Radiation Oncology最新文献

The role of hyperthermia (HT) in conventional oncological treatment has been a subject of research for decades; however, HT has not been incorporated into treatment guidelines on a universal basis. Preclinical studies have demonstrated the mechanism of action of HT and have indicated a clear effect that can enhance the effects of radiotherapy (RT), chemotherapy, or immunotherapy. The underlying mechanism of HTs action involves either the enhancement of the immune system response or the interference with crucial cellular pathways that are aberrantly altered during the neoplastic process. Consequently, HT has the potential to augment the efficacy of RT treatments markedly. Randomized clinical trials have further demonstrated the efficacy and safety of combining RT and HT. However, it is important to note that the majority of these observations were derived from studies conducted up to two decades ago, which may not fully reflect the current standard of care. The present focus is on the combination of these treatment techniques with modern systemic treatment, which is based on immunotherapy and molecularly targeted drugs. Significant advancements have also been made in the field of HT delivery and the strategies for optimal use of HT. Therefore, it is imperative to synthesize the extant body of knowledge in this field to inform the advancement of techniques for integrating HT with radiation therapy.

Background: This systematic review and meta-analysis assessed the role of radiotherapy (RTx) in patients with unresectable or metastatic intrahepatic cholangiocarcinoma (ICC).

Methods: A systematic search of the MEDLINE, EMBASE, and Cochrane databases was conducted to identify relevant studies published before November 2024. Meta-analyses were performed to assess the median overall survival (OS), 1- and 2-year OS rates, and local control (LC) rates in patients with unresectable or metastatic ICC treated with RTx. For studies reporting hazard ratios (HR), OS was compared between patients receiving chemotherapy (CTx) with RTx versus CTx alone and between dose-escalated and conventional-dose RTx. The toxicity outcomes of the included studies were systematically reviewed.

Results: Nine articles (n = 1,792) were included in the analysis. Pooled analysis revealed a median OS of 15.59 months, with 1-year and 2-year OS rates of 69% and 38%, respectively. The one- and 2-year LC rates were 79% and 55%, respectively. Four studies comparing CTx with RTx versus CTx alone revealed that the combination group had significantly improved OS (HR, 0.67). Additionally, dose-escalated RTx was associated with better OS than conventional-dose RTx (HR, 0.53). Grade ≥ 3 gastrointestinal toxicity occurred in 3.7% of patients, and grade 5 toxicity was rare (0.3%).

Conclusions: RTx, particularly with dose escalation or in combination with CTx, may provide survival benefits with acceptable toxicity, supporting further prospective evaluations of unresectable or metastatic ICC.

Introduction: Vestibular schwannoma (VS) often shows transient post-radiosurgery swelling ("pseudoprogression," PP) that mimics true progression (TP). We validated volumetric rules to separate PP from TP and linked growth patterns to clinical outcome.

Method: We retrospectively reviewed 259 sporadic VS cases treated with single-fraction stereotactic radiosurgery (2012-2024). SRS was delivered with a median margin dose of 12 Gy, prescribed to the institutional peripheral isodose line, using a median of 5 isocentres. Tumours were manually segmented on serial MRIs ≥ 24 months. PP was defined as > 20% volume rise ≤ 12 months followed by ≥ 10% fall ≤ 24 months; TP as > 15% rise > 36 months with persistent growth. Two alternative thresholds (> 25% rise any time; >10% rise > 24 months without regression) were tested. Longitudinal trajectories were clustered with Gaussian-mixture models. Outcomes included hearing, facial and trigeminal function, and Dizziness Handicap Index (DHI).

Results: Four growth clusters emerged: early PP (35.5%), late PP (11.2%), stable (41.3%) and TP (12%). The PP rule yielded 86% sensitivity and 93% specificity (AUC 0.92); the TP rule 77%/95% (AUC 0.90). Alternative thresholds performed worse (AUC 0.81-0.85). Serviceable hearing was preserved in ≥ 86% of PP or stable tumours but only 61% in TP (p < 0.01).

Conclusion: Time-anchored volumetric rules accurately distinguish transient post-SRS swelling from genuine progression. Incorporating these criteria into routine surveillance can prevent premature salvage therapy while ensuring timely intervention for the minority of tumours that truly grow.

Cardiotoxicity following thoracic radiotherapy remains a critical issue, and this study aimed to assess the risk of Cardiovascular-Related Death (CVRD) after thoracic radiotherapy while comparing the risk of CVRD at different cancer sites. Data on patients with thoracic cancers treated with radiotherapy between 2000 and 2020 were analyzed, and the risk of CVRD was evaluated using death rates, Fine-Gray competing risks model, standardized mortality ratio (SMR), absolute excess risk (AER), and Cox regression to develop a predictive model. Patients receiving radiotherapy for thoracic cancer had a significantly increased risk of CVRD compared with the general population (Overall AER = 28.59, SMR = 2.37, 95% CI: 2.33-2.40). The risk of CVRD after radiotherapy was significantly lower in the right chest than the left (HR = 0.84, 95% CI: 0.79-0.89) and significantly higher in the left lower lung than in the upper (HR = 1.11, 95% CI: 1.01-1.22). A predictive model for the risk of CVRD in patients with left lower lung after radiotherapy was further constructed (C-index = 0.67, 95% CI: 0.67-0.68). The findings highlight that thoracic radiotherapy significantly increases cardiovascular disease risk, with patients with left lower lung cancer exhibiting the highest CVRD risk. A robust predictive model was developed, offering valuable insights for managing and predicting CVRD risk in thoracic malignancies.

Background: To evaluate treatment outcomes, toxicity, and recurrence patterns by dose level in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) and weekly cisplatin.

Methods: We retrospectively analyzed 48 NPC patients treated between 2005 and 2019 with IMRT and weekly cisplatin (40 mg/m²). The planning target volume (PTV) received a median total dose of 57.6 Gy (1.8 Gy/fraction) with a simultaneous integrated boost to the primary tumor and nodal metastases up to 70.4 Gy. To assess recurrence patterns, follow-up imaging was deformably co-registered with planning CTs (pCT), and recurrent gross tumor volumes (rGTVs) were delineated and mapped to pCTs. Recurrences were categorized using a centroid-based system into five types: A (central high-dose), B (peripheral high-dose), C (central intermediate-/low-dose), D (peripheral intermediate-/low-dose), and E (extraneous dose).

Results: With a median follow-up of 73 months (range 24-156), 9 patients (19%) had died. The 3-, 5-, and 10-year overall survival rates were 98%, 96%, and 67%, respectively. Local control rates (LCR) at 2, 3, and 5 years were 92%, 89%, and 89%; regional control was 96%, 94%, and 94%; and distant control was 92%, 89%, and 89%. Treatment was well tolerated, with no grade ≥ 4 toxicities. Grade 3 acute toxicities occurred in 23 patients (48%), most commonly dysphagia, with nearly all resolving within 90 days. Among treatment failures, distant metastases (13%) and local relapses (10%) were most frequent. Of 8 local and/or regional recurrences analyzed, 2 were type A (central high-dose), 3 type B ("marginal"), 2 type C (central intermediate-/low-dose), and 1 type E ("out-of-field").

Conclusion: IMRT with weekly cisplatin yields excellent survival and locoregional control with acceptable toxicity in NPC. Distant metastasis as one of the predominant failure patterns highlights the need for more effective systemic therapies. Most local recurrences arose within high-dose areas, suggesting a potential opportunity for treatment optimization.

Background: To address the issue where single Volumetric Modulated Arc Therapy (VMAT) delivery times often exceed a patient's comfortable breath-hold capacity of approximately 20s during Deep Inspiration Breath-Hold (DIBH) radiotherapy for breast cancer, this study proposes and systematically evaluates a novel time-control optimization strategy. The goal is to reduce overall delivery time and improve temporal uniformity across individual arcs within the United Imaging Healthcare (UIH) uTPS platform.

Methods: The study included 32 left-sided breast cancer patients, with 16 having undergone breast-conserving surgery and 16 having undergone mastectomy. For each patient, 16 distinct VMAT plans were generated to compare combinations of optimization algorithms (FMO/SPO), fluence modes (FF/FFF), and various dose rates. A novel bounding factor analysis was introduced to quantify delivery bottlenecks by assessing the relative contributions of gantry rotation, MLC movement, and MU delivery to the overall treatment time.

Results: The time-control strategy effectively reduced the mean arc delivery time and improved its uniformity across all tested combinations. The bounding factor analysis revealed that FMO plans were primarily limited by Multi-Leaf Collimator (MLC) movement, whereas SPO plans were predominantly limited by Monitor Unit (MU) delivery. Consequently, when the time-control strategy was applied to FMO plans, it shortened delivery times by restricting MLC mobility, which led to some dosimetric degradation. In contrast, for SPO plans, the strategy maintained or enhanced MLC movement while significantly reducing time, thus preserving or even improving dosimetric quality. Notably, the combination of SPO with the high-dose-rate (1400 MU/min) FFF mode reduced single-arc delivery times to approximately 10s.

Conclusions: The proposed time-control strategy is a superior solution for shortening delivery time and enhancing patient comfort without significant dosimetric compromise.

Objective: Immune checkpoint inhibitors plus thoracic radiotherapy (RT) may magnify the radiation pneumonitis (RP) risk. Data on the risk for symptomatic RP in small cell lung cancer (SCLC) patients following RT after induction immunochemotherapy using anti-programmed cell death protein-1 monoclonal antibody Serplulimab, cisplatin plus etoposide are limited.

Methods: This retrospective study included 443 SCLC patients from two hospitals who finished thoracic intensity-modulated radiation therapy or volumetric modulated arc therapy between April 1, 2022 and March 31, 2025. The primary endpoint was the incidence of grade 2 or worse (grade 2+) RP. Fine-Gray competing risks regression analyses were used to identify the potential risk factors of RP2+.

Results: The follow-up duration was (15.8 ± 4.6) weeks since the end of RT. In detail, 87 (19.6%), 35 (7.9%), and 6 (1.4%) patients developed grade 2, grade 3, and grade 4 RP respectively. Six patients died from non-RP-related diseases were treated as competing events. On univariate analysis, male, pneumoconiosis, ECOG status, concurrent chemoradiotherapy (CCRT) were positively correlated with the incidence of RP2+, with subdistribution hazard ratio (SHR) and 95% confidence interval (CI) of 1.81 (1.29-2.55), 2.56 (1.35-4.87), 1.53 (1.17-1.99) and 2.15 (1.35-3.42), respectively (all P < 0.05), while VO_2max, left ventricular ejection fraction (LVEF), and forced expiratory volume in one second (FEV₁) were negatively correlated with RP2+, with SHR and 95%CI of 0.89 (0.84-0.935), 0.98 (0.96-1.00), and 0.34 (0.19-0.61), respectively (all P < 0.05). Further multivariate competing risks analysis revealed that male, CCRT, and VO2max were independent predictors of RP2+, with SHR and 95% as 1.84 (1.22-2.78), 1.72 (1.04-2.87), and 0.92 (0.86-0.98), respectively (all P < 0.05). Additionally, immunochemotherapy before RT, preexisting pulmonary co-morbidities and smoking history were not significant indicators of RP2+ (P > 0.05, respectively).

Conclusion: The incidence of RP2 + following sequential immunochemotherapy and RT was positively associated with male and CCRT, but negatively correlated with VO₂ max in SCLC patients.

Clinical trial number: Not applicable.