Radiation Oncology最新文献

Background and aim: The present study aimed to evaluate the use of ¹⁸F-2-[¹⁸F]-fluoro-2-deoxy-d-glucose (FDG) PET/MRI (Positron emission tomography-computed tomography) in predicting the pathological response to neoadjuvant chemotherapy (NAC) in patients with breast cancer (BC) compared to the use of MRI (Magnetic Resonance Imaging) alone.

Methods: We searched numerous databases, including PubMed, Scopus, Embase, and Science Direct, using curated keywords. The variance of each study was determined using the binomial distribution, and STATA version 14 was used to analyze the data by performing random-effect models. Additionally, we calculated study heterogeneity using the chi-squared test and I² index and utilized funnel plots and Egger tests to assess publication bias.

Results: The current investigation analyzed 239 patients from six published studies. The pooled estimated sensitivity and specificity of ¹⁸F-FDG PET/MRI was 0.91 (95% CI = 0.90 to 0.92, I² = 100% and P = 0.000) and 0.62 (95% CI = 0.53 to 0.72, I² = 99.8% and P = 0.000), respectively. Pooled sensitivity and specificity of MRI were 0.78 (95%CI = 0.59 to 0.96, I² = 100% and P = 0.000) and 0.56 (95%CI = 0.33 to 0.80, I² = 99.8% and P = 0.000), respectively.

Conclusions: Based on our findings, the combined form of ¹⁸F-FDG PET/MRI imaging is more sensitive and specific than MRI alone for predicting response to NAC in BC patients.

Background: The potential of carbon ion radiation therapy (CIRT) as a curative treatment for localized prostate cancer (PCa) has garnered attention due to its characteristic dose distribution. We prospectively collected and analyzed over five years to investigate the outcomes of localized PCa treated with CIRT at our institution.

Patients and methods: The study included patients with histologically confirmed prostate adenocarcinoma. CIRT treatment was administered at a total dose of 57.6 Gy (RBE) in 16 fractions over four weeks. Uroflowmetry (UFM) and residual urine measurements were performed at various time points: before CIRT treatment, one month after starting CIRT, three months after treatment, and annually for five years starting from 1 year after the completion of CIRT. Prostate volume was measured using transrectal ultrasonography (TRUS).

Results: A total of 304 prostate cancer patients were analyzed. UFM parameters were significantly worsened immediately after the treatment. However, they recovered to pretreatment levels after three months and remained stable until five years post-treatment. Notably, Average flow rate showed significant improvement after three years of treatment compared to before the treatment. Prostate volume decreased to 80% of baseline in patients treated with CIRT alone and to 60-70% of baseline in those receiving combined CIRT and either short- or long-term ADT. The logistic-binomial analysis identified post-voiding residual urine volume (PVR) as a significant factor for predicting adverse events in the acute phase.

Conclusions: Following CIRT treatment, the voiding parameters in PCa patients significantly deteriorated immediately. However, after three months, they returned to their pre-treatment levels and remained stable for five years.

Background: The purpose of this study is to assess the feasibility of mixed-reality (MixR) visualization for patient setup in breast and chest wall radiotherapy (RT) by performing a first-in-human clinical trial comparing MixR with a 3-point alignment.

Methods: IRB approval was granted for a study incorporating MixR during the setup process for patients undergoing proton (n = 10) or photon (n = 8) RT to the breast or chest wall. For each patient, MixR was utilized for five fractions and compared against another five fractions using 3-point alignment. During fractions with MixR, the patient was aligned by at least one therapist wearing a HoloLens 2 device who was able to guide the process by simultaneously and directly viewing the patient and a hologram of the patient's surface derived from their simulation CT scan. Alignment accuracy was quantified with cone-beam CT (CBCT) for photon treatments and CBCT plus kV/kV imaging for proton treatments. Registration time was tracked throughout the setup process as well as the amount of image guidance (IGRT) utilized for final alignment.

Results: In the proton cohort, the mean 3D shift was 0.96 cm using 3-point alignment and 1.18 cm using MixR. An equivalence test indicated that the difference in registration accuracy between the two techniques was less than 0.5 cm. In the photon cohort, the mean 3D shift was 1.18 cm using 3-point alignment and 1.00 cm using MixR. An equivalence test indicated that the difference in registration accuracy was less than 0.3 cm. Minor differences were seen in registration time and the amount of IGRT utilization.

Conclusions: MixR for patient setup for breast cancer RT is possible at the level of accuracy and efficiency provided by a 3-point alignment. Further developments in marker tracking, feedback, and a better understanding of the perceptual challenges of MixR are needed to achieve a similar level of accuracy as provided by modern surface-guided radiotherapy (SGRT) systems.

Trial registration: ClinicalTrials.gov, UFHPTI 2015-BR05: Improving Breast Radiotherapy Setup and Delivery Using Mixed-Reality Visualization, NCT05178927.

Purposes: To evaluate the impact of prophylactic cranial irradiation (PCI) on the prognosis of patients with limited-stage small cell lung cancer (SCLC) in the era of MRI surveillance.

Methods: Limited-stage SCLC patients with complete remission (CR) or partial remission (PR) of tumor after definitive chemo-radiotherapy (CRT) were retrospectively analyzed. Survival data were calculated by Kaplan-Meier methods, Cox proportional hazards model was applied for multivariate prognostic analysis.

Results: Between June 2002 and January 2017, 620 patients with limited-stage SCLC were accrued in our study. After CRT, 228 (36.8%) patients achieved CR, of whom, 29 patients did not receive PCI, among the rest 199 patients, 172 (86.4%) received brain MRI to exclude brain metastasis (BM) before PCI. With a median follow-up time of 25.6 months, the cumulative BM rate was 17.1% and 37.9% in patients who received or did not receive PCI (P = 0.011). The median survival time was 30.2 months and 30.5 months, respectively and the 1 -, 3 -, 5-year survival rates were 93.7%, 42.9%, 35.8% and 83.4%, 46.5%, 41.9%, respectively (P = 0.98). Multivariate analysis indicated that baseline KPS ≥ 90 was a favorable independent prognostic factor for OS in CR patients (HR: 0.33, 95% CI: 0.23-0.46, P = 0.000). After CRT, 392 (63.2%) patients achieved PR, 53 cases did not receive PCI and 310 (91.4%) of the remaining 339 patients received brain MRI before PCI. With a median follow-up time of 15.5 months, the cumulative brain metastasis rate was 12.7% and 46.2% respectively (P = 0.000). The median survival time was 25.7 months and 18.6 months, respectively. The 1 -, 3 -, and 5-year survival rates were 87.6%, 40.2%, 29.2% and 75.7%, 16.7%, 10.3% (P = 0.000). Baseline KPS ≥ 90 (HR: 0.32, 95% CI: 0.25-0.41, P = 0.000) and PCI (HR: 0.57, 95% CI: 0.41-0.79, P = 0.001) were favorable prognostic factors for OS in PR patients.

Conclusions: In this study, PCI significantly reduced the incidence of BM in patients with limited-stage SCLC who were evaluated as CR and PR after CRT, but it has no significantly positive impact on overall survival in CR patients. Further prospective randomized studies were warranted.

Background: Craniopharyngioma is a rare and slow-growing benign sellar or parasellar epithelial tumor. The number of patients receiving proton beam therapy (PBT) has increased. This study aimed to systematically evaluate and analyze the comprehensive evidence regarding the safety and efficacy of PBT for craniopharyngioma.

Methods: We searched four databases: the Cochrane Library, PubMed, Embase, and Web of Science. The period was from their inception to February 16, 2024. Two researchers independently screened the literature and extracted data.

Results: Among 486 candidate articles, eight studies were included in our study. Exactly 393 patients with craniopharyngioma underwent PBT in these studies. These studies reported data on survival and toxicity. The median sample size was 42.5 patients. The median age was 9.1-37 years; the female proportion was 48.9%, and the median follow-up time was 29-91.4 months. All patients were treated once daily, five times a week, with a fraction of 1.8 Gy (RBE) per session. The median total dose was 54.0 Gy (RBE). The local control rates at 3 and 5 years in these studies were 99% and 93%, respectively. The overall survival rates at 3 and 5 years in these studies were both 100%. The incidence of acute and late toxicities was mainly grade 1-2. The main late toxicities included vascular and visual toxicities, hypothalamic obesity, endocrinopathy, and panhypopituitarism.

Conclusions: PBT for craniopharyngioma, especially in children and adolescents, has shown impressive local control and acceptable acute and late toxicities.

Background: Pulsed low dose rate radiotherapy (PLDR) is a new radiation delivery method, in which the fractional dose is divided into sub-fractional doses with periodical time breaks in between. The goal of our study is to assess the toxicity on healthy tissues resulting from PLDR as compared to conventional radiotherapy (CRT) using the same physical X-ray dose.

Methods: We analyzed the weight and survival time for CRT and PLDR groups and studied the inflammatory cytokine transforming Growth Factor-β (TGF-β), usually released following irradiation. Histopathological and immunohistochemical analyses were conducted for intestinal and bone marrow tissues from rats subjected to 8 Gy whole- body irradiation using CRT and PLDR techniques. We investigated genotoxicity by performing a comet assay (CA) in splenic tissues.

Results: Our findings showed an improvement in survival time with PLDR versus CRT by 82%.The mean survival time for CRT rats' group was 6.3 days, while it was 35.9 days for PLDR group.The weight of CRT group decreased gradually by 3.7%, while weight of PLDR group increased gradually by 2.4%.CRT resulted in more cellular atrophy in bone marrow and intestinal tissues than in PLDR treatments as shown by hematoxylin and eosin staining analysis. In addition, the transforming growth factor-β (TGF-β) expression in bone marrow and intestinal tissues of CRT was higher than those expressed in tissues from PLDR as demonstrated by the Immuno reactive score (IRS). It was10(0.53) and 9.8(0.55) for BM and intestinal tissues, respectively from CRT group and 5.8(0.63) for PLDR for both tissues. The measured CA parameters were larger with CRT compared to PLDR, where the Tail Length (TL), Tail DNA % (TD%) and Tail Moment (TM) measurements were 25.4(3.4), 56.5(7.6) % and 20.5(3.5) for CRT, 7.3(1.9), 30.0(7.2) % and 5.7(1.8) for PLDR, with P value 0.000064, 0.0004 and 0.00017, respectively.

Conclusion: This study indicates that PLDR can reduce the toxicity on normal tissues compared to CRT.

Background: Intrahepatic cholangiocarcinoma (ICC) is a challenging primary liver cancer with a poor prognosis, especially in unresectable cases. Traditional palliative irradiation is limited in reducing liver doses. This study aimed to evaluate the efficacy and toxicity of respiratory-gated proton beam therapy without fiducial markers for intrahepatic cholangiocarcinoma.

Methods: Between October 2011 and February 2022, 24 patients (median [range] age, 71 [41-88] years) were evaluated at our institution. Twelve patients were pathologically diagnosed with ICC. All patients underwent respiratory-gated proton beam therapy at a dose of 48-83.6 (relative biological effectiveness) in 20-38 fractions with four-dimensional computed tomography planning. The median follow-up period was 18.5 (range, 2.0-74.0) months. The median tumor size was 41 (range, 10-134) mm. Twenty-one patients were classified as having Child-Pugh class A, and three patients were classified as having Child-Pugh class B. Local progression was defined as any growth of the irradiated tumor.

Results: The median survival time was 28 months for all patients. The Kaplan-Meier estimates of the 2-year overall survival, progression-free survival, and local tumor control rates were 51%, 26%, and 73%, respectively. Local tumor control rates were non-inferior to those reported in previous studies using fiducial markers. One patient had grade 4 pleural effusion; however, whether this was an adverse event due to the proton beam therapy was unclear.

Conclusions: Respiratory-gated proton beam therapy without fiducial markers is an effective and less invasive treatment option for ICC, showing potential for improved local control and tolerable adverse effects.

Background: The aim of this study was to evaluate the inter-fraction reproducibility and intra-fraction stability of breast radiotherapy using voluntary deep-inspiration breath hold (DIBH) and free breathing (FB) based on an optical surface imaging system (OSIS).

Methods: Seventeen patients (510 breath-hold sessions) treated using a field-in-field (FiF) technique and twenty patients (600 breath-free sessions) treated with a volume-modulated arc therapy (VMAT) technique were included in this retrospective study. All the patients were positioned with the guidance of CBCT and OSIS, and also monitored with OSIS throughout the whole treatment session. Eight setup variations in three directions were extracted from the treatment reports of OSIS for all sessions and were subsequently manually introduced to treatment plans, resulting in a total of 296 perturbed plans. All perturbed plans were recalculated, and the dose volume histograms (DVH) for the target and organs at risk (OAR) were analyzed.

Results: The OSIS and CBCT for both DIBH and FB treatments showed a good agreement of less than 0.30 cm in each direction. The intra-fraction respiratory motion data during DIBH were -0.06 ± 0.07 cm, 0.12 ± 0.15 cm, and 0.12 ± 0.12 cm in the lateral, longitudinal, and vertical directions, respectively; for FB, the respiratory motion data were -0.02 ± 0.12 cm, 0.08 ± 0.18 cm, and 0.14 ± 0.20 cm, respectively. For the target, DIBH plans were more sensitive to setup errors; the mean deviations in D₉₅ for CTV were 39.78 Gy-40.17 Gy for DIBH and 38.46 Gy-40.52 Gy for FB, respectively. For the OARs, the mean deviations of V₁₀, V₂₀, and D_mean to the heart; V₅, V₂₀, and D_mean to the ipsilateral lung; and D_mean to the breast were lower for the FB plan compared with the DIBH plan.

Conclusion: Based on OSIS, our results indicate that both DIBH and FB can provide good reproducibility in the inter-fractions and stability in the intra-fractions. When the patient respiratory motion is large, the FB technology has greater possibility for the undercoverage of the target volume, while DIBH technology is more likely to result in increases in dose to OARs (the lung, heart, and contralateral breast).

Background: Recent research has demonstrated that the use of artificial intelligence (AI) in radiotherapy (RT) has significantly streamlined the process for physicians to treat patients with tumors; however, bibliometric studies examining the correlation between AI and RT are not available. Providing a thorough overview of the knowledge structure and research hotspots between AI and RT was the main goal of the current study.

Method: A search was conducted on the Web of Science Core Collection (WoSCC) database for publications pertaining to AI and RT between 2003 and 2023. VOSviewers, CiteSpace, and the R program "bibliometrix" were used to do the bibliometric analysis.

Results: The analysis comprised 615 publications from 64 countries, with USA and China leading the pack. Since 2017, there have been more and more publications about RT and AI every year. The research center that made the biggest contribution to this topic was Maastricht University. The most articles published journal in this field was Frontiers in Oncology, while Medical Physics received the greatest number of citations. Dekker Andre is the author with the greatest number of published articles, while Philippe Lambin was the most often co-cited author. In the newly identified research hotspots, "autocontouring algorithm", "deep learning", and "machine learning" stand out as the main terms.

Conclusion: In fact, our bibliometric analysis offers insightful information on current research directions and advancements pertaining to the use of AI in RT. For academics looking to understand the connection between AI and RT, this study is a great resource because it highlights current research frontiers and hot trends.

Background: Durvalumab, an anti-PD-L1 immune checkpoint inhibitor, after radio-chemotherapy (RCT) has changed the management of locally advanced non-small cell lung cancer (LA NSCLC). A series of retrospective studies have investigated different cut-off of lymphocyte count (LyC) and neutrophil-to-lymphocyte ratio (NLR) to predict survival in LA NSCLC. None of these studies has validated their threshold in an independent group of patients. We wanted to assess the OS prognostic value of NLR and LyC in patients with LA NSCLC treated by RCT and durvalumab, with threshold determination and their validation in an external cohort.

Methods: Patients were enrolled in four institutions between Oct. 2017 and Jan. 2022. Pre durvalumab LyC, neutrophils count (NC) and NLR were collected. To define NLR and LyC cut-off value predicting survival event, time dependent Receiver Operating Characteristics (ROC) curves was performed. Survival outcomes were estimated by the Kaplan-Meier method and differences were compared using univariate and multivariate Cox proportional hazard models.

Results: We included 76 patients in the training set and 85 in the test set. The best cut off were 2,94 for NLR and 0,61 G/l for LyC to predict OS in the training set. For patients with NLR > 2,94, univariate analysis showed no significant deterioration in OS in either the training set (p = 0,066) or the test set (p = 0,12). Patients with LyC > 0,61 G/L, in univariate analysis, had longer OS in training set (p = 0,030) and in test set (p = 0,0062). This OS increase was not found in multivariate analysis (p = 0,057) in training set but was confirmed in test set (0,039).

Conclusion: LyC > 0,61 G/l is associated with longer OS for LA NSCLC patient's treated with RCT and durvalumab in univariate analysis. In this context, a particular expectation for organs at risk sparing during RT to avoid lymphopenia seems important.

Trial registration: Retrospectively registered.