Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.04.010
Zohaib Sherwani MD , Ulysses Gardner MD, MBA , Irina Vergalasova PhD , Hong Zhang MD, PhD , Daniel Song MD , Surendra Prajapati PhD , Pretesh Patel MD , Mitchell Kamrava MD , Lara Hathout MD
High-dose-rate (HDR) brachytherapy has demonstrated significant clinical efficacy in the management of prostate cancer, facilitating dose escalation in both boost and monotherapy settings. However, recent graduates in radiation oncology report limited exposure to brachytherapy during training, resulting in reduced procedural proficiency and a lack of confidence in performing and assessing brachytherapy treatment plans. This technical report addresses key aspects of plan evaluation within the computed tomography- and magnetic resonance imaging-based workflow for whole-gland prostate HDR brachytherapy, both as monotherapy and as a boost modality. It aims to equip residents and recent graduates with a structured approach to evaluating treatment plans, thereby enhancing their competency and confidence in HDR brachytherapy practice.
{"title":"American Brachytherapy Society Education Committee Technical Report: A Resident’s Guide to Evaluation of Prostate High Dose Rate Brachytherapy Treatment Plans","authors":"Zohaib Sherwani MD , Ulysses Gardner MD, MBA , Irina Vergalasova PhD , Hong Zhang MD, PhD , Daniel Song MD , Surendra Prajapati PhD , Pretesh Patel MD , Mitchell Kamrava MD , Lara Hathout MD","doi":"10.1016/j.prro.2025.04.010","DOIUrl":"10.1016/j.prro.2025.04.010","url":null,"abstract":"<div><div><span><span>High-dose-rate (HDR) brachytherapy<span> has demonstrated significant clinical efficacy in the management of prostate cancer, facilitating dose escalation in both boost and </span></span>monotherapy settings. However, recent graduates in </span>radiation oncology report limited exposure to brachytherapy during training, resulting in reduced procedural proficiency and a lack of confidence in performing and assessing brachytherapy treatment plans. This technical report addresses key aspects of plan evaluation within the computed tomography- and magnetic resonance imaging-based workflow for whole-gland prostate HDR brachytherapy, both as monotherapy and as a boost modality. It aims to equip residents and recent graduates with a structured approach to evaluating treatment plans, thereby enhancing their competency and confidence in HDR brachytherapy practice.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 58-65"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057915","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.06.005
Sungmin Woo MD, PhD , Anton S. Becker MD, PhD , Angela Tong MD , Hebert Alberto Vargas MD , Peter B. Schiff MD, PhD , David J. Byun MD , Michael J. Zelefsky MD
Postradiation therapy erectile dysfunction can significantly impact the quality of life of patients with prostate cancer (PCa). Critical anatomic structures, such as the neurovascular bundles (NVBs), internal pudendal arteries (IPAs), penile bulb, and corporal tissues track near the prostate, making them susceptible to radiation-related damage. This study aimed to evaluate the anatomic patterns of these structures and their relationship with the prostate and to provide comprehensive illustrative examples on magnetic resonance imaging (MRI) scans. Consecutive patients with PCa who underwent MRI-linear accelerator-based stereotactic body radiation therapy from January 2024 until December 2024 were included. NVB patterns were classified into 3 categories: (1) “classical” with discrete NVB elements, (2) “adherent,” dispersed and adherent to prostatic capsule, and (3) “absent.” The smallest distance between the IPA and the prostate capsule and the membranous urethral length, serving as a surrogate for the distance between corporal tissue and prostatic apex, were also measured. These MRI scan findings were compared between prostate volumes >40 and <40 mL and between MRI scan findings and pathologic features of the dominant intraprostatic lesion. A total of 160 men (median age 70 years, interquartile range [IQR], 64-76) were included. The most common NVB pattern was “classic” (80.0%-85.0%), followed by the “adherent” NVB pattern (13.8%-18.1%). The median smallest distance between the IPA and prostate was 2.3 cm (IQR, 1.8-2.8 cm), with 3.1% to 3.8% <1.0 cm. The median membranous urethral length was 1.5 cm (IQR, 1.2-1.8 cm), with 2.5% of patients <1.0 cm. No significant association was found between these MRI scan features and prostate volume or other variables (P = .09-.99). In conclusion, most patients with PCa demonstrated favorable anatomy for potential dose sparing of critical structures. Comprehensive MRI scan illustrations are provided to help radiation oncologists recognize the location, trajectory, and relationship of these structures, facilitating their contouring and ultimately aiding in achieving meaningful dose reductions to these erectile function structures.
{"title":"Identification of Key Anatomic Structures on Magnetic Resonance Imaging During Prostate Stereotactic Body Radiation Therapy for Dose Avoidance to Reduce Erectile Dysfunction Risk","authors":"Sungmin Woo MD, PhD , Anton S. Becker MD, PhD , Angela Tong MD , Hebert Alberto Vargas MD , Peter B. Schiff MD, PhD , David J. Byun MD , Michael J. Zelefsky MD","doi":"10.1016/j.prro.2025.06.005","DOIUrl":"10.1016/j.prro.2025.06.005","url":null,"abstract":"<div><div>Postradiation therapy erectile dysfunction can significantly impact the quality of life of patients with prostate cancer (PCa). Critical anatomic structures, such as the neurovascular bundles (NVBs), internal pudendal arteries (IPAs), penile bulb, and corporal tissues track near the prostate, making them susceptible to radiation-related damage. This study aimed to evaluate the anatomic patterns of these structures and their relationship with the prostate and to provide comprehensive illustrative examples on magnetic resonance imaging (MRI) scans. Consecutive patients with PCa who underwent MRI-linear accelerator-based stereotactic body radiation therapy from January 2024 until December 2024 were included. NVB patterns were classified into 3 categories: (1) “classical” with discrete NVB elements, (2) “adherent,” dispersed and adherent to prostatic capsule, and (3) “absent.” The smallest distance between the IPA and the prostate capsule and the membranous urethral length, serving as a surrogate for the distance between corporal tissue and prostatic apex, were also measured. These MRI scan findings were compared between prostate volumes >40 and <40 mL and between MRI scan findings and pathologic features of the dominant intraprostatic lesion. A total of 160 men (median age 70 years, interquartile range [IQR], 64-76) were included. The most common NVB pattern was “classic” (80.0%-85.0%), followed by the “adherent” NVB pattern (13.8%-18.1%). The median smallest distance between the IPA and prostate was 2.3 cm (IQR, 1.8-2.8 cm), with 3.1% to 3.8% <1.0 cm. The median membranous urethral length was 1.5 cm (IQR, 1.2-1.8 cm), with 2.5% of patients <1.0 cm. No significant association was found between these MRI scan features and prostate volume or other variables (<em>P =</em> .09-.99). In conclusion, most patients with PCa demonstrated favorable anatomy for potential dose sparing of critical structures. Comprehensive MRI scan illustrations are provided to help radiation oncologists recognize the location, trajectory, and relationship of these structures, facilitating their contouring and ultimately aiding in achieving meaningful dose reductions to these erectile function structures.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 66-73"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555735","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.07.004
Aisling M. Glynn MD , Teo Stanescu PhD , Joanna Javor MSc , Laura A. Dawson MD , Yaacov R. Lawrence MRCP , Michael Yan MD, MPH
{"title":"Celiac Plexus Radiosurgery for the Management of Pancreatic Cancer Pain: Key Tips and Considerations","authors":"Aisling M. Glynn MD , Teo Stanescu PhD , Joanna Javor MSc , Laura A. Dawson MD , Yaacov R. Lawrence MRCP , Michael Yan MD, MPH","doi":"10.1016/j.prro.2025.07.004","DOIUrl":"10.1016/j.prro.2025.07.004","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages e17-e27"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755112","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.07.006
Julia E. Peltenburg MD , Rosalyne Westley MD, PhD , Lois A. Daamen MD, PhD , Renaud Tissier PhD , Katherine L. Aitken MD, PhD , Uffe Bernchou MD, PhD , Simon Boeke MD, PhD , Petra M. Braam MD, PhD , Ali Hosni MD, PhD , Martijn P.W. Intven MD, PhD , Tomas Janssen PhD , Jan-Jakob Sonke PhD , Michael W. Straza Jr MD, PhD , William A. Hall MD, PhD , Marlies E. Nowee MD, PhD
Purpose
Stereotactic body radiation therapy (SBRT) is a local treatment option for liver metastases. The introduction of magnetic resonance imaging (MRI) guided SBRT has paved the way for optimal treatment outcomes by improving tumor visualization, daily plan adaptation and margin reduction. The purpose of this study was to review the tolerability of MRI-guided liver SBRT and to present early toxicity and quality of life (QoL) outcomes from a prospective multicenter registry.
Methods and Materials
All patients enrolled in the MOMENTUM study (NCT04075305) who were treated for liver metastases between April 2019 and April 2023 on a 1.5T MR-Linac were included. Descriptive statistics were used to present tolerability of treatment, acute toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0) and Quality of Life questionnaires (QLQ-C30 and EQ-5D-5L) at baseline and 3 months after treatment.
Results
A total of 135 patients (median age, 67 years; range, 31-93) were treated in 7 institutes across 4 countries. The most common primary tumor origins were colorectal (50%) and lung cancer (12%). Prescribed total SBRT doses ranged from 20.0 to 67.5 Gy, delivered in 2 to 12 fractions of 7 to 22.5 Gy per fraction (median biologically effective dose, 180 Gy; range, 59.5-540 Gy). A total of 97% of patients (n = 131) completed their treatment, with no interruptions due to poor tolerability. Up to 3 months, 14 grade 3 toxicities were reported in 12 patients (10.6%), with only 1 (0.9%) recorded as radiation therapy related (gastritis). No grade ≥4 toxicities were reported. Sixty-two and 63 patients completed the QLQ-C30 and EQ-5D-5L questionnaires at both time points, respectively. These showed a worsening of 5 to 10 points at 3 months for role functioning, nausea, fatigue, constipation, and pain.
Conclusions
In this prospective cohort, 97% of treatments were well tolerated and completed successfully, with only 1 case of acute grade 3 radiation therapy related toxicity and no grade ≥4 toxicity reported. QoL outcomes showed clinically relevant worsening (defined as ≥5 points) in 5 domains, which is comparable to that of computed tomography (CT-) guided SBRT. Overall, the outcomes showed that MRI-guided SBRT is a well-tolerated and safe treatment for patients with liver metastases.
{"title":"Liver Metastases Treated With Magnetic Resonance Imaging Guided Stereotactic Body Radiation Therapy: Outcomes of Tolerability, Acute Toxicity, and Quality of Life From the MOMENTUM Study","authors":"Julia E. Peltenburg MD , Rosalyne Westley MD, PhD , Lois A. Daamen MD, PhD , Renaud Tissier PhD , Katherine L. Aitken MD, PhD , Uffe Bernchou MD, PhD , Simon Boeke MD, PhD , Petra M. Braam MD, PhD , Ali Hosni MD, PhD , Martijn P.W. Intven MD, PhD , Tomas Janssen PhD , Jan-Jakob Sonke PhD , Michael W. Straza Jr MD, PhD , William A. Hall MD, PhD , Marlies E. Nowee MD, PhD","doi":"10.1016/j.prro.2025.07.006","DOIUrl":"10.1016/j.prro.2025.07.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic body radiation therapy (SBRT) is a local treatment option for liver metastases. The introduction of magnetic resonance imaging (MRI) guided SBRT has paved the way for optimal treatment outcomes by improving tumor visualization, daily plan adaptation and margin reduction. The purpose of this study was to review the tolerability of MRI-guided liver SBRT and to present early toxicity and quality of life (QoL) outcomes from a prospective multicenter registry.</div></div><div><h3>Methods and Materials</h3><div>All patients enrolled in the MOMENTUM study (NCT04075305) who were treated for liver metastases between April 2019 and April 2023 on a 1.5T MR-Linac were included. Descriptive statistics were used to present tolerability of treatment, acute toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0) and Quality of Life questionnaires (QLQ-C30 and EQ-5D-5L) at baseline and 3 months after treatment.</div></div><div><h3>Results</h3><div>A total of 135 patients (median age, 67 years; range, 31-93) were treated in 7 institutes across 4 countries. The most common primary tumor origins were colorectal (50%) and lung cancer (12%). Prescribed total SBRT doses ranged from 20.0 to 67.5 Gy, delivered in 2 to 12 fractions of 7 to 22.5 Gy per fraction (median biologically effective dose, 180 Gy; range, 59.5-540 Gy). A total of 97% of patients (n = 131) completed their treatment, with no interruptions due to poor tolerability. Up to 3 months, 14 grade 3 toxicities were reported in 12 patients (10.6%), with only 1 (0.9%) recorded as radiation therapy related (gastritis). No grade ≥4 toxicities were reported. Sixty-two and 63 patients completed the QLQ-C30 and EQ-5D-5L questionnaires at both time points, respectively. These showed a worsening of 5 to 10 points at 3 months for role functioning, nausea, fatigue, constipation, and pain.</div></div><div><h3>Conclusions</h3><div>In this prospective cohort, 97% of treatments were well tolerated and completed successfully, with only 1 case of acute grade 3 radiation therapy related toxicity and no grade ≥4 toxicity reported. QoL outcomes showed clinically relevant worsening (defined as ≥5 points) in 5 domains, which is comparable to that of computed tomography (CT-) guided SBRT. Overall, the outcomes showed that MRI-guided SBRT is a well-tolerated and safe treatment for patients with liver metastases.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 48-57"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978481","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.06.003
Kevin Tran MD , Amy C. Schefler MD , Lindsey N. Nguyen MD , Devin Olek MS , Hui-Chuan Wang MS , Ramiro Pino PhD , Edward Brian Butler MD , Bin S. Teh MD
Purpose
Eye plaque brachytherapy (EPBT) is not routinely performed on large uveal melanomas (UM) as commercially available plaques often cannot ensure adequate coverage of the tumor with high doses of 85 Gy. The purpose of this study is to report our institution’s experience with a clinically novel approach of staged EPBT in treating large UM in 2 treatments, 45 Gy in each treatment.
Methods and Materials
Patients were included if they underwent staged EPBT at our institution between 2020 and 2023.
Results
A total of 13 patients with a median age of 65 were included in this study. All patients were treated with Iodine-125 with a first-stage prescription dose of 45 Gy and with a second-stage treatment occurring at median 13 weeks after with prescription dose of 45 Gy. Median follow-up was 42 months, and local control was 100% with no patients requiring an enucleation for a local recurrence or other radiation-related toxicities. At last follow-up, all tumors were decreased in size. Visual acuity worsened in 11 patients, and other radiation-related toxicities included cataract, cystoid macular edema, radiation retinopathy, and neovascular glaucoma. Three patients developed metastases, one of whom died shortly after, while all other patients were alive at last follow-up.
Conclusions
Staged EPBT for large UM is a novel and feasible globe-preserving treatment with a high rate of local control. Ocular toxicities are expected but do not require enucleation. Further prospective randomized trials should be performed to validate this treatment approach.
{"title":"Staged I-125 Eye Plaque Brachytherapy for the Treatment of Large Uveal Melanoma: A Single Institution Experience","authors":"Kevin Tran MD , Amy C. Schefler MD , Lindsey N. Nguyen MD , Devin Olek MS , Hui-Chuan Wang MS , Ramiro Pino PhD , Edward Brian Butler MD , Bin S. Teh MD","doi":"10.1016/j.prro.2025.06.003","DOIUrl":"10.1016/j.prro.2025.06.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Eye plaque brachytherapy (EPBT) is not routinely performed on large uveal melanomas (UM) as commercially available plaques often cannot ensure adequate coverage of the tumor with high doses of 85 Gy. The purpose of this study is to report our institution’s experience with a clinically novel approach of staged EPBT in treating large UM in 2 treatments, 45 Gy in each treatment.</div></div><div><h3>Methods and Materials</h3><div>Patients were included if they underwent staged EPBT at our institution between 2020 and 2023.</div></div><div><h3>Results</h3><div>A total of 13 patients with a median age of 65 were included in this study. All patients were treated with Iodine-125 with a first-stage prescription dose of 45 Gy and with a second-stage treatment occurring at median 13 weeks after with prescription dose of 45 Gy. Median follow-up was 42 months, and local control was 100% with no patients requiring an enucleation for a local recurrence or other radiation-related toxicities. At last follow-up, all tumors were decreased in size. Visual acuity worsened in 11 patients, and other radiation-related toxicities included cataract, cystoid macular edema, radiation retinopathy, and neovascular glaucoma. Three patients developed metastases, one of whom died shortly after, while all other patients were alive at last follow-up.</div></div><div><h3>Conclusions</h3><div>Staged EPBT for large UM is a novel and feasible globe-preserving treatment with a high rate of local control. Ocular toxicities are expected but do not require enucleation. Further prospective randomized trials should be performed to validate this treatment approach.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 40-47"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531105","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.06.009
Qianyi Huang MM , Jie Yu MD , Min Yang PhD , Junjian Mo MM , Ying Wang MD, PhD
{"title":"Rare Findings of Skin and Muscle Involvement in Systemic Sclerosis With Gastric Cancer","authors":"Qianyi Huang MM , Jie Yu MD , Min Yang PhD , Junjian Mo MM , Ying Wang MD, PhD","doi":"10.1016/j.prro.2025.06.009","DOIUrl":"10.1016/j.prro.2025.06.009","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 1-2"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897931","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.06.012
Lulin Yuan PhD , Quan Chen PhD , Hania Al-Hallaq PhD , Jinzhong Yang PhD , Xiaofeng Yang PhD , Huaizhi Geng PhD , Kujtim Latifi PhD , Bin Cai PhD , Qingrong Jackie Wu PhD , Ying Xiao PhD , Stanley H. Benedict PhD , Yi Rong PhD , Jeff Buchsbaum MD, PhD , X. Sharon Qi PhD
Purpose
This study aims to evaluate organs-at-risk (OARs) segmentation variability across 8 commercial artificial intelligence (AI)-based segmentation software using independent multi-institutional data sets, and to provide recommendations for clinical practices using AI-segmentation.
Methods and Materials
A total of 160 planning computed tomography image sets from 4 anatomic sites: head and neck, thorax, abdomen, and pelvis were retrospectively pooled from 3 institutions. Contours for 31 OARs generated by the software were compared to clinical contours using multiple accuracy metrics, including: dice similarity coefficient (DSC), 95 percentile of Hausdorff distance, surface DSC, as well as relative added path length as an efficiency metric. A 2-factor analysis of variance was used to quantify variability in contouring accuracy across software platforms (intersoftware) and patients (interpatient). Pairwise comparisons were performed to categorize the software into different performance groups, and intersoftware variations were calculated as the average performance differences between the groups.
Results
Significant intersoftware and interpatient contouring accuracy variations (P < .05) were observed for most OARs. The largest intersoftware variations in DSC in each anatomic region were cervical esophagus (0.41), trachea (0.10), spinal cord (0.13), and prostate (0.17). Among the organs evaluated, 7 had mean DSC >0.9 (ie, heart, liver), 15 had DSC ranging from 0.7 to 0.89 (ie, parotid, esophagus). The remaining organs (ie, optic nerves, seminal vesicle) had DSC<0.7. Of the 31 organs, 16 (52%) had relative added path length less than 0.1.
Conclusions
Our results reveal significant intersoftware and interpatient variability in the performance of AI-segmentation software. These findings highlight the need of thorough software commissioning, testing, and quality assurance across disease sites, patient-specific anatomies, and image acquisition protocols.
{"title":"Quantitative Evaluation of Artificial Intelligence-Based Organ Segmentation Across Multiple Anatomic Sites Using 8 Commercial Software Platforms","authors":"Lulin Yuan PhD , Quan Chen PhD , Hania Al-Hallaq PhD , Jinzhong Yang PhD , Xiaofeng Yang PhD , Huaizhi Geng PhD , Kujtim Latifi PhD , Bin Cai PhD , Qingrong Jackie Wu PhD , Ying Xiao PhD , Stanley H. Benedict PhD , Yi Rong PhD , Jeff Buchsbaum MD, PhD , X. Sharon Qi PhD","doi":"10.1016/j.prro.2025.06.012","DOIUrl":"10.1016/j.prro.2025.06.012","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate organs-at-risk (OARs) segmentation variability across 8 commercial artificial intelligence (AI)-based segmentation software using independent multi-institutional data sets, and to provide recommendations for clinical practices using AI-segmentation.</div></div><div><h3>Methods and Materials</h3><div>A total of 160 planning computed tomography image sets from 4 anatomic sites: head and neck, thorax, abdomen, and pelvis were retrospectively pooled from 3 institutions. Contours for 31 OARs generated by the software were compared to clinical contours using multiple accuracy metrics, including: dice similarity coefficient (DSC), 95 percentile of Hausdorff distance, surface DSC, as well as relative added path length as an efficiency metric. A 2-factor analysis of variance was used to quantify variability in contouring accuracy across software platforms (intersoftware) and patients (interpatient). Pairwise comparisons were performed to categorize the software into different performance groups, and intersoftware variations were calculated as the average performance differences between the groups.</div></div><div><h3>Results</h3><div>Significant intersoftware and interpatient contouring accuracy variations (<em>P</em> < .05) were observed for most OARs. The largest intersoftware variations in DSC in each anatomic region were cervical esophagus (0.41), trachea (0.10), spinal cord (0.13), and prostate (0.17). Among the organs evaluated, 7 had mean DSC >0.9 (ie, heart, liver), 15 had DSC ranging from 0.7 to 0.89 (ie, parotid, esophagus). The remaining organs (ie, optic nerves, seminal vesicle) had DSC<0.7. Of the 31 organs, 16 (52%) had relative added path length less than 0.1.</div></div><div><h3>Conclusions</h3><div>Our results reveal significant intersoftware and interpatient variability in the performance of AI-segmentation software. These findings highlight the need of thorough software commissioning, testing, and quality assurance across disease sites, patient-specific anatomies, and image acquisition protocols.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages e47-e59"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978495","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.07.002
Zhaohui Su PhD
{"title":"Kiss Not Goodbye","authors":"Zhaohui Su PhD","doi":"10.1016/j.prro.2025.07.002","DOIUrl":"10.1016/j.prro.2025.07.002","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Page 7"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978497","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}
Pub Date : 2026-01-01DOI: 10.1016/j.prro.2025.07.005
Jiyeon Park PhD , Julie A. Bradley MD, MHCDS , Nancy P. Mendenhall MD, FACR, FASTRO , Raymond B. Mailhot Vega MD, MPH , Teena Burchianti MSN, APRN, ANP-BC, OCN , Yawei Zhang PhD , Hardev Grewal PhD , Mohammad Saki PhD , Twyla Willoughby PhD, FAAPM , Perry B. Johnson PhD , Mark Artz PhD, MBA
Proton treatment using pencil-beam scanning (PBS) for patients with breast cancer offers advantages in achieving a conformal dose distribution while also reducing the cardiac dose. However, when employing 2 anterior fields to mitigate the effects of respiratory motion on dose delivery, managing the ipsilateral lung doses becomes critical due to the high linear-energy transfer (LET) at the distal end of the beams. Although the incidence of radiation pneumonitis (RP) after breast radiation therapy is relatively low, it is essential to address the cases that develop RP following proton treatment to minimize lung toxicity. We conducted a retrospective case study analyzing follow-up computed tomography images taken at 1 week, 1.5 months, and 4.5 months after the onset of the patient’s pneumonitis symptoms to correlate them with proton doses. The patient’s PBS treatment was prescribed at a dose of 50 Gy with an additional 10 Gy boost, using a relative biological effectiveness (RBE) of 1.1, delivered in 2 Gy daily fractions. Our histogram analysis revealed noticeable increases in Hounsfield units at a dose of 40 Gy (RBE = 1.1), underscoring a potential dose-volume parameter that could help minimize the occurrence of RP. Furthermore, the lung volume associated with the RP was encompassed with an iso-LET level greater than 5.0 keV/μm, with a proton dose exceeding 40 Gy (RBE = 1.1). In examining the LET-dependent RBE-weighted dose using the McNamara model in the original treatment plan, we found the volumes receiving more than 50 Gy (V50Gy) and 40 Gy (V40Gy) were 110 cc and 267 cc, respectively. By incorporating dose objectives of V50Gy and V40Gy to limit the ipsilateral lung volume into PBS plans, the volumes were successfully reduced to 0 cc and 3 cc, while maintaining target dose coverage and robustness. Optimizing a breast PBS plan (RBE = 1.1) using objectives that addressed both the V50Gy and V40Gy to minimize lung exposure was shown to be clinically feasible and should be considered as a strategy to reduce lung toxicity when treating breast cancer with PBS proton therapy.
{"title":"Radiation-Induced Acute Lung Pneumonitis After Pencil-Beam Scanning Proton Treatment for Breast Cancer: Correlation With Dose-Volume Parameters and Optimization Objectives to Reduce Lung Toxicities","authors":"Jiyeon Park PhD , Julie A. Bradley MD, MHCDS , Nancy P. Mendenhall MD, FACR, FASTRO , Raymond B. Mailhot Vega MD, MPH , Teena Burchianti MSN, APRN, ANP-BC, OCN , Yawei Zhang PhD , Hardev Grewal PhD , Mohammad Saki PhD , Twyla Willoughby PhD, FAAPM , Perry B. Johnson PhD , Mark Artz PhD, MBA","doi":"10.1016/j.prro.2025.07.005","DOIUrl":"10.1016/j.prro.2025.07.005","url":null,"abstract":"<div><div>Proton treatment using pencil-beam scanning (PBS) for patients with breast cancer offers advantages in achieving a conformal dose distribution while also reducing the cardiac dose. However, when employing 2 anterior fields to mitigate the effects of respiratory motion on dose delivery, managing the ipsilateral lung doses becomes critical due to the high linear-energy transfer (LET) at the distal end of the beams. Although the incidence of radiation pneumonitis (RP) after breast radiation therapy is relatively low, it is essential to address the cases that develop RP following proton treatment to minimize lung toxicity. We conducted a retrospective case study analyzing follow-up computed tomography images taken at 1 week, 1.5 months, and 4.5 months after the onset of the patient’s pneumonitis symptoms to correlate them with proton doses. The patient’s PBS treatment was prescribed at a dose of 50 Gy with an additional 10 Gy boost, using a relative biological effectiveness (RBE) of 1.1, delivered in 2 Gy daily fractions. Our histogram analysis revealed noticeable increases in Hounsfield units at a dose of 40 Gy (RBE = 1.1), underscoring a potential dose-volume parameter that could help minimize the occurrence of RP. Furthermore, the lung volume associated with the RP was encompassed with an iso-LET level greater than 5.0 keV/μm, with a proton dose exceeding 40 Gy (RBE = 1.1). In examining the LET-dependent RBE-weighted dose using the McNamara model in the original treatment plan, we found the volumes receiving more than 50 Gy (<em>V</em><sub>50Gy</sub>) and 40 Gy (<em>V</em><sub>40Gy</sub>) were 110 cc and 267 cc, respectively. By incorporating dose objectives of <em>V</em><sub>50Gy</sub> and <em>V</em><sub>40Gy</sub> to limit the ipsilateral lung volume into PBS plans, the volumes were successfully reduced to 0 cc and 3 cc, while maintaining target dose coverage and robustness. Optimizing a breast PBS plan (RBE = 1.1) using objectives that addressed both the <em>V</em><sub>50Gy</sub> and <em>V</em><sub>40Gy</sub> to minimize lung exposure was shown to be clinically feasible and should be considered as a strategy to reduce lung toxicity when treating breast cancer with PBS proton therapy.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 1","pages":"Pages 8-14"},"PeriodicalIF":3.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978463","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}
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