Radiation Oncology最新文献

Background: Recurrent cervical cancer remains a therapeutic challenge despite advances in primary treatment. The emerging paradigm of oligorecurrence and oligometastasis has opened avenues for curative-intent local therapies, including re-irradiation. Modern radiotherapy techniques have enabled high-dose delivery with acceptable toxicity. This study aims to assess clinical outcomes and treatment-related toxicities in patients with oligorecurrent or oligometastatic cervical cancer treated with modern re-irradiation techniques.

Methods: This retrospective study included 20 cervical cancer patients with oligorecurrence or synchronous/metachronous oligometastases (≤ 5 lesions) who underwent at least one course of re-irradiation. Survival outcomes including locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier analysis. Genitourinary (GU), gastrointestinal (GI), and hematologic toxicities were assessed and graded based on CTCAE version 5.0.

Results: The median age was 53 years (range: 33-70), with 75% initially diagnosed at FIGO 2018 stage III. The predominant histologies were squamous cell carcinoma (50%) and adenocarcinoma (45%). Recurrences most commonly involved pelvic (30%) and para-aortic (30%) lymph nodes, with 50% occurring in-field. Stereotactic body radiotherapy (SBRT), volumetric modulated arc therapy (VMAT), and MR-guided adaptive brachytherapy (MR-GABT) were the most commonly used re-irradiation modalities, employed in 95% of patients. Median times to first and second recurrence were 11.1 months (IQR: 6.0-17.3) and 13.7 months (IQR: 5.6-21.7), respectively. At a median follow-up of 33.6 months, PFS, LRRFS, DMFS, and OS rates after the first recurrence were were 31.8%, 33.6%, 60.5%, and 84.2% respectively. Grade ≥ 2 genitourinary (GU), gastrointestinal (GI), and hematologic toxicities were observed in 40%, 25%, and 55% of patients, respectively. Grade 3 hematologic toxiciy was 25% and mostly occurred during chemotherapy administration. No grade ≥ 3 GU or GI toxicities were reported. The mean accumulated D0.03 cc after re-irradiation to bladder, rectum, sigmoid and bowel for in-fied/out-of-field were 83.8 ± 6.7/78.5 ± 7.5), 71.2 ± 3.9/69.5 ± 5.2, 68.0 ± 5.5/61.0 ± 5.3, and 62.9 ± 4.6/62.4 ± 7.1 GyEQD2₍₃₎, respectively.

Conclusion: Re-irradiation with contemporary radiotherapy techniques appears to be a feasible and effective salvage option for selected patients with limited recurrent or metastatic cervical cancer, yielding favorable survival and acceptable toxicity profiles.

Objective: This study evaluated the 8th edition American Joint Committee on Cancer (AJCC) staging system for esophageal squamous cell carcinoma (ESCC) and developed an improved staging framework using automated recursive partitioning analysis (autoRPA).

Methods: This retrospective study included 2773 ESCC patients treated with definitive intensity-modulated radiation therapy (IMRT) or chemo-IMRT across 8 Chinese centers (2001-2019). Kaplan‒Meier curves and log-rank tests were used to assess overall survival (OS). AutoRPA-derived stage groupings were optimized via the revised T/N criteria. The proposed staging was compared with the 8th edition AJCC staging via hazard discrimination, consistency, sample balance, and predictive accuracy.

Results: The 3-year, and 5-year rates for the entire cohort were 43.5%, and 34.0%, respectively. The AJCC T4a/T4b stages exhibited overlapping OS curves, prompting their consolidation into a single T4 stage. While the AJCC N2 and N3 stages showed overlapping OS curves, supraclavicular lymph node (SLN) metastasis independently predicted worse OS than N2, with outcomes similar to those of N3. Location-based SLN classification further refined nodal staging, with cervical esophageal-SLN metastasis classified as N1, upper thoracic-SLN metastasis as N2, and middle or lower thoracic-SLN metastasis as N3, yielding distinct OS stratification. The autoRPA-derived staging outperformed the 8th edition AJCC staging in hazard consistency, sample balance, and predictive accuracy, with RPA-I exhibiting distinctly sharper OS curves than other stages.

Conclusion: Combining T4a/T4b and SLN subclassification enhanced prognostic precision in ESCC, with the autoRPA staging demonstrating superior hazard consistency, sample balance, and predictive accuracy compared to the 8th edition AJCC staging, thereby guiding therapeutic strategies.

Purpose: Spiral volumetric modulated arc therapy (SVMAT) is an integrated radiation therapy technique with longitudinal couch movement to generate a spiral/helical trajectory. This approach combines the merits of volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT). This study aimed to investigate the treatment planning of SVMAT for whole-brain radiotherapy (WBRT) with simultaneous integrated boost (SIB) for a large number (> 40) of metastases.

Materials and methods: Ten patients with multiple brain metastases (40-120 metastases) were retrospectively enrolled. These patients had previously received treatment with HT using the WBRT + SIB technique. Prescribed doses of 40 Gy for the whole brain and 60 Gy for the metastases were delivered in 20 fractions. In this study, SVMAT plans were designed using DeepPlan (version 1.3, Wisdom Tech., Hefei, Anhui, China) as the treatment planning system for the radiotherapy machine NeuRT Aurora (Neusoft IntelliRay Technology, Shenyang, Liaoning, China). In all SVMAT plans, the patient couch was set to move out after specified multiple gantry rotations and then move in within a single treatment fraction. The number of gantry rotations ranged between 6 and 16. These SVMAT plans were compared with HT and piecewise VMAT (previously proposed PVMAT) based on a plan quality metric (PQM) comprising 20 metrics.

Results: For target coverage and conformity index (CI) of whole brain and metastases, no significant differences were observed between the SVMAT&HT or between SVMAT&PVMAT plans (p > 0.05). The sparing of right hippocampus, optic nerves and optic chiasm were improved using the SVMAT plan compared to the HT plan (p < 0.05). However, no significant difference was observed between the SVMAT and PVMAT plans for OAR sparing (p > 0.05). The mean total scores of PQM were 51.70 ± 8.14 (mean ± standard deviation), 53.24 ± 5.84, 53.64 ± 7.16, 54.24 ± 7.06, 54.60 ± 6.30, and 55.05 ± 6.18 points for SVMAT plans with gantry rotations of 6 8, 10, 12, 14, and 16, respectively. The average score for HT was 38.18 ± 5.48 points, which was significantly lower than that for the SVMAT plans (p < 0.05). Furthermore, the mean score for PVMAT was 54.34 ± 6.48 points, and no significant differences were observed between SVMAT and PVMAT (p > 0.05). The beam delivery time was shorter for SVMAT with 6 (271.5 ± 53.7 s), 8(310.3 ± 42.9 s), and 10(359.6 ± 34.4 s) rotations compared to HT (393.0 ± 25.0 s) (p < 0.05) and also shorter for SVMAT with six rotations compared to PVMAT (312.6 ± 53.7 s) (p < 0.05).

Conclusions: For WBRT + SIB, SVMAT achieved improved plan quality and higher delivery efficiency compared with HT and had similar plan quality compared with PVMAT.

Ewing sarcoma (ES) is a rare, aggressive bone malignancy where local control remains central to cure. Modern systemic therapy has improved 5-year overall survival for localized disease to ~ 70%, but outcomes vary by tumor site, size, and patient age. Surgery offers durable control when negative margins (R0) can be achieved without major functional loss, while radiotherapy (RT) is essential for unresectable tumors, close/positive margins, or anatomically challenging locations. This narrative review critically appraises the efficacy, limitations, and late effects of RT and surgery, synthesizing data from cooperative group analyses, retrospective series, and contemporary guidelines. Advances in RT, including IMRT/VMAT, proton beam therapy, and precise target delineation, have enhanced tumor coverage and reduced toxicity, though late effects (growth disturbance, fractures, endocrine sequelae, and secondary malignancies) remain concerns, particularly in children. Surgical outcomes depend heavily on margin status and anatomical site, with adjuvant RT improving control in R1/R2 or pelvic cases. Based on this synthesis, a pragmatic, risk-adapted decision algorithm is proposed: surgery is preferred for achievable R0 resection with acceptable function; RT is indicated when resection is morbid or margins compromised; adjuvant RT is reserved for positive/close margins or high-risk sites; and whole-lung irradiation remains selective for lung-dominant remission. Multidisciplinary decision-making, adherence to standardized RT protocols, and long-term survivorship monitoring are emphasized. Future research should prioritize prospective, multi-institutional trials with uniform outcome definitions and extended follow-up, aiming to refine modality selection, minimize late effects, and improve quality of life. This framework provides a transparent, margin-anchored, anatomy-informed pathway for optimizing local control while preserving long-term outcomes in ES patients.

Objectives: This study aimed to assess the prevalence and risk factors associated with late xerostomia and hyposalivation in head and neck cancer (HNC) patients after radiotherapy (RT).

Materials and methods: An observational, multicentric cross-sectional study was conducted on 260 HNC patients attending various radiation centers for follow up 1-year post-treatment. Clinical assessments included the Subjective Dry Mouth Score (SXI), Clinical Oral Dryness Score (CODS), and Unstimulated Salivary Flow Rate (UWS).

Results: Xerostomia was reported by 78% of patients, with higher severity in those over 50 years (Mean ± SD: 13.53 ± 1.09). Women showed lower salivary flow (UWS: r = 0.556, p < 0.0001) and higher xerostomia scores (SXI: r = 0.337, CODS: r = 0.359) than men. Tumor site correlated strongly with xerostomia (SXI: r = 0.894, p < 0.001), with oral cavity tumors showing more severe effects than nasopharyngeal tumors. Higher RT dose and fraction were negatively associated with UWS (r = -0.537, p < 0.0001) and positively correlated with SXI (r = 0.293) and CODS (r = 0.405, p < 0.0001). The regression models showed that xerostomia severity is significantly predicted by advanced tumor stage, female gender, older age, and higher radiation dose exposure.

Conclusions: The study reveals a high prevalence of xerostomia and hyposalivation among HNC survivors. Increased xerostomia severity and decreased salivary flow were significantly associated with advanced tumor stage, higher radiation doses, and concurrent chemoradiotherapy.

Clinical relevance: Understanding risk factors can guide early interventions and personalized management to enhance long-term oral health outcomes.

Background: Radiation-induced temporal lobe necrosis (TLN) impairs long-term survival of patients with nasopharyngeal carcinoma (NPC) after radiotherapy (RT). We aimed to develop an early scoring model that integrats quantitative MRI indicators and clinical factors to enhance TLN risk stratification.

Methods: Longitudinal MRI scans acquired pre-RT and within 6 months post-RT in 439 patients with NPC (67 necrotic vs. 811 normal temporal lobes) included three-dimensional T1-weighted imaging for gray matter macrostructures and diffusion tensor imaging for white matter microstructures. Clinical and combined models were built using Cox regression, and their performances were compared to evaluate the incremental value of quantitative MRI biomarkers. A composite structural MRI-based risk score (CSS) was constructed for the TLN risk stratification. The incidence of TLN was predicted using a logistic dose-response model.

Results: Combining quantitative MRI biomarkers with clinical factors, such as age, diabetes, and TL radiation dose, significantly improved predictive accuracy and increased the C-index to 0.888 (P = 0.018). CSS effectively identified individuals at high risk for TLN; those with high CSS had a significantly higher TLN risk than those with low CSS (hazard ratio (HR) [95% confidence interval (CI)] = 3.07 [1.77-5.33], P < 0.001). Individuals with high CSS required a lower 50% tolerance dose for 5-year TLN (72.0 Gy) than those with low CSS (75.2 Gy).

Conclusions: Our CSS quantitatively characterized the longitudinal structural alterations in the temporal lobes pre- and post-RT. Integrating CSS with clinical and dosimetric parameters enables accurate TLN risk stratification and informs personalized management for patients with NPC.

Clinical trial number: Not applicable.