond Cancer Treatment”, addresses one of the oldest yet often overlooked areas of radiation medicine: the therapeutic use of ionizing radiation for non-malignant disorders. More than a century after the first medical use of X-rays, functional radiotherapy for non-malignant diseases is experiencing a renaissance, supported by growing clinical and biological evidence. The articles in this issue span the historical evolution, mechanistic underpinnings, and modern clinical applications of radiotherapy across diverse indications. They address topics such as the biological effects and potential carcinogenic risks of low-dose irradiation, radiotherapy for osteoarthritis and periarticular soft-tissue disorders, benign and premalignant tumors, Graves’ ophthalmopathy, and hyperproliferative diseases including Dupuytren’s and Ledderhose’s disease, among others. Emerging applications such as stereotactic arrhythmia radioablation and functional radiotherapy for neurological or psychiatric disorders further extend its scope. Together, these contributions illustrate how radiotherapy for non-malignant diseases has evolved from empirical practice to a scientifically grounded therapy aimed at functional restoration. In the future, the establishment of standardized protocols, international registries, and prospective clinical trials will be essential to validate efficacy and safety, thereby defining the evolving role of radiotherapy beyond cancer treatment.

本期特刊“非恶性疾病的功能放射治疗-电离辐射在癌症治疗之外的潜力”，讨论了放射医学中最古老但往往被忽视的领域之一：电离辐射治疗非恶性疾病。在x射线首次用于医疗一个多世纪之后，在越来越多的临床和生物学证据的支持下，用于非恶性疾病的功能性放射治疗正在复兴。这期的文章涵盖了放射治疗的历史演变、机制基础和现代临床应用。他们讨论的主题包括低剂量辐射的生物效应和潜在致癌风险，骨关节炎和关节周围软组织疾病的放射治疗，良性和癌前肿瘤，Graves眼病，以及包括Dupuytren病和Ledderhose病在内的增殖性疾病等。诸如立体定向心律失常放射消融和神经或精神疾病的功能放疗等新兴应用进一步扩大了其范围。总之，这些贡献说明了非恶性疾病的放射治疗如何从经验实践演变为旨在功能恢复的科学基础治疗。在未来，标准化方案的建立、国际注册和前瞻性临床试验对于验证有效性和安全性至关重要，从而确定放射治疗在癌症治疗之外的发展作用。

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引用次数: 0

130 Years of Radiotherapy for Nonmalignant Diseases: A Historical Overview 130年来非恶性疾病放疗的历史回顾

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-12-12 DOI: 10.1016/j.semradonc.2025.11.004

Oliver Micke PhD , Michael Oertel PhD , Ralph Muecke PhD , Hans T. Eich PhD , Jan Kriz PhD

Radiotherapy has long been associated with the treatment of malignant tumors, yet its application in nonmalignant (benign) diseases predates many contemporary oncologic indications and has played a critical role in shaping the broader field of radiation medicine in early times. As of 2025, roughly 130 years have elapsed since the first experimental clinical applications of X‑rays and radium for non‑malignant conditions, and a review of this period may provide insights both into medical innovation and the trade‑offs inherent in using potentially harmful agents for nonmalignant indications. Such a historical overview can help us understand past missteps, guide present practice, and shape future research, especially in defining indications, optimizing dose/fractionation schedules, and ensuring long‑term monitoring of outcomes and risks. Our review will touch cornerstones and landmarks of the long and widely branched history of radiotherapy and also looks at the biographies of important pioneers of the field, so that we can learn from their thinking, research and experience.

放射治疗长期以来一直与恶性肿瘤的治疗有关，但其在非恶性（良性）疾病中的应用早于许多当代肿瘤适应症，并在早期形成更广泛的放射医学领域中发挥了关键作用。截至2025年，自X射线和镭首次用于非恶性疾病的实验性临床应用以来，已经过去了大约130年，对这一时期的回顾可能会对医疗创新和将潜在有害药物用于非恶性适应症所固有的权衡提供见解。这样的历史概述可以帮助我们了解过去的失误，指导当前的实践，并塑造未来的研究，特别是在确定适应症，优化剂量/分离计划以及确保长期监测结果和风险方面。我们的回顾将触及放射治疗漫长而广泛分支的历史的基石和里程碑，并着眼于该领域重要先驱的传记，以便我们可以从他们的思想，研究和经验中学习。

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引用次数: 0

Emerging Systemic Therapy Considerations for Pancreatic Cancer 胰腺癌新出现的全身治疗考虑

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.006

Kai-li Liang , Matthew Z. Guo , Neeha Zaidi

Pancreatic ductal adenocarcinoma (PDAC) is anticipated to be the second leading cause of cancer-related death in the United States by 2030. For the majority of patients who are diagnosed with de novo metastatic disease, 5-year overall survival remains dismal at less than 10%. Until recently, PDAC has been considered as a monolithic entity with limited treatment options. With advances in genomic profiling, targeted therapies, and immune-based strategies, a number of emerging biomarker-driven treatment modalities have begun to enter into clinical practice. In this review, we describe the historical perspective of systemic PDAC treatments in the advanced setting, as well as the emerging treatments which leverage genomic heterogeneity and synergistic mechanisms of action.

预计到2030年，胰腺导管腺癌（PDAC）将成为美国癌症相关死亡的第二大原因。对于大多数被诊断为新发转移性疾病的患者，5年总生存率仍然低于10%。直到最近，PDAC一直被认为是一个单一的实体，治疗选择有限。随着基因组分析、靶向治疗和基于免疫的策略的进步，许多新兴的生物标志物驱动的治疗方式已经开始进入临床实践。在这篇综述中，我们描述了在晚期环境中系统性PDAC治疗的历史观点，以及利用基因组异质性和协同作用机制的新兴治疗方法。

引用次数: 0

Driving Precision Medicine in Pancreatic Cancer With Molecular Genetics 分子遗传学推动胰腺癌精准医疗

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.08.004

Maria Farooq , Michael J. Pishvaian

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies with dismal 5-year survival rates. Characterized by its complex tumor microenvironment and resistance to conventional therapies, PDAC has historically been difficult to treat effectively. Recent advances in molecular profiling have revolutionized our understanding of the genetic landscape of pancreatic cancer. This review examines how molecular genetics is driving precision medicine approaches in pancreatic cancer, with particular focus on KRAS-targeted therapies. Understanding these developments is crucial for clinicians seeking to optimize treatment strategies and improve outcomes for patients with pancreatic cancer.

胰腺导管腺癌（PDAC）仍然是最致命的恶性肿瘤之一，其5年生存率低。PDAC肿瘤微环境复杂，对常规治疗有耐药性，历来难以有效治疗。分子图谱的最新进展彻底改变了我们对胰腺癌遗传格局的理解。这篇综述探讨了分子遗传学如何推动胰腺癌的精准医学方法，特别关注kras靶向治疗。了解这些发展对于寻求优化治疗策略和改善胰腺癌患者预后的临床医生至关重要。

引用次数: 0

Intraoperative Radiation for Pancreatic Cancer 胰腺癌术中放射治疗

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.008

Ahmed Elguindy , Dukagjin Blakaj , John Grecula , Eric D. Miller

Pancreatic cancer (PDAC) remains a challenging disease to treat with a poor prognosis. Management of PDAC has evolved over the last several decades with the development of more effective systemic therapy making local control of the primary tumor paramount in patients with both resectable and unresectable disease. Local recurrence after resection or progression of an unresectable tumor are significant causes of morbidity and potential mortality for patients with PDAC. Emerging data in PDAC suggest that improved local control and favorable survival can be achieved with radiation dose escalation. However, adjacent radiosensitive organs limit the ability to deliver higher doses of radiation therapy to patients. Intraoperative radiation therapy provides an ideal way to deliver large doses of radiation directly to the tumor or tumor bed while minimizing the radiation dose to adjacent normal organs. The purpose of this review is to provide an overview of the current literature demonstrating the utility of intraoperative radiation therapy in patients with resectable and unresectable PDAC.

胰腺癌（PDAC）仍然是一种具有挑战性的疾病，治疗预后差。在过去的几十年里，随着更有效的全身治疗的发展，PDAC的管理已经发生了变化，对于可切除和不可切除的疾病患者来说，局部控制原发肿瘤至关重要。切除后局部复发或不可切除肿瘤进展是PDAC患者发病和潜在死亡的重要原因。PDAC的新数据表明，随着辐射剂量的增加，局部控制的改善和良好的生存可以实现。然而，邻近的放射敏感器官限制了向患者提供高剂量放射治疗的能力。术中放射治疗提供了一种理想的方法，可以直接向肿瘤或肿瘤床提供大剂量的辐射，同时最大限度地减少对邻近正常器官的辐射剂量。本综述的目的是提供当前文献综述，证明术中放疗在可切除和不可切除PDAC患者中的应用。

引用次数: 0

Adjuvant Radiation for Resected Pancreatic Cancer: Historical Review and Current State 胰腺癌切除术的辅助放疗：历史回顾与现状

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.009

John Starner , Yen-Ruh Wuu , Nicholas Hornstein , Karyn A. Goodman , Joseph M. Herman , Ross Abrams , Leila T. Tchelebi

Pancreatic cancer is the third leading cause of cancer-related deaths, projected to become the second leading cause by 2040. Curative intent resection remains the only non-palliative treatment strategy; however, the 5-year overall survival rate remains 20% among resected patients. Postoperative treatments, including radiation therapy, have been studied to improve outcomes for patients, but the data remains inconclusive. Owing to improvements in radiation treatment quality and advancements in systemic therapy to control micrometastatic disease, further research is critical to determine the role of adjuvant radiation therapy in pancreatic cancer patients and to identify which patients derive the most benefit. Herein, we review the role of adjuvant radiation therapy in resected pancreatic ductal adenocarcinoma, evaluate the current state, and discuss future directions.

胰腺癌是癌症相关死亡的第三大原因，预计到2040年将成为第二大原因。治疗目的切除仍然是唯一的非姑息治疗策略；然而，切除患者的5年总生存率仍为20%。术后治疗，包括放射治疗，已被研究以改善患者的预后，但数据仍不确定。由于放射治疗质量的提高和控制微转移性疾病的全身治疗的进展，进一步的研究对于确定辅助放射治疗在胰腺癌患者中的作用以及确定哪些患者获得最大的益处至关重要。在此，我们回顾辅助放射治疗在胰腺导管腺癌切除术中的作用，评估目前的状态，并讨论未来的方向。

引用次数: 0

Optimal Target Volume Delineation for Pancreatic Cancer: Triangulating What Should be Targeted 胰腺癌的最佳靶体积描绘：三角定位应该是什么

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.08.003

Amol Narang

Optimal target volume delineation for pancreatic cancer remains an unanswered question across all stages of disease. To-date, target volume delineation has been highly variable across major clinical trials that have explored the role of radiation for this disease, which undoubtedly has contributed to the significant variation in outcomes that have been observed between such trials and the current controversy that has therefore been generated surrounding the role of radiation for pancreatic cancer. Importantly, emerging data has increasingly suggested that elective volume targeting is critical for this disease and that volume delineation should be driven by those patterns of locoregional spread that drive locoregional failure, namely extra-pancreatic perineural invasion. Herein, we review the historical approaches that have been used for target volume delineation across key studies to-date as well as recent data that provide critical insights into optimal target volume delineation in the setting of radiation for pancreatic cancer.

胰腺癌的最佳靶体积划定仍然是一个悬而未决的问题，在所有阶段的疾病。迄今为止，在探索放射治疗胰腺癌的作用的主要临床试验中，靶体积的描绘变化很大，这无疑导致了这些试验之间观察到的结果的显著差异，以及目前围绕放射治疗胰腺癌的作用产生的争议。重要的是，新出现的数据越来越多地表明，选择性体积靶向对于这种疾病至关重要，并且体积描绘应该由驱动局部区域衰竭的局部区域扩散模式驱动，即胰腺外神经周围浸润。在此，我们回顾了迄今为止在关键研究中用于靶体积描绘的历史方法，以及最近的数据，这些数据为胰腺癌放射治疗中最佳靶体积描绘提供了关键见解。

引用次数: 0

Beyond Opioids in Pancreatic Cancer: Palliative Radiotherapy and Celiac Plexus Radiosurgery 胰腺癌中的阿片类药物：姑息性放疗和腹腔丛放射手术

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.005

Marcin Miszczyk , Ross A. Abrams , Yaacov R. Lawrence

This review examines established and evolving approaches for radiation therapy as a palliative treatment modality in patients with pancreatic cancer within the context of effective patient-provider communication and early palliative care team based management. At presentation most patients with pancreatic cancer have advanced disease and a limited life expectancy. Typically, they suffer from multiple disease-related symptoms. Systemic therapies have limited palliative efficacy against symptoms associated with local disease. This is in contrast to radiation therapy, which appears efficient in achieving local symptom control. In addition to more conventional tumour-targeting stereotactic body radiation therapy (SBRT), and short-course conventional radiotherapy, a recent clinical trial demonstrated the effectiveness of a new approach - celiac plexus radiosurgery. In this article, we evaluate and compare the effectiveness of these treatment methods, demonstrating the important, yet underappreciated, role that hypofractionated radiation therapy has within the multidisciplinary management of patients with pancreatic cancer, including those with metastatic disease.

本文综述了在有效的患者-提供者沟通和早期姑息治疗团队管理的背景下，胰腺癌患者放射治疗作为姑息治疗方式的既定和不断发展的方法。多数胰腺癌患者发病时病情已进展，预期寿命有限。通常，他们患有多种与疾病相关的症状。对于与局部疾病相关的症状，全身治疗的缓解效果有限。这与放射治疗相反，放射治疗似乎能有效地控制局部症状。除了更传统的肿瘤靶向立体定向放射治疗（SBRT）和短期常规放射治疗外，最近的一项临床试验证明了一种新方法的有效性-腹腔丛放射手术。在本文中，我们评估和比较了这些治疗方法的有效性，证明了低分割放疗在胰腺癌患者（包括转移性疾病患者）的多学科治疗中的重要作用，但未被充分认识。

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引用次数: 0

Quality and Quantity: Dual Benefits of Ablative Radiation in Oligometastatic Pancreatic Cancer 质与量：消融放疗治疗少转移性胰腺癌的双重益处

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.004

Todd A. Aguilera , Ahmed M. Elamir , Ethan B. Ludmir

Oligometastatic pancreatic cancer (OPanc) poses significant opportunities in management, as increasingly metastases can be safely and effectively targeted with local therapy. We review the existing literature on SABR for OPanc, highlighting its potential benefits and limitations with an aim to define the trajectory of opportunity. SABR may offer a meaningful benefit to patients with OPanc, improving quality of life by enabling breaks from systemic therapy while potentially enhancing quantity of life or survival. Patient selection and clearly defined goals will be critical to demonstrate the value of this approach, and well powered prospective studies may be key. The most intriguing aspect of this discussion is the potential for SABR to enhance antitumor immunity that may play a role in prolonged minimal residual disease that can be achieved in some patients. This can translate to improved quality of life by reducing the need for systemic therapy. This approach may offer a novel solution to the treatment challenges associated with OPanc. Further research is needed to confirm the hypotheses and establish the definitive role of SABR in OPanc treatment.

少转移性胰腺癌（OPanc）在治疗中提供了重要的机会，因为越来越多的转移可以安全有效地靶向局部治疗。我们回顾了现有的关于OPanc SABR的文献，强调了其潜在的好处和局限性，目的是确定机会的轨迹。SABR可能为OPanc患者提供有意义的益处，通过中断全身治疗来改善生活质量，同时潜在地增加生命或生存期。患者选择和明确定义的目标对于证明这种方法的价值至关重要，而强有力的前瞻性研究可能是关键。这个讨论中最有趣的方面是SABR增强抗肿瘤免疫的潜力，这可能在一些患者中实现的延长的最小残留疾病中发挥作用。这可以通过减少对全身治疗的需求来改善生活质量。这种方法可能为与OPanc相关的治疗挑战提供一种新的解决方案。需要进一步的研究来证实这些假设，并确定SABR在OPanc治疗中的明确作用。

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