Seminars in Radiation Oncology最新文献

英文中文

Debate 2: The Case for Focal External Beam Radiation Therapy Boost Over Brachytherapy Boost for Prostate Cancer 辩论2：前列腺癌局灶外束放射治疗强化优于近距离放射治疗强化的案例

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.005

Anna M Dornisch , Tyler M Seibert

Modern trials demonstrate excellent outcomes for men with localized prostate cancer treated with radiation therapy. However, some patients experience recurrences, and more than one-third of recurrences are localized to the prostate. Treatment intensification through dose intensification could substantially benefit some patients with localized, unfavorable-risk prostate cancer. Currently, modern phase 3 randomized controlled trials support 2 treatment strategies. ASCENDE-RT evaluated whole-gland LDR brachytherapy boost, and FLAME evaluated a focal external beam radiation therapy (EBRT) boost to MRI-visible lesions. This review compares a FLAME-style EBRT boost vs a LDR brachytherapy boost in terms of oncologic outcomes, toxicity, and feasibility. The FLAME trial demonstrates that an EBRT boost to MRI visible lesions improves local control as well as regional and distant metastasis free survival without a significant increase in toxicity. In contrast, ASCENDE-RT reports an improvement in only biochemical recurrence free survival, and this comes at the expense of increased gastrointestinal and genitourinary toxicity. Beyond efficacy and toxicity, we discuss the challenges to widespread implementation of each technique, as treatment advances are only beneficial if they are available. While both techniques have unique barriers to implementation, we believe addressing the barriers for focal EBRT boost implementation are more addressable. In conclusion, we maintain that available high-level evidence supports a focal EBRT boost over brachytherapy because focal EBRT boost was shown to give a meaningful improvement in oncologic outcomes with minimal impact on quality of life.

现代试验表明，用放射疗法治疗局限性前列腺癌的效果很好。然而，一些患者会出现复发，超过三分之一的复发局限于前列腺。通过剂量强化来强化治疗可以使一些局限性、不良风险前列腺癌患者获益。目前，现代3期随机对照试验支持两种治疗策略。ASCENDE-RT评估了全腺体LDR近距离治疗的增强效果，FLAME评估了局灶外束放疗（EBRT）对mri可见病变的增强效果。本综述比较了flame型EBRT增强与LDR近距离治疗增强在肿瘤预后、毒性和可行性方面的差异。FLAME试验表明，EBRT对MRI可见病变的增强可以改善局部控制以及区域和远处转移的生存，而不会显著增加毒性。相比之下，ASCENDE-RT仅改善了生化无复发生存，而这是以增加胃肠道和泌尿生殖系统毒性为代价的。除了疗效和毒性之外，我们还讨论了每种技术广泛实施的挑战，因为治疗进步只有在它们可用时才有益。虽然这两种技术在实施方面都有独特的障碍，但我们认为解决重点EBRT促进实施的障碍是更容易解决的。总之，我们认为现有的高水平证据支持局灶性EBRT增强优于近距离治疗，因为局灶性EBRT增强已被证明在对生活质量影响最小的情况下对肿瘤预后有显著改善。

{"title":"Debate 2: The Case for Focal External Beam Radiation Therapy Boost Over Brachytherapy Boost for Prostate Cancer","authors":"Anna M Dornisch , Tyler M Seibert","doi":"10.1016/j.semradonc.2025.04.005","DOIUrl":"10.1016/j.semradonc.2025.04.005","url":null,"abstract":"<div><div>Modern trials demonstrate excellent outcomes for men with localized prostate cancer treated with radiation therapy. However, some patients experience recurrences, and more than one-third of recurrences are localized to the prostate. Treatment intensification through dose intensification could substantially benefit some patients with localized, unfavorable-risk prostate cancer. Currently, modern phase 3 randomized controlled trials support 2 treatment strategies. ASCENDE-RT evaluated whole-gland LDR brachytherapy boost, and FLAME evaluated a focal external beam radiation therapy (EBRT) boost to MRI-visible lesions. This review compares a FLAME-style EBRT boost vs a LDR brachytherapy boost in terms of oncologic outcomes, toxicity, and feasibility. The FLAME trial demonstrates that an EBRT boost to MRI visible lesions improves local control as well as regional and distant metastasis free survival without a significant increase in toxicity. In contrast, ASCENDE-RT reports an improvement in only biochemical recurrence free survival, and this comes at the expense of increased gastrointestinal and genitourinary toxicity. Beyond efficacy and toxicity, we discuss the challenges to widespread implementation of each technique, as treatment advances are only beneficial if they are available. While both techniques have unique barriers to implementation, we believe addressing the barriers for focal EBRT boost implementation are more addressable. In conclusion, we maintain that available high-level evidence supports a focal EBRT boost over brachytherapy because focal EBRT boost was shown to give a meaningful improvement in oncologic outcomes with minimal impact on quality of life.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 415-422"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Debate 2: Primary Localized Prostate Cancer: The Case for Whole-Gland Brachytherapy Boost 辩论2：原发性局限性前列腺癌：全腺体近距离放射治疗的案例

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.006

Amani A. Chowdhury , Peter J. Hoskin

Whole gland brachytherapy (BT) boost in combination with external beam radiotherapy (EBRT) improves biochemical relapse free survival (bRFS) for intermediate- and high-risk prostate cancer (PCa). Three randomized control studies (RCT) have demonstrated superiority over EBRT alone, and a meta-analysis alongside updated long-term data demonstrates an ongoing benefit with whole gland BT boost. There are concerns that improved tumor control comes at the expense of late genitourinary (GU) and gastrointestinal (GI) toxicities. Although studies investigating the role of a focal boost to the dominant intraprostatic lesion (DIL) have been conducted with promising outcomes and low toxicity rates, the multifocal and multiclonal nature of PCa as well as lack of head-to-head RCTs makes it difficult to justify the use of focal boost in place of whole gland boost. Similarly, many studies have used various EBRT techniques to deliver boost treatment despite the radiobiological advantages and stronger evidence base advocating for BT. On this basis, as well as the challenges of precise delineation of the DIL, whole gland BT boost in combination with EBRT remains the optimal radical radiotherapy regime for locally advanced PCa.

全腺体近距离放射治疗（BT）联合外束放射治疗（EBRT）可提高中高危前列腺癌（PCa）的生化无复发生存率（bRFS）。三项随机对照研究（RCT）证明了EBRT优于单独使用EBRT，一项荟萃分析以及更新的长期数据表明，全腺体BT增强的持续益处。人们担心，肿瘤控制的改善是以牺牲晚期泌尿生殖系统（GU）和胃肠道（GI）毒性为代价的。尽管研究局灶性增强对前列腺内主要病变（DIL）的作用的研究已经取得了令人鼓舞的结果和低毒性率，但PCa的多灶性和多克隆性以及缺乏头对头随机对照试验使得很难证明使用局灶性增强代替整个腺体增强是合理的。同样，许多研究使用了各种EBRT技术来提供增强治疗，尽管放射生物学优势和更强的证据基础支持BT。在此基础上，以及精确描绘DIL的挑战，全腺体BT增强联合EBRT仍然是局部晚期PCa的最佳根治性放疗方案。

{"title":"Debate 2: Primary Localized Prostate Cancer: The Case for Whole-Gland Brachytherapy Boost","authors":"Amani A. Chowdhury , Peter J. Hoskin","doi":"10.1016/j.semradonc.2025.04.006","DOIUrl":"10.1016/j.semradonc.2025.04.006","url":null,"abstract":"<div><div>Whole gland brachytherapy (BT) boost in combination with external beam radiotherapy (EBRT) improves biochemical relapse free survival (bRFS) for intermediate- and high-risk prostate cancer (PCa). Three randomized control studies (RCT) have demonstrated superiority over EBRT alone, and a meta-analysis alongside updated long-term data demonstrates an ongoing benefit with whole gland BT boost. There are concerns that improved tumor control comes at the expense of late genitourinary (GU) and gastrointestinal (GI) toxicities. Although studies investigating the role of a focal boost to the dominant intraprostatic lesion (DIL) have been conducted with promising outcomes and low toxicity rates, the multifocal and multiclonal nature of PCa as well as lack of head-to-head RCTs makes it difficult to justify the use of focal boost in place of whole gland boost. Similarly, many studies have used various EBRT techniques to deliver boost treatment despite the radiobiological advantages and stronger evidence base advocating for BT. On this basis, as well as the challenges of precise delineation of the DIL, whole gland BT boost in combination with EBRT remains the optimal radical radiotherapy regime for locally advanced PCa.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 402-414"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiotherapy for High-Risk Prostate Cancer 放疗治疗高危前列腺癌

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.05.002

Sophia C. Kamran , Xin Gao , Constantinos Zamboglou

引用次数: 0

The Evolving Management of Radiorecurrent Prostate Cancer 放射复发性前列腺癌的发展管理

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-06-12 DOI: 10.1016/j.semradonc.2025.04.014

Jacob Pozin , Menal Bhandari , Luca Valle , Nicholas G. Nickols , Amar U. Kishan , Sophia C. Kamran , Brian Baumann , Jason A. Efstathiou , Juanita Crook , David Pasquier , Stanley L. Liauw , Matthew M. Harkenrider , Abhishek A. Solanki

The detection of local radiorecurrence (LRR) of prostate cancer in the prostate or prostate bed after radiation therapy is increasingly common with the advent of advanced imaging modalities such as the PSMA PET/CT. Our aim is to review the literature and define the optimal workup for identifying LRR and discuss the key principals in management, with a focus on salvage re-irradiation. We performed a narrative review of the literature and ongoing studies centered on LRR workup and treatment. Workup for biochemical recurrence postradiation therapy includes PSMA PET/CT, multiparametric MRI, and systematic and targeted biopsy to confirm and define the extent of LRR. Historically, treatment options have included observation, palliative androgen deprivation therapy (ADT), or salvage local therapy to eradicate the LRR. Salvage local re-irradiation can be delivered using stereotactic body radiotherapy (SBRT), high dose rate (HDR) brachytherapy, or low dose rate (LDR) brachytherapy. Commonly used treatment regimens and practical considerations for the different salvage re-irradiation modalities based on the available literature are discussed. Salvage re-irradiation is a safe and effective treatment approach that offers a second chance to “cure” prostate cancer, while also delaying the need for palliative hormonal therapy. Salvage re-irradiation should be carefully considered in patients with LRR after weighing potential benefits against risks. Further data are needed to identify the optimal volume, dose and fractionation regimens.

随着PSMA PET/CT等先进成像技术的出现，前列腺癌放射治疗后前列腺或前列腺床局部放射复发（LRR）的检测越来越普遍。我们的目的是回顾文献并定义识别LRR的最佳工作，并讨论管理中的关键原则，重点是回收再辐照。我们对以LRR随访和治疗为中心的文献和正在进行的研究进行了叙述性回顾。放射治疗后生化复发的检查包括PSMA PET/CT、多参数MRI以及系统和靶向活检，以确认和确定LRR的程度。从历史上看，治疗方案包括观察，姑息性雄激素剥夺疗法（ADT），或挽救局部治疗以根除LRR。抢救性局部再照射可采用立体定向全身放疗（SBRT）、高剂量率（HDR）近距离放疗或低剂量率（LDR）近距离放疗。根据现有文献，讨论了常用的治疗方案和不同打捞再照射方式的实际考虑。补救性再照射是一种安全有效的治疗方法，为“治愈”前列腺癌提供了第二次机会，同时也推迟了姑息性激素治疗的需要。对于LRR患者，在权衡潜在的获益与风险后，应仔细考虑补救性再照射。需要进一步的数据来确定最佳的体积、剂量和分离方案。

{"title":"The Evolving Management of Radiorecurrent Prostate Cancer","authors":"Jacob Pozin , Menal Bhandari , Luca Valle , Nicholas G. Nickols , Amar U. Kishan , Sophia C. Kamran , Brian Baumann , Jason A. Efstathiou , Juanita Crook , David Pasquier , Stanley L. Liauw , Matthew M. Harkenrider , Abhishek A. Solanki","doi":"10.1016/j.semradonc.2025.04.014","DOIUrl":"10.1016/j.semradonc.2025.04.014","url":null,"abstract":"<div><div>The detection of local radiorecurrence (LRR) of prostate cancer in the prostate or prostate bed after radiation therapy is increasingly common with the advent of advanced imaging modalities such as the PSMA PET/CT. Our aim is to review the literature and define the optimal workup for identifying LRR and discuss the key principals in management, with a focus on salvage re-irradiation. We performed a narrative review of the literature and ongoing studies centered on LRR workup and treatment. Workup for biochemical recurrence postradiation therapy includes PSMA PET/CT, multiparametric MRI, and systematic and targeted biopsy to confirm and define the extent of LRR. Historically, treatment options have included observation, palliative androgen deprivation therapy (ADT), or salvage local therapy to eradicate the LRR. Salvage local re-irradiation can be delivered using stereotactic body radiotherapy (SBRT), high dose rate (HDR) brachytherapy, or low dose rate (LDR) brachytherapy. Commonly used treatment regimens and practical considerations for the different salvage re-irradiation modalities based on the available literature are discussed. Salvage re-irradiation is a safe and effective treatment approach that offers a second chance to “cure” prostate cancer, while also delaying the need for palliative hormonal therapy. Salvage re-irradiation should be carefully considered in patients with LRR after weighing potential benefits against risks. Further data are needed to identify the optimal volume, dose and fractionation regimens.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 3","pages":"Pages 450-462"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypofractionated Radiation Therapy in the Definitive Management of Head and Neck Cancer 低分割放疗在头颈部肿瘤的最终治疗中的应用

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.01.002

Dominic H. Moon M.D. , Musaddiq J. Awan M.D.

The use of hypofractionated radiation therapy has increased among many cancers, although its use in head and neck cancers remains limited due to concerns regarding acute and late toxicities. Recent retrospective and prospective studies demonstrate the preliminary safety and efficacy of hypofractionation in the definitive, postoperative, and preoperative settings for head and neck treatment. This article seeks to comprehensively review the rationale and data for novel fractionation schemes in this disease site. We also provide practical clinical and dosimetric insights based on our institutional experiences with hypofractionation in head and neck cancers.

在许多癌症中，低分割放射治疗的使用有所增加，尽管由于对急性和晚期毒性的担忧，其在头颈部癌症中的使用仍然有限。最近的回顾性和前瞻性研究表明，在头颈部治疗的最终、术后和术前设置中，低分割的初步安全性和有效性。本文旨在全面回顾这种疾病部位的新分离方案的基本原理和数据。我们还提供实用的临床和剂量学的见解基于我们的机构经验，在头颈癌的低分割。

引用次数: 0

Managing Patients with Head and Neck Cancer and Advanced Age or Comorbidities 头颈癌和高龄或合并症患者的管理

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.001

James M. Price , Loren K. Mell

The dominant treatment paradigm for locoregionally advanced head and neck squamous cell carcinoma (HNSCC) involves postoperative or definitive radiotherapy with concurrent cisplatin chemotherapy. Despite years of research investigating de-intensified treatment, cisplatin-based chemoradiotherapy remains the standard, yet it is associated with significant acute and chronic toxicity. However, due to shared risk factors, such as advanced age, and tobacco and alcohol use, patients with HNSCC frequently have comorbid illnesses that impact treatment tolerability, adding complexity to treatment-related decision-making. In addition, many patients have medical contraindications to cisplatin, requiring alternative treatment strategies. It is thus important to consider how well patients are likely to tolerate treatment, and how to adapt treatment in response to a patient's condition, when weighing treatment options. In this review, we aim to offer readers guidance in managing the elderly or comorbid patient with HNSCC, with particular attention to (i) approaching comorbidity and fragility assessment to make determinations on intensity of treatment, (ii) considering primary treatment modality (eg, surgery vs radiotherapy, chemo-radiotherapy vs radiotherapy alone) and (iii) choice of concurrent systemic therapy agent.

局部晚期头颈部鳞状细胞癌（HNSCC）的主要治疗模式包括术后或最终放疗合并顺铂化疗。尽管多年来对去强化治疗的研究，以顺铂为基础的放化疗仍然是标准，但它与显著的急性和慢性毒性有关。然而，由于共同的危险因素，如高龄、吸烟和饮酒，HNSCC患者经常有影响治疗耐受性的合并症，增加了治疗相关决策的复杂性。此外，许多患者有顺铂的医学禁忌症，需要替代治疗策略。因此，在权衡治疗方案时，重要的是要考虑患者对治疗的耐受程度，以及如何根据患者的病情调整治疗。在这篇综述中，我们的目的是为读者提供管理老年或合并症的HNSCC患者的指导，特别注意(i)走近合并症和脆弱性评估，以确定治疗强度，（ii）考虑主要治疗方式（例如，手术与放疗，化疗-放疗与单独放疗）和（iii）选择同步全身治疗药物。

{"title":"Managing Patients with Head and Neck Cancer and Advanced Age or Comorbidities","authors":"James M. Price , Loren K. Mell","doi":"10.1016/j.semradonc.2025.02.001","DOIUrl":"10.1016/j.semradonc.2025.02.001","url":null,"abstract":"<div><div>The dominant treatment paradigm for locoregionally advanced head and neck squamous cell carcinoma (HNSCC) involves postoperative or definitive radiotherapy with concurrent cisplatin chemotherapy. Despite years of research investigating de-intensified treatment, cisplatin-based chemoradiotherapy remains the standard, yet it is associated with significant acute and chronic toxicity. However, due to shared risk factors, such as advanced age, and tobacco and alcohol use, patients with HNSCC frequently have comorbid illnesses that impact treatment tolerability, adding complexity to treatment-related decision-making. In addition, many patients have medical contraindications to cisplatin, requiring alternative treatment strategies. It is thus important to consider how well patients are likely to tolerate treatment, and how to adapt treatment in response to a patient's condition, when weighing treatment options. In this review, we aim to offer readers guidance in managing the elderly or comorbid patient with HNSCC, with particular attention to (i) approaching comorbidity and fragility assessment to make determinations on intensity of treatment, (ii) considering primary treatment modality (eg, surgery <em>vs</em> radiotherapy, chemo-radiotherapy <em>vs</em> radiotherapy alone) and (iii) choice of concurrent systemic therapy agent.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 197-206"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Radiation-Therapy Related Salivary Dysfunction 放射治疗相关的唾液功能障碍

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.006

Grace C. Blitzer , Cristina Paz , Sara S. McCoy , Randall J. Kimple

Radiation-induced xerostomia (RIX) is a common and debilitating side effect of head and neck cancer radiotherapy, significantly impacting patients' quality of life. This review comprehensively summarizes the current understanding of RIX, encompassing its clinical quantification, underlying pathophysiology, and established and emerging treatment modalities. We explore various objective and subjective measures used to quantify salivary flow and assess the severity of xerostomia in clinical settings. The pathophysiological mechanisms leading to RIX are elucidated, including radiation damage to salivary glands, alterations in saliva composition, and the role of inflammatory processes. Current treatment strategies, such as saliva substitutes and stimulants, are discussed alongside their limitations. Furthermore, we delve into novel investigational approaches, including gene therapy, stem cell transplantation, and pharmacologic interventions, offering promising avenues for future RIX management. This review provides clinicians and researchers with a comprehensive overview of RIX, highlighting the need for continued research to develop more effective preventative and therapeutic strategies to alleviate this burdensome condition.

放射性口干症（RIX）是头颈癌放疗的常见副作用，严重影响患者的生活质量。这篇综述全面总结了目前对RIX的理解，包括其临床量化，潜在的病理生理学，以及建立和新兴的治疗方式。我们探索各种客观和主观的措施，用于量化唾液流量和评估严重程度的口干症在临床设置。导致RIX的病理生理机制被阐明，包括对唾液腺的辐射损伤、唾液成分的改变和炎症过程的作用。目前的治疗策略，如唾液替代品和兴奋剂，讨论了他们的局限性。此外，我们还深入研究了新的研究方法，包括基因治疗、干细胞移植和药物干预，为未来的RIX治疗提供了有希望的途径。这篇综述为临床医生和研究人员提供了对RIX的全面概述，强调了继续研究以开发更有效的预防和治疗策略以减轻这一繁重疾病的必要性。

{"title":"Radiation-Therapy Related Salivary Dysfunction","authors":"Grace C. Blitzer , Cristina Paz , Sara S. McCoy , Randall J. Kimple","doi":"10.1016/j.semradonc.2025.02.006","DOIUrl":"10.1016/j.semradonc.2025.02.006","url":null,"abstract":"<div><div>Radiation-induced xerostomia (RIX) is a common and debilitating side effect of head and neck cancer radiotherapy, significantly impacting patients' quality of life. This review comprehensively summarizes the current understanding of RIX, encompassing its clinical quantification, underlying pathophysiology, and established and emerging treatment modalities. We explore various objective and subjective measures used to quantify salivary flow and assess the severity of xerostomia in clinical settings. The pathophysiological mechanisms leading to RIX are elucidated, including radiation damage to salivary glands, alterations in saliva composition, and the role of inflammatory processes. Current treatment strategies, such as saliva substitutes and stimulants, are discussed alongside their limitations. Furthermore, we delve into novel investigational approaches, including gene therapy, stem cell transplantation, and pharmacologic interventions, offering promising avenues for future RIX management. This review provides clinicians and researchers with a comprehensive overview of RIX, highlighting the need for continued research to develop more effective preventative and therapeutic strategies to alleviate this burdensome condition.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 278-284"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Immunotherapy With Curative Intent Radiotherapy for Patients With Cancers of the Head and Neck 头颈部肿瘤患者的免疫治疗与治疗目的放疗

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.005

Jordan Hill , Jonathan D. Schoenfeld

引用次数: 0

Principles and Paradigms of De-Escalated Elective Nodal Irradiation: Boldly Going Towards an Inflection Point in Head and Neck Radiotherapy 降压选择性淋巴结照射的原则和范例：大胆走向头颈部放疗的拐点

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.01.001

Amir H. Safavi MD, MSc , Nancy Y. Lee MD , C. Jillian Tsai MD, PhD

Fundamental axioms of elective nodal irradiation (ENI) for head and neck cancers merit re-examination in contemporary practice. Standard ENI doses to volumes bordering critical organs-at-risk increased during the transition from two-dimensional radiation planning to intensity-modulated radiotherapy, despite improvements in detection of occult nodal metastases with modern imaging, use of concurrent chemotherapy, and identification of human papillomavirus (HPV)-related radiosensitivity. Historical large ENI volumes covering low-risk nodal regions continue to be commonly used even as awareness grows regarding the predominant pattern-of-failure within existing gross disease. In this review, we outline principles for de-escalating head and neck ENI dose and volume and highlight the emerging paradigm of ENI omission. We also propose a three-part approach to ENI de-escalation, the rationale for early adoption of de-escalated ENI in the absence of level-one evidence, and strategies to promote early adoption in light of modest equipoise and an inflection point towards changing the status quo.

选择性淋巴结照射（ENI）治疗头颈癌的基本原理值得在当代实践中重新审视。在从二维放射计划向调强放疗过渡期间，尽管现代成像技术在隐匿淋巴结转移的检测、同步化疗的使用和人乳头瘤病毒（HPV）相关放射敏感性的鉴定方面有所改善，但关键危险器官周边体积的标准ENI剂量增加了。覆盖低风险淋巴结区域的历史大ENI量继续被普遍使用，即使人们对现有总体疾病中主要的失败模式的认识不断提高。在这篇综述中，我们概述了降低头颈部ENI剂量和体积的原则，并强调了新兴的ENI遗漏范例。我们还提出了一个由三部分组成的ENI降级方法，在缺乏一级证据的情况下早期采用降级ENI的理由，以及根据适度平衡和改变现状的拐点促进早期采用的策略。

{"title":"Principles and Paradigms of De-Escalated Elective Nodal Irradiation: Boldly Going Towards an Inflection Point in Head and Neck Radiotherapy","authors":"Amir H. Safavi MD, MSc , Nancy Y. Lee MD , C. Jillian Tsai MD, PhD","doi":"10.1016/j.semradonc.2025.01.001","DOIUrl":"10.1016/j.semradonc.2025.01.001","url":null,"abstract":"<div><div>Fundamental axioms of elective nodal irradiation (ENI) for head and neck cancers merit re-examination in contemporary practice. Standard ENI doses to volumes bordering critical organs-at-risk increased during the transition from two-dimensional radiation planning to intensity-modulated radiotherapy, despite improvements in detection of occult nodal metastases with modern imaging, use of concurrent chemotherapy, and identification of human papillomavirus (HPV)-related radiosensitivity. Historical large ENI volumes covering low-risk nodal regions continue to be commonly used even as awareness grows regarding the predominant pattern-of-failure within existing gross disease. In this review, we outline principles for de-escalating head and neck ENI dose and volume and highlight the emerging paradigm of ENI omission. We also propose a three-part approach to ENI de-escalation, the rationale for early adoption of de-escalated ENI in the absence of level-one evidence, and strategies to promote early adoption in light of modest equipoise and an inflection point towards changing the status quo.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 143-156"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reirradiation for Locally Recurrent Head and Neck Cancer: State-of-the-Art and Future Directions 局部复发头颈癌的再放射治疗：最新进展及未来方向

IF 2.6 3区医学 Q3 ONCOLOGY

Seminars in Radiation Oncology

Pub Date : 2025-03-14 DOI: 10.1016/j.semradonc.2025.02.009

Jack Phan , Michael T. Spiotto , Christopher D. Goodman , Jay Reddy , Phillip Newcomm , Adam S. Garden , Anna Lee

Reirradiation of the head and neck presents one of the most complex and challenging scenarios faced by (for) clinicians due to the narrow therapeutic window. Its use is increasing in clinical practice, often guided by empirical and pragmatic approaches due to the limited availability of high-level evidence from randomized clinical trials. Successful reirradiation requires a precise balance between tumor control probability (TCP) and normal tissue complication probability (NTCP). Advances in radiation technologies, including intensity-modulated radiation therapy (IMRT), proton beam therapy (PBT), and stereotactic body radiation therapy (SBRT), have enabled more precise high-dose delivery, potentially improving dose distribution and reducing severe toxicity. This review explores current state-of-the-art approaches to reirradiating recurrent head and neck cancer, focusing on modern reirradiation techniques and critically assessing the literature on their clinical application, integration with systemic therapy, and future directions. It also addresses key practical challenges related to patient selection and toxicity/risk management, offering a comprehensive overview of the evolving treatment landscape and highlighting some of the most complex issues clinicians face in reirradiation.

由于治疗窗口狭窄，头颈部的再照射是临床医生面临的最复杂和最具挑战性的情况之一。它在临床实践中的应用越来越多，由于随机临床试验的高水平证据有限，通常以经验和务实的方法为指导。成功的再照射需要肿瘤控制概率（TCP）和正常组织并发症概率（NTCP）之间的精确平衡。放射技术的进步，包括调强放射治疗（IMRT）、质子束治疗（PBT）和立体定向体放射治疗（SBRT），使更精确的高剂量递送成为可能，有可能改善剂量分布并减少严重毒性。本综述探讨了目前最先进的复发性头颈癌再照射方法，重点关注现代再照射技术，并对其临床应用、与全身治疗的结合以及未来发展方向进行了批判性评估。它还解决了与患者选择和毒性/风险管理相关的关键实际挑战，提供了不断发展的治疗前景的全面概述，并强调了临床医生在再照射中面临的一些最复杂的问题。

{"title":"Reirradiation for Locally Recurrent Head and Neck Cancer: State-of-the-Art and Future Directions","authors":"Jack Phan , Michael T. Spiotto , Christopher D. Goodman , Jay Reddy , Phillip Newcomm , Adam S. Garden , Anna Lee","doi":"10.1016/j.semradonc.2025.02.009","DOIUrl":"10.1016/j.semradonc.2025.02.009","url":null,"abstract":"<div><div>Reirradiation of the head and neck presents one of the most complex and challenging scenarios faced by (for) clinicians due to the narrow therapeutic window. Its use is increasing in clinical practice, often guided by empirical and pragmatic approaches due to the limited availability of high-level evidence from randomized clinical trials. Successful reirradiation requires a precise balance between tumor control probability (TCP) and normal tissue complication probability (NTCP). Advances in radiation technologies, including intensity-modulated radiation therapy (IMRT), proton beam therapy (PBT), and stereotactic body radiation therapy (SBRT), have enabled more precise high-dose delivery, potentially improving dose distribution and reducing severe toxicity. This review explores current state-of-the-art approaches to reirradiating recurrent head and neck cancer, focusing on modern reirradiation techniques and critically assessing the literature on their clinical application, integration with systemic therapy, and future directions. It also addresses key practical challenges related to patient selection and toxicity/risk management, offering a comprehensive overview of the evolving treatment landscape and highlighting some of the most complex issues clinicians face in reirradiation.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"35 2","pages":"Pages 243-258"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Seminars in Radiation Oncology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀