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Radiation Therapy for HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline HPV阳性口咽鳞状细胞癌的放射治疗:ASTRO临床实践指南。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.05.007
Danielle N. Margalit MD, MPH , Christopher J. Anker MD , Michalis Aristophanous PhD , Musaddiq Awan MD , Gopal K. Bajaj MD, MBA , Lisa Bradfield BA , Joseph Califano MD , Jimmy J. Caudell MD, PhD , Christina H. Chapman MD, MS , Adam S. Garden MD , Paul M. Harari MD , Amanda Helms MLIS , Alexander Lin MD , Ellie Maghami MD , Ranee Mehra MD , Lance Parker MBA , Yelizaveta Shnayder MD , Sharon Spencer MD , Paul L. Swiecicki MD , Jillian Chiaojung Tsai MD, PhD , David J. Sher MD, MPH

Purpose

Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct disease from other head and neck tumors. This guideline provides evidence-based recommendations on the critical decisions in its curative treatment, including both definitive and postoperative radiation therapy (RT) management.

Methods

ASTRO convened a task force to address 5 key questions on the use of RT for management of HPV-associated OPSCC. These questions included indications for definitive and postoperative RT and chemoradiation; dose-fractionation regimens and treatment volumes; preferred RT techniques and normal tissue considerations; and posttreatment management decisions. The task force did not address indications for primary surgery versus RT. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.

Results

Concurrent cisplatin is recommended for patients receiving definitive RT with T3-4 disease and/or 1 node >3 cm, or multiple nodes. For similar patients who are ineligible for cisplatin, concurrent cetuximab, carboplatin/5-fluorouracil, or taxane-based systemic therapy are conditionally recommended. In the postoperative setting, RT with concurrent cisplatin (either schedule) is recommended for positive surgical margins or extranodal extension. Postoperative RT alone is recommended for pT3-4 disease, >2 nodes, or a single node >3 cm. Observation is conditionally recommended for pT1-2 disease and a single node ≤3 cm without other risk factors. For patients treated with definitive RT with concurrent systemic therapy, 7000 cGy in 33 to 35 fractions is recommended, and for patients receiving postoperative RT without positive surgical margins and extranodal extension, 5600 to 6000 cGy is recommended. For all patients receiving RT, intensity modulated RT over 3-dimensional techniques with reduction in dose to critical organs at risk (including salivary and swallowing structures) is recommended. Reassessment with positron emission tomography-computed tomography is recommended approximately 3 months after definitive RT/chemoradiation, and neck dissection is recommended for convincing evidence of residual disease; for equivocal positron emission tomography-computed tomography findings, either neck dissection or repeat imaging is recommended.

Conclusions

The role and practice of RT continues to evolve for HPV-associated OPSCC, and these guidelines inform best clinical practice based on the available evidence.

目的:人乳头瘤病毒(HPV)相关口咽鳞状细胞癌(OPSCC)是一种不同于其他头颈部肿瘤的疾病。本指南就其根治性治疗的关键决策提供循证建议,包括最终治疗和术后放疗(RT)管理:方法:ASTRO 召集了一个特别工作组,以解决有关使用 RT 治疗 HPV 相关性 OPSCC 的 5 个关键问题。这些问题包括最终和术后 RT 及化学放疗的适应症;剂量分次方案和治疗量;首选 RT 技术和正常组织考虑因素;以及治疗后管理决策。特别工作组没有讨论初次手术与 RT 的适应症。推荐意见以系统性文献综述为基础,采用预先确定的建立共识方法和系统对证据质量和推荐强度进行分级:结果:对于接受确定性 RT 治疗的 T3-4 疾病和/或 1 个结节大于 3 cm 或多个结节的患者,建议同时使用顺铂。对于不符合顺铂治疗条件的类似患者,有条件地推荐同时使用西妥昔单抗、卡铂/5-氟尿嘧啶或基于类固醇的全身治疗。在术后环境中,如果手术边缘阳性或结节外扩展,建议同时使用顺铂(任选一种方案)进行 RT 治疗。对于 pT3-4 病变、>2 个结节或单个结节>3 厘米的患者,建议术后单纯 RT。对于 pT1-2 病变和单个结节≤3 cm 且无其他危险因素的患者,建议有条件地进行观察。对于接受确定性 RT 治疗并同时接受全身治疗的患者,建议使用 7000 cGy,33 至 35 分次;对于接受术后 RT 且手术边缘无阳性和结节外扩展的患者,建议使用 5600 至 6000 cGy。对于所有接受 RT 的患者,建议采用三维技术进行强度调控 RT,并减少危险关键器官(包括唾液和吞咽结构)的剂量。建议在明确RT/化疗后3个月左右进行正电子发射断层扫描-计算机断层扫描复查,如果有令人信服的残留疾病证据,建议进行颈部切除术;如果正电子发射断层扫描-计算机断层扫描结果不明确,建议进行颈部切除术或重复成像:HPV相关OPSCC的RT作用和实践仍在不断发展,这些指南为基于现有证据的最佳临床实践提供了参考。
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引用次数: 0
Increase in Hypofractionated Radiation Therapy Among Patients with Invasive Breast Cancer or Ductal Carcinoma In Situ: Who is Left Behind? 浸润性乳腺癌或原位导管癌患者接受低分次放疗的人数增加:谁被落下了?
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.04.010

Purpose

We aimed to update the trend of hypofractionated whole-breast irradiation (HF-WBI) use over time in the US and examine factors associated with lack of HF-WBI adoption for patients with early-stage invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) undergoing a lumpectomy.

Methods and Materials

Among patients who underwent a lumpectomy, we identified 928,034 patients with early-stage IBC and 330,964 patients with DCIS in the 2004 to 2020 National Cancer Database. We defined HF-WBI as 2.5-3.33 Gy/fraction to the breast and conventionally fractionated WBI as 1.8-2.0 Gy/fraction. We evaluated the trend of HF-WBI utilization using a generalized linear model with the log link and binomial distribution. Factors associated with HF-WBI utilization were assessed using multivariable logistic regression in patients diagnosed between 2018 and 2020.

Results

Among patients with IBC, HF-WBI use has significantly increased from 0.7% in 2004 to 63.9% in 2020. Similarly, HF-WBI usage among patients with DCIS has also increased significantly from 0.4% in 2004 to 56.6% in 2020. Black patients with IBC were less likely than White patients to receive HF-WBI (adjusted odds ratio [AOR] 0.81; 95% CI, 0.77-0.85). Community cancer programs were less likely to administer HF-WBI to patients with IBC (AOR, 0.80; 95% CI, 0.77-0.84) and to those with DCIS (AOR, 0.87; 95% CI, 0.79-0.96) than academic/research programs. Younger age, positive nodes, larger tumor size, low volume programs, and facility location were also associated with lack of HF-WBI adoption in both patient cohorts.

Conclusions

HF-WBI utilization among postlumpectomy patients has significantly increased from 2004 to 2020 and can finally be considered standard of care in the US. We found substantial disparities in adoption within patient and facility subgroups. Reducing disparities in HF-WBI adoption has the potential to further alleviate health care costs while improving patients’ quality of life.

目的:我们旨在更新美国随着时间推移使用低分次全乳照射(HF-WBI)的趋势,并研究接受肿块切除术的早期浸润性乳腺癌(IBC)或导管原位癌(DCIS)患者未采用HF-WBI的相关因素:在接受肿块切除术的患者中,我们在 2004-2020 年全国癌症数据库中识别出 928,034 名早期 IBC 患者和 330,964 名 DCIS 患者。我们将乳腺高频-全乳腺照射定义为 2.5-3.33 Gy/分次,将传统的全乳腺分次照射定义为 1.8-2.0 Gy/分次。我们使用对数链接和二项分布的广义线性模型评估了高频-全乳腺放射治疗的使用趋势。在2018年至2020年期间确诊的患者中,我们使用多变量逻辑回归评估了与高频-WBI使用相关的因素:在IBC患者中,高频-WBI的使用率从2004年的0.7%大幅增至2020年的63.9%。同样,DCIS 患者中高频-WBI 的使用率也从 2004 年的 0.4% 显著增至 2020 年的 56.6%。与白人患者相比,黑人 IBC 患者接受高频-WBI 的可能性较低(调整后的几率比 [AOR] 0.81,95% CI:0.77-0.85)。与学术/研究项目相比,社区癌症项目不太可能对 IBC 患者(AOR 0.80,95% CI:0.77-0.84)和 DCIS 患者(AOR 0.87,95% CI:0.79-0.96)实施 HF-WBI。年龄较小、结节阳性、肿瘤较大、手术量较少以及医疗机构所在地也与两组患者均未采用高频-WBI有关:结论:从2004年到2020年,乳房切除术后患者对高频-WBI的使用率显著增加,在美国最终可被视为标准护理。我们发现,在患者和医疗机构亚群中,采用率存在很大差异。缩小高频生物输导技术的使用差距有可能进一步降低医疗成本,同时提高患者的生活质量。
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引用次数: 0
Custom-Trained Deep Learning-Based Auto-Segmentation for Male Pelvic Iterative CBCT on C-Arm Linear Accelerators 在 C-Arm 线性加速器上为男性盆腔迭代 CBCT 进行基于深度学习的自定义训练的自动分割。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.01.006

Purpose

The purpose of this investigation was to evaluate the clinical applicability of a commercial artificial intelligence–driven deep learning auto-segmentation (DLAS) tool on enhanced iterative cone beam computed tomography (iCBCT) acquisitions for intact prostate and prostate bed treatments.

Methods and Materials

DLAS models were trained using 116 iCBCT data sets with manually delineated organs at risk (bladder, femoral heads, and rectum) and target volumes (intact prostate and prostate bed) adhering to institution-specific contouring guidelines. An additional 25 intact prostate and prostate bed iCBCT data sets were used for model testing. Segmentation accuracy relative to a reference structure set was quantified using various geometric comparison metrics and qualitatively evaluated by trained physicists and physicians. These results were compared with those obtained for an additional DLAS-based model trained on planning computed tomography (pCT) data sets and for a deformable image registration (DIR)-based automatic contour propagation method.

Results

In most instances, statistically significant differences in the Dice similarity coefficient (DSC), 95% directed Hausdorff distance, and mean surface distance metrics were observed between the models, as the iCBCT-trained DLAS model outperformed the pCT-trained DLAS model and DIR-based method for all organs at risk and the intact prostate target volume. Mean DSC values for the proposed method were 0.90 for these volumes of interest. The iCBCT-trained DLAS model demonstrated a relatively suboptimal performance for the prostate bed segmentation, as the mean DSC value was <0.75 for this target contour. Overall, 90% of bladder, 93% of femoral head, 67% of rectum, and 92% of intact prostate contours generated by the proposed method were deemed clinically acceptable based on qualitative scoring, and approximately 63% of prostate bed contours required moderate or major manual editing to adhere to institutional contouring guidelines.

Conclusions

The proposed method presents the potential for improved segmentation accuracy and efficiency compared with the DIR-based automatic contour propagation method as commonly applied in CBCT-based dose evaluation and calculation studies.

目的:评估商业人工智能(AI)驱动的深度学习自动分割(DLAS)工具在增强迭代锥束 CT(iCBCT)采集的完整前列腺和前列腺床治疗中的临床适用性:使用116个iCBCT数据集训练DLAS模型,这些数据集具有人工划定的风险器官(OARs--膀胱、股骨头和直肠)和目标体积(完整前列腺和前列腺床),符合特定机构的轮廓指引。另有 25 个完整前列腺和前列腺床 iCBCT 数据集用于模型测试。相对于参考结构集,使用各种几何比较指标对分割准确性进行量化,并由经过培训的物理学家和医生进行定性评估。这些结果与在规划 CT(pCT)数据集上训练的另一个基于 DLAS 的模型和基于可变形图像配准(DIR)的自动轮廓传播方法获得的结果进行了比较:在大多数情况下,模型之间在狄斯相似系数(DSC)、95%定向豪斯多夫距离和平均表面距离指标上存在显著的统计学差异,因为在所有OAR和完整前列腺靶体积上,iCBCT训练的DLAS模型优于pCT训练的DLAS模型和基于DIR的方法。对于这些感兴趣体积,拟议方法的平均 DSC 值≥0.90。iCBCT 训练的 DLAS 模型在前列腺床分割方面表现相对较差,因为平均 DSC 值为结论:与 CBCT 剂量评估和计算研究中常用的基于 DIR 的自动轮廓传播方法相比,所提出的方法具有提高分割准确性和效率的潜力。
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引用次数: 0
The Srimad Bhagavata Purana Book X: A Lesson in the Beauty of the Midnight Sky 薄伽梵往世书》(Srimad Bhagavata Purana)第十卷:午夜天空之美的一堂课
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.02.005
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引用次数: 0
Utility of Clinical-Pathological Parameters for Exclusion of BRCA1/2 Mutation Carriers as Candidates for Partial Breast Irradiation 排除 BRCA1/2 基因突变携带者作为乳腺部分照射候选者的临床病理参数的实用性
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.04.019
Rinat Bernstein-Molho MD , Narmeen Abu-Shehada MSc , Einav Nili Gal-Yam MD, PhD , Douglas Zippel MD , Tehillah Menes MD , Miri Sklair-Levy MD , Shira Galper MD , Orit Kaidar-Person MD

Purpose

Several international groups have published guidelines to identify low-risk breast cancer (BC) patients who are eligible for partial breast irradiation (PBI). These include the American Society for Radiation Oncology (ASTRO), the European Society for Radiotherapy and Oncology (ESTRO), and ESTRO subgroups such as the Intraoperative radiation (IORT) Task Force and Groupe Européen de Curiethérapie (GEC) -ESTRO. Only ASTRO guidelines recommend against the use of PBI in known carriers of germline pathogenic variants (PVs) in BRCA1/2. The aim of this study was to evaluate the proportion of BC patients, subsequently found to be BRCA1/2 PV carriers who would be eligible for PBI based on clinical-pathologic criteria of the above-mentioned international guidelines.

Methods and Materials

Data were extracted from the medical records of consecutive BC BRCA1/2 PV carriers treated at a single institution between 2006 and 2023. Data included patient demographics, tumor characteristics, treatment, and disease outcomes.

Results

Overall, 498 patients with 518 primary tumors were analyzed. Of these, 282 (12 of them with synchronous bilateral disease) presented with unknown genetic status at diagnosis and formed the study cohort. The median age at diagnosis was 42.7 years (range, 23.8-77.9). Based on the recent ASTRO guidelines (not including conditionally recommended criteria), 17 of 294 (5.8%) of the carriers had tumors that would be eligible for PBI, including 3 Her2-positive tumors and 5 patients diagnosed between ages 40 and 49 years. Using the ESTRO IORT and the ACROP-ESTRO PBI criteria, 9 of 294 (3%) would be eligible, whereas with the GEC-ESTRO low-risk criteria, 31 of 294 (10.5%) of the carriers would be eligible, and their intermediate risk criteria would increase eligibility for PBI by an additional 8.2% (overall 18.7%).

Conclusions

Using clinical-pathologic criteria published in international guidelines, 3% to 18% of BRCA1/2 PV carriers will have tumors eligible for PBI. Therefore, especially in populations who are at high risk for being BRCA1/2 PV carriers, we recommend adhering to stricter guidelines. In our cohort, ASTRO, ESTRO-IORT, and ESTRO PBI had the lowest probability of identifying BRCA1/2 PV carriers as eligible for PBI.

目的多个国际组织已发布指南,以确定符合乳腺部分照射(PBI)条件的低风险乳腺癌(BC)患者。这些组织包括美国放射肿瘤学会(ASTRO)、欧洲放射治疗和肿瘤学会(ESTRO)以及术中放射(IORT)工作组和欧洲放射治疗小组(GEC)-ESTRO 等 ESTRO 分组。只有 ASTRO 指南建议不要对已知的 BRCA1/2 基因致病变异(PV)携带者使用 PBI。本研究的目的是根据上述国际指南的临床病理学标准,评估随后发现为 BRCA1/2 PV 携带者的 BC 患者中符合 PBI 的比例。数据包括患者的人口统计学特征、肿瘤特征、治疗和疾病结局。结果共分析了 498 例患者的 518 个原发肿瘤。其中,282 名患者(其中 12 人患有同步双侧疾病)在诊断时基因状态不明,组成了研究队列。确诊时的中位年龄为 42.7 岁(23.8-77.9 岁)。根据最新的ASTRO指南(不包括有条件推荐标准),294名携带者中有17人(5.8%)的肿瘤符合PBI条件,其中包括3名Her2阳性肿瘤患者和5名诊断年龄在40至49岁之间的患者。根据 ESTRO IORT 和 ACROP-ESTRO PBI 标准,294 例中有 9 例(3%)符合 PBI 标准,而根据 GEC-ESTRO 低风险标准,294 例中有 31 例(10.5%)符合 PBI 标准,而根据中度风险标准,符合 PBI 标准的比例将增加 8.2%(总比例为 18.7%)。因此,特别是在 BRCA1/2 PV 携带者的高危人群中,我们建议遵守更严格的指南。在我们的队列中,ASTRO、ESTRO-IORT 和 ESTRO PBI 鉴定 BRCA1/2 PV 携带者符合 PBI 的概率最低。
{"title":"Utility of Clinical-Pathological Parameters for Exclusion of BRCA1/2 Mutation Carriers as Candidates for Partial Breast Irradiation","authors":"Rinat Bernstein-Molho MD ,&nbsp;Narmeen Abu-Shehada MSc ,&nbsp;Einav Nili Gal-Yam MD, PhD ,&nbsp;Douglas Zippel MD ,&nbsp;Tehillah Menes MD ,&nbsp;Miri Sklair-Levy MD ,&nbsp;Shira Galper MD ,&nbsp;Orit Kaidar-Person MD","doi":"10.1016/j.prro.2024.04.019","DOIUrl":"10.1016/j.prro.2024.04.019","url":null,"abstract":"<div><h3>Purpose</h3><p>Several international groups have published guidelines to identify low-risk breast cancer (BC) patients who are eligible for partial breast irradiation (PBI). These include the American Society for Radiation Oncology (ASTRO), the European Society for Radiotherapy and Oncology (ESTRO), and ESTRO subgroups such as the Intraoperative radiation (IORT) Task Force and Groupe Européen de Curiethérapie (GEC) -ESTRO. Only ASTRO guidelines recommend against the use of PBI in known carriers of germline pathogenic variants (PVs) in <em>BRCA1</em>/<em>2</em>. The aim of this study was to evaluate the proportion of BC patients, subsequently found to be <em>BRCA1/2</em> PV carriers who would be eligible for PBI based on clinical-pathologic criteria of the above-mentioned international guidelines.</p></div><div><h3>Methods and Materials</h3><p>Data were extracted from the medical records of consecutive BC <em>BRCA1/2</em> PV carriers treated at a single institution between 2006 and 2023. Data included patient demographics, tumor characteristics, treatment, and disease outcomes.</p></div><div><h3>Results</h3><p>Overall, 498 patients with 518 primary tumors were analyzed. Of these, 282 (12 of them with synchronous bilateral disease) presented with unknown genetic status at diagnosis and formed the study cohort. The median age at diagnosis was 42.7 years (range, 23.8-77.9). Based on the recent ASTRO guidelines (not including conditionally recommended criteria), 17 of 294 (5.8%) of the carriers had tumors that would be eligible for PBI, including 3 Her2-positive tumors and 5 patients diagnosed between ages 40 and 49 years. Using the ESTRO IORT and the ACROP-ESTRO PBI criteria, 9 of 294 (3%) would be eligible, whereas with the GEC-ESTRO low-risk criteria, 31 of 294 (10.5%) of the carriers would be eligible, and their intermediate risk criteria would increase eligibility for PBI by an additional 8.2% (overall 18.7%).</p></div><div><h3>Conclusions</h3><p>Using clinical-pathologic criteria published in international guidelines, 3% to 18% of <em>BRCA1/2</em> PV carriers will have tumors eligible for PBI. Therefore, especially in populations who are at high risk for being <em>BRCA1/2</em> PV carriers, we recommend adhering to stricter guidelines. In our cohort, ASTRO, ESTRO-IORT, and ESTRO PBI had the lowest probability of identifying <em>BRCA1/2</em> PV carriers as eligible for PBI.</p></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Pages 435-442"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In Regard to Ethan B. Ludmir et al 关于 Ethan B. Ludmir 等人
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.03.006
Sarah Akhtar MBBS, Maria Tariq MBBS, FCPS, Bareera Shamsi MBBS, Sehrish Abrar MBBS, FCPS, Bilal Mazhar Qureshi MBBS, FCPS, Asim Hafiz MBBS, FCPS, Nasir Ali MBBS, FCPS, Ahmed Nadeem Abbasi MBBS, FRCR
{"title":"In Regard to Ethan B. Ludmir et al","authors":"Sarah Akhtar MBBS,&nbsp;Maria Tariq MBBS, FCPS,&nbsp;Bareera Shamsi MBBS,&nbsp;Sehrish Abrar MBBS, FCPS,&nbsp;Bilal Mazhar Qureshi MBBS, FCPS,&nbsp;Asim Hafiz MBBS, FCPS,&nbsp;Nasir Ali MBBS, FCPS,&nbsp;Ahmed Nadeem Abbasi MBBS, FRCR","doi":"10.1016/j.prro.2024.03.006","DOIUrl":"10.1016/j.prro.2024.03.006","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Pages 464-465"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correspondence: In Regard to Gogineni et al. Correspondence: In Regard to Gogineni et al.
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.04.021
Laraib Khan MBBS, Maham Khan MBBS, Tooba Ali MBBS, Mariam Hina MBBS, Asim Hafiz MBBS, FCPS, Sehrish Abrar MBBS, FCPS, Nasir Ali MBBS, FCPS, Ahmed Nadeem Abbasi MBBS, FFRRCSI, Bilal Mazhar Qureshi MBBS, FCPS
{"title":"Correspondence: In Regard to Gogineni et al.","authors":"Laraib Khan MBBS,&nbsp;Maham Khan MBBS,&nbsp;Tooba Ali MBBS,&nbsp;Mariam Hina MBBS,&nbsp;Asim Hafiz MBBS, FCPS,&nbsp;Sehrish Abrar MBBS, FCPS,&nbsp;Nasir Ali MBBS, FCPS,&nbsp;Ahmed Nadeem Abbasi MBBS, FFRRCSI,&nbsp;Bilal Mazhar Qureshi MBBS, FCPS","doi":"10.1016/j.prro.2024.04.021","DOIUrl":"10.1016/j.prro.2024.04.021","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 5","pages":"Page 468"},"PeriodicalIF":3.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Update on H3K27M-altered Diffuse Midline Glioma: Diagnostic and Therapeutic Challenges in Clinical Practice H3K27M改变的弥漫中线胶质瘤的最新进展:临床实践中的诊断和治疗挑战。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.04.013

H3K27-altered diffuse midline glioma (DMG H3K27-altered) is a relatively newly-designated WHO entity which primarily affects the midline structures of the central nervous system (CNS), including the brainstem (predominantly pontine region), thalamus, midbrain, or spinal cord, and primarily affects children and young adults. Despite the proximity of these tumors to eloquent areas in the CNS, novel stereotactic approaches have facilitated the ability to obtain tissue diagnoses without significant morbidity, providing molecular diagnostic information in more than half of patients. Conventionally fractionated radiation therapy to a total dose of 54-60 Gy in 27-30 fractions and 24 Gy in 12 fractions play a crucial role in the definitive treatment of these tumors in the primary and salvage settings, respectively. Hypofractionated regimens may allow for accelerated treatment courses in selected patients without jeopardizing disease control or survival. The decision to add concurrent or adjuvant systemic therapy mainly relies on the physicians’ experience without solid evidence in the literature in favor of any particular regimen. Recently, novel agents, such as ONC201 have demonstrated promising oncologic outcomes in progressive/recurrent tumors and are currently under investigation in ongoing randomized trials. Given the scarcity of data and well-established guidelines due to the rare nature of the disease, we provide a contemporary overview on the molecular underpinnings of this disease entity, describe the role of radiotherapy and systemic therapy, and present practice management principles based on the published literature.

H3K27 改变的弥漫性中线胶质瘤(DMG H3K27-altered)是世界卫生组织新近指定的一种肿瘤,主要影响中枢神经系统(CNS)的中线结构,包括脑干(主要是桥脑区域)、丘脑、中脑或脊髓,主要影响儿童和年轻成人。尽管这些肿瘤靠近中枢神经系统的发音区,但新型的立体定向方法有助于获得组织诊断而不会造成严重的发病,并能为一半以上的患者提供分子诊断信息。传统的分次放射治疗总剂量为 54-60 Gy(27-30 次/分)和 24 Gy(12 次/分),这两种疗法分别在原发性和挽救性治疗中对这些肿瘤的最终治疗起着至关重要的作用。在不影响疾病控制或存活率的情况下,低分次治疗方案可使特定患者的治疗疗程加快。是否增加并发或辅助系统治疗主要取决于医生的经验,而文献中并没有支持任何特定方案的确凿证据。最近,ONC201 等新型药物在进展期/复发性肿瘤中显示出良好的肿瘤治疗效果,目前正在进行的随机试验中对其进行研究。鉴于这种疾病的罕见性,我们将提供有关这种疾病的分子基础的当代概述,描述放疗和系统治疗的作用,并根据已发表的文献介绍实践管理原则。
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引用次数: 0
Erratum to: Pashtan IM, Kosak T, Shin K-Y, et al. An Automated, Dynamic Radiation Oncology Prescription Checking System. Pract Radiat Oncol. 2024;14:343-352. 勘误:Pashtan IM, Kosak T, Shin K-Y, et al. An Automated, Dynamic Radiation Oncology Prescription Checking System.Pract Radiat Oncol.2024;14:343-352.
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.05.003
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引用次数: 0
Adapt-On-Demand: A Novel Strategy for Personalized Adaptive Radiation Therapy for Locally Advanced Lung Cancer 按需适应:针对局部进展期肺癌的个性化自适应放疗新策略。
IF 3.4 3区 医学 Q2 ONCOLOGY Pub Date : 2024-09-01 DOI: 10.1016/j.prro.2024.02.007

Purpose

Real-time adaptation of thoracic radiation plans is compelling because offline adaptive experiences show that tumor volumes and lung anatomy can change during therapy. We present and analyze a novel adaptive-on-demand (AOD) workflow combining online adaptive radiation therapy (o-ART) on the ETHOS system with image guided radiation therapy delivery on a Halcyon unit for conventional fractionated radiation therapy of locally advanced lung cancer (LALC).

Methods and Materials

We analyzed 26 patients with LALC treated with the AOD workflow, adapting weekly. We timed segments of the workflow to evaluate efficiency in a real-world clinic. Target coverage and organ at risk (OAR) doses were compared between adaptive plans (ADP) and nonadaptive scheduled plans (SCH). Planning robustness was evaluated by the frequency of preplanning goals achieved in ADP plans, stratified by tumor volume change.

Results

The AOD workflow was achievable within 30 minutes for most radiation fractions. Over the course of therapy, we observed an average 26.6% ± 23.3% reduction in internal target volume (ITV). Despite these changes, with o-ART, ITV and planning target volume (PTV) coverage (V100%) was 99.2% and 93.9% for all members of the cohort, respectively. This represented a 2.9% and 6.8% improvement over nonadaptive plans (P < .05), respectively. For tumors that grew >10%, V100% was 93.1% for o-ART and 76.4% for nonadaptive plans, representing a median 17.2% improvement in the PTV coverage (P < .05). In these plans, critical OAR constraints were met 94.1% of the time, whereas in nonadaptive plans, this figure was 81.9%. This represented reductions of 1.32 Gy, 1.34 Gy, or 1.75 Gy in the heart, esophagus, and lung, respectively. The effect was larger when tumors had shrunk more than 10%. Regardless of tumor volume alterations, the PTV/ITV coverage was achieved for all adaptive plans. Exceptional cases, where dose constraints were not met, were due to large initial tumor volumes or tumor growth.

Conclusions

The AOD workflow is efficient and robust in responding to anatomic changes in LALC patients, providing dosimetric advantages over standard therapy. Weekly adaptation was adequate to keep pace with changes. This approach is a feasible alternative to conventional offline replanning workflows for managing anatomy changes in LALC radiation therapy.

目的 由于离线自适应经验表明肿瘤体积和肺部解剖结构会在治疗过程中发生变化,因此实时调整胸部放射计划非常重要。我们介绍并分析了一种新型的按需自适应性(AOD)工作流程,该流程将 ETHOS 系统上的在线自适应放射治疗(o-ART)与 Halcyon 设备上的图像引导放射治疗给药相结合,用于局部晚期肺癌(LALC)的常规分次放射治疗。我们对工作流程的各个环节进行了计时,以评估实际临床中的效率。比较了适应性计划(ADP)和非适应性计划(SCH)的目标覆盖率和风险器官(OAR)剂量。根据肿瘤体积的变化分层,通过 ADP 计划中实现预计划目标的频率来评估计划的稳健性。在治疗过程中,我们观察到内部靶体积(ITV)平均减少了 26.6% ± 23.3%。尽管出现了这些变化,但使用 o-ART,队列中所有成员的内靶体积(ITV)和计划靶体积(PTV)覆盖率(V100%)分别为 99.2% 和 93.9%。与非适应性计划相比,分别提高了2.9%和6.8%(P< .05)。对于生长率为 10%的肿瘤,o-ART 的 V100% 为 93.1%,而非适应性计划的 V100% 为 76.4%,PTV 覆盖率的中位数提高了 17.2%(P <.05)。在这些计划中,有94.1%的时间满足了临界OAR限制,而在非适应性计划中,这一数字为81.9%。这意味着心脏、食道和肺部分别减少了 1.32 Gy、1.34 Gy 或 1.75 Gy。当肿瘤缩小 10%以上时,效果更大。无论肿瘤体积如何变化,所有适应性计划都能达到 PTV/ITV 覆盖率。结论AOD工作流程在应对LALC患者的解剖结构变化方面高效稳健,与标准疗法相比具有剂量优势。每周调整一次足以跟上变化的步伐。这种方法可以替代传统的离线重新规划工作流程,用于管理 LALC 放射治疗中的解剖变化。
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引用次数: 0
期刊
Practical Radiation Oncology
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