Radiation Oncology最新文献

Background: Cancer associated fibroblasts have become a target of interest in different malignancies for positron emission tomography (PET) imaging, using positron emitter labelled fibroblast activation protein inhibitors (FAPI). New data underline the advanced imaging properties of FAPI-PET/CT for the staging of esophageal cancer compared to standard imaging. Potential benefits of FAPI-PET/CT in radiation therapy planning are the subject of this investigation.

Methods: Ten patients with newly diagnosed esophageal cancer treated with radiochemotherapy (RCT) were retrospectively analyzed. All patients underwent [68Ga]OncoFAP-PET/CT in treatment position to facilitate radiation treatment planning. Six patients received neoadjuvant RCT as part of a trimodal therapy and four patients underwent definitive RCT. In five cases, restaging after initial treatment was performed with FAPI-PET/CT.

Results: [68Ga]OncoFAP-PET/CT based imaging showed a high correlation with the endoscopic staging for initial imaging. In three cases, new sites of disease were unmasked, not visible in CT- and endosonographic staging. [68Ga]OncoFAP-PET/CT based RT delineation offered good definition of clinical target volumes, especially in retro-/paracardial areas and the gastroesophageal junction.

Conclusion: [68Ga]OncoFAP-PET/CT may aid and improve radiation treatment planning for patients with esophageal cancer.

Background: Glioblastomas all eventually relapse after initial treatment, and an option to treat these recurrences is fractionated stereotactic reirradiation (fSRT). The location of recurrences following reirradiation has not been studied for fSRT delivered by a dedicated stereotactic device. We aimed to analyze these locations to better elucidate safety margins, dose and fractionation regimens.

Methods: We retrospectively analyzed the data of patients with glioblastoma recurrence that had been reirradiated by fSRT in October 2010-December 2020, in 25 Gy in 5 fractions delivered by a CyberKnife^® at Institut de Cancérologie de Lorraine. We matched the images of the post-fSRT relapse with the stereotactic radiation treatment planning scan to determine the relapse location.

Results: The location of recurrences after fSRT was "out-field" in 43.5%, "marginal" in 40.3%, and "in-field" in 16.1% of patients (N = 62). A GTV-PTV margin of 1 mm (versus 2-3 mm, HR = 0.38 [0.15-0.95], p = 0.037) and a PTV volume of ≥ 36 cc (HR = 5.18 [1.06-25.3], p = 0.042) were significantly associated with the "marginal" recurrences. Being ≥ 60 years old at initial treatment (HR = 3.06 [1.17-8.01], p = 0.023) and having one or more previous recurrences (HR = 5.29 [1.70-16.5], p = 0.004) were significantly associated with "out-field" recurrences. The median PFS from fSRT was 3.4 months, and OS from diagnosis and from fSRT were 25.7 and 10.8 months respectively.

Conclusion: Reirradiation of glioblastoma recurrence by fSRT with 25 Gy in 5 fractions provides good local control.

Background and purpose: The study aimed to create a radiomics model based on breast intra- and peri-tumoral regions in dynamic contrast-enhanced (DCE) MRI to distinguish benign from malignant breast lesions of Breast Imaging Reporting and Data System (BI-RADS) 4.

Materials and methods: A total of 516 patients from Hospital 1 were assigned to the training cohort. Then, 146 and 52 patients were enrolled from Hospital 2 and 3, respectively, as the internal and external test cohort. Seven classification models were built, using features extracted from the intra- and peri-tumoral regions. Diagnostic performance was evaluated by receiver operating characteristics (ROC) analysis and compared by the DeLong test. Subgroup analysis was performed after stratifying all lesions by enhancement pattern and the subdivision of BI-RADS 4.

Results: The Comb2 model, built with features from peri-tumoral 2 mm and intra-tumoral region, demonstrated the best performance with AUCs of 0.828 and 0.844 in the internal and external test cohort, respectively. The Comb2 model was robust in both mass and non-mass enhancement (NME) lesions. At the three exploratory cutoff values on the ROC curve, the model identified 9.1% (sensitivity of C1 ≥ 98%), 27.3% (sensitivity of C2 ≥ 95%) and 36.4% (sensitivity of C3 ≥ 90%) of the benign lesions in the external test cohort. Applying the identified cutoff values in the external test cohort showed the potential to lower the number of unnecessary biopsies of benign lesions.

Conclusion: An MRI-based radiomics model built with features extracted from the intra-tumoral region combined with the peri-tumoral 2 mm showed the best potential to reduce false-positive diagnoses and may avoid unnecessary biopsies with a low underestimate risk.

Background: Deformable registration plays an important role in the accurate delineation of tumors. Most of the existing deep learning methods ignored two issues that can lead to inaccurate registration, including the limited field of view in MR scans and the different scanning angles that can exist between multimodal images. The purpose of this study is to improve the registration accuracy between CT and MR for nasopharyngeal carcinoma cases.

Methods: 269 cases were enrolled in the study, and 188 cases were designated for training, while a separate set of 81 cases was reserved for testing. Each case had a CT volume and a T1-MR volume. The treatment table was removed from their CT images. The CycleFCNs model was used for deformable registration, and two strategies including adaptive mask registration strategy and weight allocation strategy were adopted for training. Dice similarity coefficient, Hausdorff distance, precision, and recall were calculated for normal tissues of CT-MR image pairs, before and after the registration. Three deformable registration methods including RayStation, Elastix, and VoxelMorph were compared with the proposed method.

Results: The registration results of RayStation and Elastix are essentially consistent. Upon employing the VoxelMorph model and the proposed method for registration, a clear trend of increased dice similarity coefficient and decreased hausdorff distance can be observed. It is noteworthy that for the temporomandibular joint, pituitary, optic nerve, and optic chiasma, the proposed method has improved the average dice similarity coefficient from 0.86 to 0.91, 0.87 to 0.93, 0.85 to 0.89, and 0.77 to 0.83, respectively, as compared to RayStation. Additionally, within the same anatomical structures, the average hausdorff distance has been decreased from 2.98 mm to 2.28 mm, 1.83 mm to 1.53 mm, 3.74 mm to 3.56 mm, and 5.94 mm to 5.87 mm. Compared to the original CycleFCNs model, the improved model has significantly enhanced the dice similarity coefficient of the brainstem, pituitary gland, and optic nerve (P < 0.001).

Conclusions: The proposed method significantly improved the registration accuracy for multi-modal medical images in NPC cases. These findings have important clinical implications, as increased registration accuracy can lead to more precise tumor segmentation, optimized treatment planning, and ultimately, improved patient outcomes.

Background: External beam radiotherapy (EBRT) is a standard treatment for localized prostate cancer, with recent advancements favoring a reduced number of treatment sessions. Stereotactic body radiotherapy (SBRT) is a form of radiotherapy that delivers higher doses per fraction, typically in five or fewer sessions. This retrospective study aims to evaluate the implementation of the PACE-SBRT protocol for localized prostate cancer at our center by assessing the incidence and severity of toxicity, as well as biochemical relapse-free survival.

Methods: We conducted a retrospective analysis of patients with localized prostate cancer treated with SBRT at the Iridium Network in Antwerp, Belgium, who were treated between January 1, 2020, and December 31, 2022. Data were extracted from electronic medical records and included descriptive information on patient outcomes. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Acute toxicity was defined as events occurring within 90 days post-SBRT, whereas late toxicity was evaluated at 6 months, 1 year, 2 years, and 3 years post treatment. Biochemical recurrence was defined via the Phoenix criteria, as a rise in PSA levels of 2 ng/mL or more above the post treatment nadir.

Results: A total of 267 patients met the eligibility criteria for this study. In total, 9% of patients were low risk, 51% were intermediate risk, and 40% were high risk. The cumulative incidence of Grade 2 or higher GU toxicity was 27%, and for GI toxicity, it was 2%. At 24 months, 11.5% (20/175) of patients experienced CTCAE grade 2 or higher GU toxicity, and 1.7% (3/175) experienced grade 2 or higher GI toxicity. Biochemical relapse occurred in 1.5% (4/267) of patients, leading to a 2-year biochemical relapse-free survival rate of 98.5%.

Conclusion: SBRT for localized prostate cancer has favorable oncological outcomes with a low incidence of Grade 2 or higher toxicity. The results of this study are consistent with findings from prospective trials, suggesting that SBRT is an effective treatment modality. Trial registration Retrospectively registered.

Background and aims: Liver cancer is the third leading cause of cancer related death due to treatment resistance and late onset of symptoms (Rumgay in J Hepatol 77: 1598-1606, 2022). The role of external beam radiotherapy (EBRT) in treatment of unresectable liver cancer needs to be defined. The use of particle therapy such as carbon ion radiation therapy (CIRT) with high linear energy transfer (LET) could increase efficacy of EBRT while limiting the toxic effects of radiation on non-cancerous liver tissue. Promising effects of CIRT have been described in several studies during the past decades, mostly in Japan. To date, no standardized treatment protocol has been established and European data on CIRT for liver cancer is lacking. This retrospective analysis aims to investigate efficacy and safety of hypofractionated CIRT compared to photon-based stereotactic body radiation (SBRT) in primary liver cancer.

Method: Thirty-six (n = 36) and twenty (n = 20) patients with primary malignant liver tumors were treated with hypofractionated CIRT (4 fractions) and photon-based SBRT, respectively, between 2011 and 2022 and were retrospectively evaluated for survival, local control, and toxicity.

Results: Two-year local control rate after CIRT was 92.3%. Compared to photon- based SBRT, CIRT scores with a significantly longer median distant progression free survival (3.1 versus 0.9 years). In a matched pair comparison of the two treatment regimens, the CIRT cohort demonstrated both longer 2-year overall survival (100% versus 59.6%) and longer 2-year distant PFS (75.7% versus 22.9%). No significant impairment of liver function was observed in either cohort.

Conclusion: In this retrospective analysis, patients who received CIRT presented excellent local tumor control and had better oncologic outcomes than patients who received photon-based SBRT. SBRT with carbon ions is a promising local ablative treatment option that needs further investigation in large prospective trials.

Objective: Preservation of visual acuity remains a challenging issue after globe sparing therapy of large uveal melanoma. The aim of our study was analyzing the functional outcome after brachytherapy with bi-nuclide plaques (BBNP), maintaining prognostic factors for legal blindness (LB).

Methods: We have analyzed all consecutive patients with large uveal melanoma treated with BBNP at our institution between 01/1999 and 12/2020. The post-treatment follow-up data were screened up to 06/2023. Univariate and multivariate Cox regression analysis was performed to identify predictive factors for development of LB following BBNP.

Results: Overall, 570 patients with median age of 65.6 years (interquartile range [IQR]: 54.5-74.0) underwent BBNP. During the median post-treatment follow-up of 30.8 months (IQR: 12.9-57.3), LB was diagnosed in 287 (50.4%) patients. Patients' age (> 67 years, adjusted hazard ratio [aHR] = 1.58, 95%-confidence interval [CI] = 1.24-2.00, p < 0.0001), tumor thickness (> 8.5 mm, aHR = 1.43, 95%-CI = 1.12-1.82, p = 0.004), VA (> 0.5 LogMAR, aHR = 1.59, 95%-CI = 1.25-2.02, p < 0.0001), and ciliary body involvement (aHR = 0.77, 95%-CI = 0.60-0.97, p = 0.029) were confirmed as independent predictors of LB in the final multivariable Cox regression analysis.

Conclusions: Approximately a half of patients with large uveal melanoma develop LB around 2.5 years after brachytherapy. Further optimization of treatment strategies, including both therapeutic and preventive measures, has the potential to enhance the functional outcome after episcleral plaque therapy for large UMs.

Background: This single-arm phase II trial aimed to assess the effectiveness and safety of incorporating hyperthermia into salvage concurrent chemoradiotherapy (CCRT) for previously irradiated unresectable recurrent head and neck cancer.

Methods: We enrolled patients with non-metastatic recurrent head and neck cancer who had previously undergone radiotherapy (RT) and were unfit for salvage surgery. Eligible patients received hyperthermia during salvage CCRT. RT consisted of an upfront boost with 10 Gy in 2 fractions to gross tumor volume, followed by 40 Gy in 20 fractions to clinical target volume, for a total of 50 Gy in 22 fractions. Weekly hyperthermia for 6 sessions started after RT initiation; each session lasted for 40 min, beginning within 2 h after RT and maintaining a maximum temperature of 42 ± 0.5 °C. Concurrent chemotherapy included weekly cisplatin 20 mg/m² and docetaxel 10-12 mg/m² for 6 weeks. Primary endpoint was overall response rate (ORR). Overall survival (OS), progression-free survival (PFS) and toxicities were evaluated.

Results: Among 35 eligible patients, ORR was 82.9%, with complete response in 54.3%, partial response in 28.6%, stable disease in 11.4%, and progressive disease in 5.7%. After a median follow-up of 2.7 years, median OS was 32.8 months (95% confidence interval [CI], 16.7-48.9), and 2-year OS was 57.1% (95% CI, 40.6-73.6). Median PFS was 14.9 months (95% CI, 5.7-24.1), and 2-year PFS was 34.3% (95% CI, 18.6-50.0). Acute mucositis was grade 0-1 in 68.6%, grade 2 in 25.7%, and grade 3 in 5.7%. Acute dermatitis was grade 0-1 in 85.7% and grade 2 in 14.3%. No definite burn injury occurred. Grade 3-4 leucopenia, anemia, thrombocytopenia accounted for 14.3%, 14.3%, and 8.6%, respectively. Osteonecrosis was noted in 12 patients. No grade 5 toxicity was observed.

Conclusions: Adding hyperthermia to salvage CCRT greatly enhances tumor response and survival rates compared to historical re-irradiation outcomes for previously irradiated unresectable recurrent head and neck cancer, with manageable toxicities.

Trial registration: ClinicalTrials.gov (Identifier: NCT02567383 ), Registered October 1 , 201 5 - https://www.

Clinicaltrials: gov/study/NCT02567383.

Background: Lung cancer patients with comorbid interstitial lung disease (LC-ILD) have an increased risk of developing severe or even fatal radiation pneumonitis after thoracic radiotherapy. However, the underlying mechanisms of its pathogenesis are still inconclusive. No approved biomarker or medicine is available to prevent pulmonary toxicities in LC-ILD patients. Appropriate management for them remains a challenge for clinicians due to treatment-related complications.

Methods: To elucidate the histopathological characteristics and molecular mechanisms responsible for this severe toxicity in vivo, C57BL/6J mice were used to develop different lung injury models, including radiation-induced lung injury (RILI), bleomycin-induced pulmonary fibrosis (BIPF), and severe radiation-related lung injury (sRRLI) murine model. Biopsy examination was performed on hematoxylin and eosin (H&E), Masson's trichrome, and immunohistochemistry-stained lung tissue sections. Changes in lung function were measured. RNA extracted from mouse lung tissues was sequenced on the Illumina Novaseq platform.

Results: A severe lung injury model after irradiation was built based on pre-existing ILD mice induced by BLM administration. Enhanced lung injury was observed in the sRRLI model, including higher mortality and pulmonary function loss within six months compared to the mono-treatment groups. Autopsy revealed that bilateral diffuse alveolar damage (DAD) with an overlap of exudative, proliferative, and fibrosing patterns was usually presented in the sRRLI model. The histological phenotypes manifested exudative predominated DAD phase in the early phase and proliferating DAD pattern in the late phase. Bioinformatic analysis showed signaling pathways relevant to immune cell migration, epithelial cell development, and extracellular structure organization were commonly activated in different models. Furthermore, the involvement of epithelial cells and the infiltration of macrophages and CD4 + lymphocytes were validated during extensive lung remodeling in the sRRLI group.

Conclusions: Delayed effects of significantly declined lung function and high mortality were observed in the sRRLI model. DAD with progressive inflammation and fibrosis in bilateral lungs contributed to severe or even fatal complications after partial thoracic irradiation. The hyperactivation of inflammatory responses was clarified during long-term pulmonary toxicities. More studies are needed to investigate potential strategies to prevent and rescue severe lung complications.