Radiation Oncology最新文献

Background: The Fred Hutchinson Cancer Center (FHCC) has developed a novel in-house method for ocular proton therapy by adapting a pencil beam scanning (PBS) beamline and using a commercial treatment planning system. This manuscript outlines the workflow from simulation to treatment delivery and presents our experiences with the initial 40 patients.

Methods: Key innovations of our treatment approach include in-house developed treatment chair and gaze localization systems, CT imaging for planning, and a Monte Carlo algorithm for dose calculation. We gathered data on patient characteristics, dose volume statistics, and total treatment time. Additionally, we examined the distances patients traveled to access ocular proton therapy. An example illustrating our treatment technique is also presented.

Results: The average patient age at the time of treatment was 63.9 years. Tumor apical height ranged from 0.7 to 11.9 mm, and the largest basal diameter from 2.8 to 15.5 mm. GTV volumes ranged from 0.02 to 0.89 cc, while PTV volumes ranged from 0.17 to 2.27 cc. The D99% dose to GTV ranged from 5041 to 5242 cGy (RBE). The median mean dose to the lacrimal gland was 1570 cGy (RBE), while the median D2% doses to the optic nerve, macula, and optic disc were 4188 cGy (RBE), 5024 cGy (RBE), and 5133 cGy (RBE), respectively. Out of the 40 patients, 16 successfully met all treatment planning goals. The remaining patients did not meet some goals due to the target either abutting or being close (< 2 mm) laterally or distally to the OARs. The total treatment duration per fraction was approximately 25 min. Nearly one-third of the patients traveled around 900 miles to receive ocular treatment.

Conclusions: The approach at FHCC demonstrates that ocular proton therapy can be effectively delivered using a general-purpose PBS beamline, providing a solution for centers without dedicated ocular beamlines.

Background: Hypothalamic hamartomas (HHs) are congenital, non-neoplastic tumors originating from the hypothalamic region. While surgical resection remains the standard treatment, it is associated with substantial morbidity, leading to the exploration of minimally invasive approaches such as radiofrequency thermocoagulation (RFTC), laser interstitial thermal therapy (LiTT), and stereotactic radiosurgery (SRS). This systematic review and meta-analysis evaluate the efficacy and safety of SRS in managing HHs, with a focus on seizure control, endocrine function, and treatment-related complications.

Methods: A comprehensive literature search was conducted on December 6, 2024, using PubMed, Embase, Scopus, and Web of Science. Studies that evaluated the role of SRS in HH patients were included. The R program was used to calculate the pooled estimates.

Results: Seven studies with 152 HH patients were included. The meta-analysis revealed a pooled post-SRS seizure improvement rate of 77% (95% CI: 61%-91%) and a seizure-free status rate of 48% (95% CI: 19%-78%). In addition, the meta-analysis showed a pooled good outcome, Engel I/II, rate of 67% (95% CI: 48%-84%), and a pooled adverse radiation effect (ARE) rate of 0% (95% CI: 0%-1%).

Conclusion: SRS provides favorable seizure control and a promising safety profile for managing patients with HH.

Clinical trial number: Not applicable.

Background: Financial toxicity, defined as hardship from medical costs, is an emerging concept in healthcare. Here we define financial toxicity in head and neck cancer patients receiving radiation, identify risk factors, and determine associations with HRQoL, treatment morbidity, and survival.

Methods: We conducted a prospective study on consecutive patients referred to a tertiary referral center for radiation therapy for head and neck malignancies (July 2021-June 2023). Patients provided consent and were assessed using validated patient-reported outcome measures for financial toxicity (FACIT-COST), HRQoL (EORTC-QLQ-C30), and symptom burden (PRO-CTCAE) before and after radiation therapy. Primary outcomes included two-year overall survival (OS), treatment morbidity (ER visits, hospitalizations, feeding tube placement, missed radiation days), HRQoL, and symptom burden.

Results: Among 74 patients (median age 69), all completed pre-radiation therapy (pre-RT) measures, and 39 completed post-RT measures. Median pre-RT COST was 29 (range: 0-44), with 41.9% scoring ≤25, indicating worse financial toxicity. Lower pre-RT COST scores correlated with younger age, Black race, Medicaid insurance, single or unemployed status, advanced T-stage, and concurrent chemoradiotherapy (p < 0.05). These patients had worse HRQoL, more severe symptoms, increased feeding tube placements, and more ER visits/hospitalizations (p < 0.05). OS was worse with lower pre- (HR = 0.95; 95% CI = 0.91-0.99; p = 0.015) and post-RT COST scores (HR = 0.92; 95% CI = 0.86-0.98; p = 0.012).

Conclusions: Financial toxicity is common in head and neck radiation patients and linked to worse HRQoL, morbidity, and OS. Affected patients had clear socioeconomic risk factors and advanced disease. Further research should explore interventions to improve cancer outcomes.

Background: Specific congenic mice derived from inbred C3H/HeJ mice, which present early onset pneumonitis, and C57BL/6J mice manifesting later onset pneumonitis with pulmonary fibrosis, vary in time to respiratory distress from these responses following whole thorax irradiation.

Methods: Herein, to investigate a potential adaptive immunity contribution to lung disease in this model, we used flow cytometry to enumerate the pulmonary lymphocytes of C3H/HeJ, C57BL/6J and three lines of sub/congenic mice, at respiratory distress from 18 Gy whole thorax irradiation and in strain matched controls.

Results: CD4 + lymphocyte % of C3H/HeJ mice exceeded that of C57BL/6J mice at both radiation-induced respiratory distress and in unirradiated controls (P < 0.04) and pulmonary CD4+% was reduced, at distress relative to control levels, in fibrosis responding strains. CD8 + lymphocyte % was reduced in distressed mice, compared to controls, for 8 of 10 comparisons by strain and sex including those of both pneumonitis and pneumonitis with fibrosis responses. γδ + lymphocyte % was largely unchanged at distress from control levels. Time to radiation-induced respiratory distress, and strain fibrosis score, were each negatively correlated with pulmonary CD4+%, and with the CD4/CD8 ratio, measured in distressed mice (r<-0.76; P < 0.01) or in unirradiated controls (r<-0.75; P < 0.02). Inclusion of the lymphocyte profile of unirradiated mice of a separate C3H/HeJ and C57BL6/J-derived congenic line, named Radpf1 and known to be spared radiation-induced lung disease, yielded a pulmonary CD4+% correlation with time to respiratory distress of (r = 0.16, P = 0.76) and of (r=-0.83; P = 0.04) for strain fibrosis score.

Conclusions: Pulmonary lymphocyte profiling revealed strain-dependent %CD4 + lymphocytes, measured in mice manifesting radiation-induced respiratory distress or in untreated controls, to correlate with fibrotic lung disease in this mouse model.

Background: Adaptive radiotherapy (ART) is an advanced form of image-guided radiotherapy that involves the re-contouring and re-planning of a patient's treatment plan, either while the patient is on the table (online) or in between fractions (offline). ART allows for the adjustment of a treatment plan to respect a patient's changes in internal anatomy, something that is critical in the treatment of gastrointestinal (GI) malignancies in which the mobile and radiosensitive GI tract plays a key role in driving toxicity. Herein we review the indications for both online and offline ART in GI cancers.

Main text: Online ART plays a critical role in the treatment of pancreatic cancer when using stereotactic body radiotherapy (SBRT). A variety of ART workflows have demonstrated that ART allows for the safe dose-escalated treatment of locally advanced pancreatic cancer. In addition to pancreatic cancer, there are now a bevy of data demonstrating that ART plays a key role in the treatment of liver cancers and abdominal oligometastases when using SBRT and allows for the safe delivery of single-fraction abdominal SBRT. While lower GI cancers are generally not treated with SBRT-like doses, both online and offline ART workflows have been shown to potentially reduce toxicity in patients with anal and rectal cancers. Improved integration of artificial intelligence and direct-to-unit workflows in ART hold promise that the overall process can become more efficient, allowing for more widespread adoption in GI radiation oncology.

Conclusions: ART is an expanding radiotherapy paradigm in which a patient's treatment plan is adjusted to match observed changes in patient anatomy and has been successfully incorporated into the treatment of a variety of GI cancers. The successful implementation of workflows in pancreatic cancer, liver cancers, and lower GI cancers, amongst others, as well as incorporation into multi-center clinical trials, suggest that ART will continue to play a critical role of GI radiation oncology for years to come. As improvements in efficiency and access allow for increasing use of ART world-wide, we predict that ART will continue to play a critical part in the management of patients with GI malignancies.

Background: Oral stents may reduce toxicities during radiation therapy for head and neck cancer (HNC). Customized 3D-printed oral stents offer faster production and achieve comparable patient-reported outcomes to conventionally fabricated stents. However, their design process remains time-consuming, lacks standardization, and relies heavily on skilled technicians. We hypothesized that semi-automating the design process for 3D-printed, mouth-opening, tongue-depressing (MOTD) stents could standardize the design workflow and decrease design time.

Methods: Using oral stent design principles established over decades by oral oncologists, we created a customized computer program (Autostent) using MATLAB to semi-automate the design process of MOTD stents. We subsequently compared Autostent to a previously described method that utilized non-automated computer-aided design. Three users designed stents for four patients with HNC enrolled in a prospective observational study. These patients were selected based on their varying dental anatomies, and each user repeatedly designed an MOTD stent for each patient three times, employing both the non-automated and semi-automated methods. Both methods were compared in terms of design time and stent volume.

Results: Semi-automation reduced the average design time by 23.6 min (51.2%, p = 0.001), regardless of user, dental anatomy, or trial number. Additionally, semi-automation decreased the average stent volume by 4.33 mL (12.9%, p = 0.016, univariate analysis). Although this reduction was not statistically significant when considering other experimental variables (p = 0.40, multivariate analysis), semi-automation did lower the variability in stent volume among users (the overall standard error of the mean decreased by 40%).

Conclusion: Our semi-automated workflow for designing and fabricating customized, 3D-printed MOTD stents significantly improves efficiency and reduces variability in the design. While these results indicate greater consistency compared to manual methods, further development is warranted to achieve full automation and to optimize clinical integration.