Seminars in Radiation Oncology最新文献

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Clinical Applications of Quantitative Imaging and Artificial Intelligence for Pancreatic Cance 胰腺癌定量成像与人工智能的临床应用

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.003

Yeseul Kim , David Martinus , Taydan T. Tran , Michael K. Rooney , Anya Pant , Rance B. Tino , Eugene J. Koay

Pancreatic cancer remains as a leading cause of cancer death in the United States due to the disease’s deadly combination of evasiveness to detection, aggressive biology, and resistance to treatment. Quantitative imaging and artificial intelligence (AI) methods are emerging as promising and innovative techniques to combat the extensive challenges facing the clinic in the diagnosis and treatment of pancreatic ductal adenocarcinoma. These methods extract data from the fabric of clinical images that allow for earlier diagnosis, improved prognostication, automation of treatment planning, and increased reliability for response assessment. This review examines quantitative imaging techniques from 2013 to 2025 and summarizes them into three parts: differential diagnosis for pancreatic disease, grading and staging of pancreatic tumors, and treatment response assessment and prognosis prediction. We outline key challenges specific to pancreatic cancer and potential mitigations for future direction. We also highlight developing areas such as MRI-guided adaptive radiotherapy, automated target delineation, and integrated radiomic-omics tools that may help incorporate quantitative imaging into routine care of pancreatic cancer. Altogether, the current investigation suggests that quantitative imaging will become an integral tool for this disease across the oncologic journey of a patient.

在美国，胰腺癌仍然是癌症死亡的主要原因，这是由于这种疾病的致命组合，难以被发现，具有侵袭性的生物学和对治疗的耐药性。定量成像和人工智能（AI）方法正在成为有前途的创新技术，以应对临床在胰腺导管腺癌的诊断和治疗中面临的广泛挑战。这些方法从临床图像结构中提取数据，从而实现早期诊断，改善预后，自动化治疗计划，并提高反应评估的可靠性。本文回顾了2013年至2025年的定量影像学技术，并将其归纳为胰腺疾病的鉴别诊断、胰腺肿瘤的分级与分期、治疗反应评估与预后预测三个部分。我们概述了胰腺癌特有的关键挑战和未来方向的潜在缓解措施。我们还强调了mri引导的自适应放疗、自动靶标描绘和集成放射组学工具等发展领域，这些工具可能有助于将定量成像纳入胰腺癌的常规护理中。总之，目前的研究表明，定量成像将成为该疾病在患者整个肿瘤过程中的一个不可或缺的工具。

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引用次数: 0

Moving Beyond the Standard Pancreatectomy for Pancreatic Adenocarcinoma 超越标准胰腺切除术治疗胰腺腺癌

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.08.001

Madeleine D. Hunter , Nupur Shridhar , Kate Mlouk , Brian Kaplan , Greg D. Sacks , Christopher L. Wolfgang , Michael D. Kluger

This manuscript describes the evolution in the operative management of pancreatic cancer. Early attempts at pancreatic resection were met with daunting peri‑operative outcomes but were fine-tuned to yield today’s established pancreatic resections. Advances in medical therapy, including neo-adjuvant therapy for borderline resectable pancreatic cancers and refined adjuvant regimens, have improved oncologic outcomes and are allowing surgeons to move beyond current anatomic distinctions of resectability. Venous, hepatic artery and celiac axis resection during pancreatectomy are now common vascular operations at specialty centers which have been associated with favorable oncologic outcomes. Recent efforts are addressing locally advanced pancreatic cancer with superior mesenteric artery and/or multivessel involvement using either arterial divestment or arterial resection and reconstruction. An additional consideration in the treatment of pancreatic cancer is the benefit and risks of neoadjuvant radiation in locally advanced cases which has been avoided thus far given concerns regarding the effect of radiation on the vasculature. Therefore, with these improvements in peri‑operative therapy and robust preoperative planning often with the aid of vascular and microvascular surgeons, several centers have been exploring new frontiers in the operative management of locally advanced pancreatic adenocarcinoma.

本文描述了胰腺癌手术治疗的进展。早期胰腺切除术的尝试在围手术期的结果令人生畏，但经过微调后，今天已经建立了胰腺切除术。医学治疗的进步，包括边缘可切除胰腺癌的新辅助治疗和精细辅助方案，改善了肿瘤预后，并使外科医生能够超越目前可切除性的解剖差异。在胰腺切除术中进行静脉、肝动脉和腹腔轴切除是目前专业中心常见的血管手术，具有良好的肿瘤预后。最近的努力是解决局部晚期胰腺癌与肠系膜上动脉和/或多血管累及，无论是动脉剥离或动脉切除和重建。胰腺癌治疗的另一个考虑因素是局部晚期病例新辅助放疗的益处和风险，由于考虑到放疗对脉管系统的影响，迄今为止一直避免新辅助放疗。因此，在血管和微血管外科医生的帮助下，随着围手术期治疗的改进和完善的术前计划，一些中心已经在局部晚期胰腺腺癌的手术治疗中探索了新的领域。

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引用次数: 0

Contemporary Advances, Evidence, and Considerations in Preoperative Therapy for Pancreatic Ductal Adenocarcinoma 胰腺导管腺癌术前治疗的当代进展、证据和考虑

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.007

Alexander D. Sherry MD , Alexandra K. Bennett MD , Ryan M. Carr MD, PhD , Mark J. Truty MD, MS , Krishan R. Jethwa MD

Localized pancreatic ductal adenocarcinoma (PDAC) has been historically associated with poor disease control outcomes following surgical resection alone. Due to the high risk of occult locoregional and distant metastatic disease and anatomic tumor complexity limiting margin-negative resectability, preoperative therapy has emerged as an appealing strategy for many patients across the spectrum of localized PDAC. Here, we critically review the context, evidence, and controversies regarding preoperative therapy for PDAC. We first discuss the natural history of PDAC, patterns of spread and postoperative therapy. We then consider current issues of resectability, patient selection, therapy sequencing, and specifically the role of radiation therapy, including chemoradiation and stereotactic body radiation therapy, in the preoperative paradigm respectively. We conclude by discussing ongoing trials attempting to provide further insights and illuminating the path towards the improvement of outcomes in this patient population.

局限性胰腺导管腺癌（PDAC）历来与单纯手术切除后疾病控制效果差有关。由于隐蔽性局部和远处转移性疾病的高风险以及肿瘤的解剖复杂性限制了边缘阴性的可切除性，术前治疗已成为许多局限性PDAC患者的一种有吸引力的策略。在这里，我们批判性地回顾了关于术前治疗PDAC的背景、证据和争议。我们首先讨论PDAC的自然历史、扩散模式和术后治疗。然后，我们考虑当前的可切除性，患者选择，治疗顺序，特别是放射治疗的作用，包括放化疗和立体定向体放射治疗，分别在术前范例中。最后，我们讨论正在进行的试验，试图提供进一步的见解，并为改善这一患者群体的结果指明道路。

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引用次数: 0

Definitive Radiotherapy for Locally Advanced Unresectable Pancreatic Cancer: Historical Review, Current State and Future Directions 局部晚期不可切除胰腺癌的明确放疗：历史回顾，现状和未来方向

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.07.002

Anjalika R. Kumar , Nina N. Sanford

Based on available Level 1 evidence, standard dose conventional chemoradiation does not improve survival in patients with locally advanced pancreas cancer (LAPC), thus chemotherapy remains the only widely accepted therapy. Yet prognosis remains poor, and despite the negative trial outcomes, most would contend that the addition of radiotherapy does confer benefit in a subset of patients with LAPC. This work reviews the published data, then discusses several key considerations for designing radiotherapy trials in LAPC including choosing clinically meaningful patient-centered endpoints, optimizing patient selection and standardizing target volume delineation. Lastly, we review several promising single arm studies on dose-escalated radiotherapy in LAPC which have paved the way for upcoming Phase III randomized trials assessing this strategy.

根据现有的一级证据，标准剂量的常规放化疗不能提高局部晚期胰腺癌（LAPC）患者的生存率，因此化疗仍然是唯一被广泛接受的治疗方法。然而，预后仍然很差，尽管试验结果消极，但大多数人认为放疗的增加确实会给一部分LAPC患者带来好处。本工作回顾了已发表的数据，然后讨论了在LAPC中设计放疗试验的几个关键考虑因素，包括选择临床有意义的以患者为中心的终点，优化患者选择和标准化靶体积描绘。最后，我们回顾了几项在LAPC中剂量递增放疗的有希望的单组研究，这些研究为即将到来的评估该策略的III期随机试验铺平了道路。

引用次数: 0

The Role of MR Guided Radiation Therapy in Pancreatic Cancer Treatment 磁共振引导放射治疗在胰腺癌治疗中的作用

IF 3.2 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-09-09 DOI: 10.1016/j.semradonc.2025.08.002

Alden D’Souza , Shannon Jiang , Michael D Chuong , Hyun Kim

引用次数: 0

Novel biomarkers for guiding treatment for prostate cancer 指导前列腺癌治疗的新生物标志物

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.002

David D. Yang, Paul L. Nguyen

Risk stratification is a cornerstone of the clinical management of nonmetastatic prostate cancer. Conventional risk stratification has relied on clinical and pathologic variables, which allow for patients to be placed into risk groups that help guide prognostication and treatment recommendations. However, the performance of conventional risk stratification systems is suboptimal, leading to undertreatment for some patients and overtreatment (with potentially avoidable side-effects) for others. In recent years, a number of novel biomarkers, with potential to significantly advance risk stratification, have appeared, including molecular, imaging, and digital pathology biomarkers. This review summarizes the technologies behind these novel biomarkers, their established clinical roles, challenges and limitations, and future directions.

风险分层是非转移性前列腺癌临床管理的基石。传统的风险分层依赖于临床和病理变量，允许将患者分为风险组，以帮助指导预后和治疗建议。然而，传统的风险分层系统的表现并不理想，导致一些患者治疗不足，而另一些患者治疗过度（可能有可避免的副作用）。近年来，出现了许多具有显著推进风险分层潜力的新型生物标志物，包括分子、成像和数字病理生物标志物。本文综述了这些新型生物标志物背后的技术、它们已确立的临床作用、挑战和局限性以及未来的发展方向。

引用次数: 0

The Use of Particle Therapy in Prostate Cancer 粒子疗法在前列腺癌中的应用

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.03.001

Abigail Pepin, Arun Goel, Neha Vapiwala

Prostate cancer represents the most common nonskin malignancy among males in the United States. There are a variety of treatment options for men with localized prostate cancer including surgery or radiation therapy. While recent advances in prostate cancer screening and treatment have improved prostate cancer outcomes, toxicity mitigation and attention to patient-related quality of life is critical. The employment of particle therapy may help us accomplish these objectives by allowing for increased dose escalation to tumor while lowering integral dose and improving dose distribution to organs at risk. Herein, we explore the use of particle bream radiotherapy for the treatment of prostate cancer and its evidence to date. More prospective data is needed on whether these therapies translate into clinically meaningful improvements in prostate cancer care, both from a quality of life and outcome perspective.

前列腺癌是美国男性中最常见的非皮肤恶性肿瘤。对于患有局限性前列腺癌的男性有多种治疗选择，包括手术或放射治疗。虽然前列腺癌筛查和治疗的最新进展改善了前列腺癌的预后，但毒性缓解和对患者相关生活质量的关注至关重要。粒子治疗的使用可以帮助我们实现这些目标，因为它允许增加肿瘤的剂量递增，同时降低整体剂量并改善危险器官的剂量分布。在此，我们探讨使用粒子鱼放射治疗前列腺癌及其证据到目前为止。从生活质量和预后的角度来看，这些疗法是否转化为前列腺癌治疗的临床有意义的改善，还需要更多的前瞻性数据。

引用次数: 0

Postoperative Radiation Therapy and Controversies Regarding Hormonal Therapy in the Management of Prostate Cancer 前列腺癌术后放射治疗及激素治疗争议

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.009

Vérane Achard , Alan Dal Pra , Paul Sargos

Biochemical recurrence (BCR) after radical prostatectomy (RP) remains a clinical challenge, with significant heterogeneity in outcomes and optimal management strategies. Salvage radiotherapy (sRT) is the standard approach, yet the role and duration of concurrent hormonal therapy (ADT) are still debated. Four key randomized controlled trials—RTOG 9601, GETUG-AFU 16, RTOG 0534 SPPORT, and RADICALS-HD—have explored the addition of ADT to sRT. While ADT consistently improved progression-free survival metastasis-free survival (MFS) benefit was not consistently observed, and overall survival (OS) gains were limited and primarily confined to patients with higher pre-sRT PSA levels (>0.6-0.7 ng/mL). Toxicity associated with long-term ADT, including metabolic and cardiovascular effects, underscores the importance of patient selection. Emerging tools such as PSMA PET/CT and the Decipher genomic classifier show promise in refining risk stratification. PSMA PET/CT can identify occult metastases and guide treatment planning, while Decipher can help predict who may benefit from ADT. Retrospective and prospective data support their integration into clinical practice. Recent trials evaluating intensified systemic therapy with androgen receptor pathway inhibitors (ARPIs) in combination with sRT suggest potential benefit in high-risk BCR populations, although added toxicity remains a concern. The optimal role and timing of ARPIs in the early salvage setting require further investigation. In conclusion, the decision to add ADT to sRT in BCR patients should be individualized based on PSA kinetics, imaging, and genomic profiling. Shared decision-making and future biomarker-driven trials will be key to personalizing therapy and improving outcomes while minimizing harm.

根治性前列腺切除术（RP）后的生化复发（BCR）仍然是一个临床挑战，在结果和最佳管理策略方面存在显著的异质性。补救性放射治疗（sRT）是标准的方法，但同步激素治疗（ADT）的作用和持续时间仍有争议。四个关键的随机对照试验RTOG 9601、GETUG-AFU 16、RTOG 0534 SPPORT和radical - hd探讨了ADT在sRT中的添加。虽然ADT持续改善无进展生存期（MFS），但并没有一致观察到无转移生存期（MFS）的益处，而且总生存期（OS）的获益有限，主要局限于srt前PSA水平较高（0.6-0.7 ng/mL）的患者。与长期ADT相关的毒性，包括代谢和心血管影响，强调了患者选择的重要性。PSMA PET/CT和Decipher基因组分类器等新兴工具在细化风险分层方面表现出了希望。PSMA PET/CT可以识别隐匿性转移并指导治疗计划，而Decipher可以帮助预测谁可能从ADT中受益。回顾性和前瞻性数据支持其融入临床实践。最近评估雄激素受体途径抑制剂（arpi）联合sRT强化全身治疗的试验表明，尽管增加的毒性仍然是一个问题，但对高危BCR人群有潜在的益处。arpi在早期救助环境中的最佳作用和时机需要进一步研究。总之，BCR患者在sRT中加入ADT的决定应根据PSA动力学、影像学和基因组谱进行个体化。共享决策和未来生物标志物驱动的试验将是个性化治疗和改善结果的关键，同时将危害降到最低。

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引用次数: 0

Advancing Prostate Cancer Treatment: A Review of CT and MR-Guided Online Adaptive Radiotherapy Techniques 推进前列腺癌治疗：CT和mr引导的在线适应性放疗技术综述

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.007

Jesus E. Juarez Casillas, Luca F. Valle, Jonathan Pham, Dylan O’Connell, X. Sharon Qi, James M. Lamb, Melissa Ghafarian, Michael L. Steinberg, Minsong Cao, Amar U. Kishan

Radiotherapy remains a cornerstone in the management of prostate cancer (PCa) with continuous technological advancements significantly improving precision and reducing treatment-related toxicity. Among these innovations, adaptive radiotherapy (ART) is revolutionizing the field by enhancing treatment precision through advanced imaging, real-time motion tracking, and on-table adaptive planning. ART carries the potential to optimize therapeutic outcomes by adjusting radiation dose in response to anatomical changes that previously could not be accounted for, thus minimizing damage to healthy tissue and increasing the delivery of dose to therapeutic targets. Magnetic resonance (MR) and computed tomography (CT) imaging have played pivotal roles in ART by providing detailed anatomical and functional insights for treatment planning and realtime guidance. This review explores the technical principles, clinical applications, and recent technological developments of ART in the management of PCa. It describes both offline and online ART workflows and compares CT-guided and MR-guided approaches, outlining how each modality enhances the precision of radiation delivery through improved visualization, auto-segmentation, and plan adaptation capabilities. As ART technologies continue to evolve, these imaging-guided modalities are poised to refine prostate RT by enabling safer dose escalation, minimized toxicity, and ultimately, improved patient outcomes.

放射治疗仍然是前列腺癌（PCa）治疗的基石，随着技术的不断进步，放射治疗的准确性大大提高，治疗相关的毒性也大大降低。在这些创新中，适应性放疗（ART）通过先进的成像、实时运动跟踪和桌上适应性规划提高治疗精度，正在彻底改变该领域。抗逆转录病毒治疗具有优化治疗结果的潜力，可以根据以前无法解释的解剖变化调整辐射剂量，从而最大限度地减少对健康组织的损害，并增加对治疗目标的剂量递送。磁共振（MR）和计算机断层扫描（CT）成像通过为治疗计划和实时指导提供详细的解剖和功能见解，在抗逆转录病毒治疗中发挥了关键作用。本文综述了ART治疗前列腺癌的技术原理、临床应用和最新技术进展。它描述了离线和在线ART工作流程，并比较了ct引导和mr引导的方法，概述了每种方式如何通过改进的可视化、自动分割和计划适应能力来提高辐射输送的精度。随着ART技术的不断发展，这些成像引导的方式可以通过更安全的剂量递增、最小化毒性并最终改善患者的预后来改进前列腺RT。

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引用次数: 0

Optimizing Radiation Therapy for Localized Prostate Cancer: Exploring Synergies With Androgen Deprivation Therapy and Novel Systemic Agents 优化局部前列腺癌的放射治疗：探索雄激素剥夺疗法和新型全身药物的协同作用

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.001

Krishnan R. Patel , Melissa Abel , Spyridon P. Basourakos , Deborah E. Citrin , Ravi A. Madan

Although radiation therapy has been used as a curative treatment option for patients with localized prostate cancer for decades, there remains a continued need to improve outcomes for patients with localized disease. Systemic therapy in the form of androgen deprivation therapy (ADT) is an important adjunct to radiation therapy which may serve to improve the curative potential of treatment; however, not all forms of systemic therapy which have demonstrated activity in metastatic prostate cancer will improve outcomes for patients with localized disease. Research into the use of radiation therapy with ADT, androgen receptor signaling inhibitors (ARSIs), chemotherapy, poly(ADP-ribose) polymerase (PARP) inhibitors, immunotherapy, and other small molecule inhibitors is ongoing and will help to define not only which of these may be beneficial for patients localized prostate cancer but also which patients may be optimal candidates to receive these adjunctive therapies.

虽然几十年来放疗一直被用作治疗局限性前列腺癌患者的一种治疗选择，但仍然需要继续改善局限性前列腺癌患者的预后。以雄激素剥夺疗法（ADT）形式进行的全身治疗是放射治疗的重要辅助手段，可能有助于提高治疗的治愈潜力；然而，并不是所有形式的系统性治疗都能改善转移性前列腺癌患者的预后。放射治疗与ADT、雄激素受体信号抑制剂（ARSIs）、化疗、聚（adp -核糖）聚合酶（PARP）抑制剂、免疫治疗和其他小分子抑制剂的使用研究正在进行中，这不仅有助于确定哪些治疗对局限性前列腺癌患者有益，而且有助于确定哪些患者可能是接受这些辅助治疗的最佳人选。

引用次数: 0

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