Practical Radiation Oncology最新文献

英文中文

Image Guided Superficial Radiation Therapy—Another Canary Dies in the Coal Mine: A Lesson For Us All 图像引导的浅表放射治疗——煤矿中的另一只金丝雀：给我们所有人的教训。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-11-29 DOI: 10.1016/j.prro.2025.09.009

Paul E. Wallner DO, FASTRO, FACR , Michael L. Steinberg MD

引用次数: 0

The Evolution of Clinical Practice Guidelines for the Postoperative Treatment of Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma: Comments and Controversies 人乳头瘤病毒相关口咽鳞状细胞癌术后治疗临床实践指南的演变：评论和争议

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-10 DOI: 10.1016/j.prro.2025.12.001

Ryan T. Hughes MD , William A. Stokes MD , Niema B. Razavian MD , David M. Routman MD , Thomas W. Lycan Jr. DO , Joshua D. Waltonen MD , Bhisham S. Chera MD

引用次数: 0

Surgical Reconstruction Toxicity Following Hypofractionated Adjuvant Radiation Therapy for Primary Cutaneous Melanoma 原发性皮肤黑色素瘤低分割辅助放疗后手术重建毒性分析。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.prro.2025.11.004

Noel X. Yang BS , Gianna L. Rosamilia MD , Andrew J. Arifin MD , Aya F. Salem MD , Alison K. Yoder MD, MPH , Sydney A. Keatts BS , Oriana Jerez BS , Ruitao Lin PhD , Andrew J. Bishop MD , Ahsan S. Farooqi MD, PhD , Roi Weiser MD , Merrick I. Ross MD , Alexander F. Mericli MD , B. Ashleigh Guadagnolo MD, MPH , Ryan P. Goepfert MD , Devarati Mitra MD, PhD

Purpose

Adjuvant radiation therapy (RT) to a cutaneous target has been associated with elevated risk of surgical complications such as graft, flap, or skin substitute reconstruction failure. We sought to better quantify the risk of surgical site complications after hypofractionated adjuvant RT delivered in the modern era to patients undergoing surgical reconstruction for their primary site cutaneous melanoma.

Methods and Materials

We reviewed clinical data on all patients treated for cutaneous melanoma at our center between 2008 and 2021 with primary tumor resection and reconstruction (graft, flap, or skin substitute), followed by 5 × 6 Gy RT. Details on post-treatment complications were assessed.

Results

A total of 193 patients with melanoma undergoing surgical reconstruction followed by hypofractionated RT were identified. Most patients carried at least 1 risk factor for wound healing complications (70% with cardiovascular disease, 64% overweight, and 23% with diabetes). Most tumors were located in the head and neck (89%). Patients initiated RT a median of 7 weeks (IQR, 5-9 weeks) from surgical reconstruction. Skin grafts were used in 62% of reconstructions, and flaps used in 44%. Electron-based RT was used for the majority of patients (n = 166, 86%). Ten patients (5%) required surgical revision after reconstruction, with half occurring after RT. The primary reconstruction for all 5 patients requiring surgical revision after RT was graft reconstruction of the scalp, with a wide range of times from reconstruction to RT (5-11 weeks) and a wide range of times from RT to surgical revision (2-28 months).

Conclusions

The risk of surgical revision after adjuvant hypofractionated RT to a surgical reconstruction involving a graft, flap, or skin substitute is low. Half of graft failures occurred before adjuvant RT and half after, which suggests that adjuvant RT only marginally increases the risk of postreconstruction complications if adequate time for healing is given.

目的：对皮肤目标进行辅助放射治疗（RT）会增加手术并发症的风险，如移植物、皮瓣或皮肤替代物重建失败。我们试图更好地量化在现代对原发部位皮肤黑色素瘤进行手术重建的患者进行低分割辅助RT后手术部位并发症的风险。方法和材料：我们回顾了2008-2021年间在我们中心接受原发性肿瘤切除和重建（移植物、皮瓣或皮肤替代品）治疗的所有皮肤黑色素瘤患者的临床数据，随后进行了5次 × 6 Gy放疗。评估了治疗后并发症的详细情况。结果：193例黑色素瘤患者接受手术重建和低分割放疗。大多数患者至少有一种伤口愈合并发症的危险因素（70%患有心血管疾病，64%超重，23%患有糖尿病）。大多数肿瘤位于头颈部（89%）。患者在手术重建后中位7周（IQR 5-9周）开始RT。62%的重建采用植皮，44%的重建采用皮瓣。大多数患者（n=166, 86%）采用电子RT。10例（5%）患者重建后需要手术翻修，其中一半发生在RT后。所有5例RT后需要手术翻修的患者的主要重建都是头皮移植物重建，从重建到RT（5-11周）的时间范围很广，从RT到手术翻修的时间范围很广（2-28个月）。结论：辅助低分割RT术后手术翻修的风险较低，手术重建包括移植物、皮瓣或皮肤替代物。移植失败的一半发生在辅助RT之前，一半发生在辅助RT之后，这表明如果给予足够的愈合时间，辅助RT只会略微增加重建后并发症的风险。

{"title":"Surgical Reconstruction Toxicity Following Hypofractionated Adjuvant Radiation Therapy for Primary Cutaneous Melanoma","authors":"Noel X. Yang BS , Gianna L. Rosamilia MD , Andrew J. Arifin MD , Aya F. Salem MD , Alison K. Yoder MD, MPH , Sydney A. Keatts BS , Oriana Jerez BS , Ruitao Lin PhD , Andrew J. Bishop MD , Ahsan S. Farooqi MD, PhD , Roi Weiser MD , Merrick I. Ross MD , Alexander F. Mericli MD , B. Ashleigh Guadagnolo MD, MPH , Ryan P. Goepfert MD , Devarati Mitra MD, PhD","doi":"10.1016/j.prro.2025.11.004","DOIUrl":"10.1016/j.prro.2025.11.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Adjuvant radiation therapy (RT) to a cutaneous target has been associated with elevated risk of surgical complications such as graft, flap, or skin substitute reconstruction failure. We sought to better quantify the risk of surgical site complications after hypofractionated adjuvant RT delivered in the modern era to patients undergoing surgical reconstruction for their primary site cutaneous melanoma.</div></div><div><h3>Methods and Materials</h3><div>We reviewed clinical data on all patients treated for cutaneous melanoma at our center between 2008 and 2021 with primary tumor resection and reconstruction (graft, flap, or skin substitute), followed by 5 × 6 Gy RT. Details on post-treatment complications were assessed.</div></div><div><h3>Results</h3><div>A total of 193 patients with melanoma undergoing surgical reconstruction followed by hypofractionated RT were identified. Most patients carried at least 1 risk factor for wound healing complications (70% with cardiovascular disease, 64% overweight, and 23% with diabetes). Most tumors were located in the head and neck (89%). Patients initiated RT a median of 7 weeks (IQR, 5-9 weeks) from surgical reconstruction. Skin grafts were used in 62% of reconstructions, and flaps used in 44%. Electron-based RT was used for the majority of patients (n = 166, 86%). Ten patients (5%) required surgical revision after reconstruction, with half occurring after RT. The primary reconstruction for all 5 patients requiring surgical revision after RT was graft reconstruction of the scalp, with a wide range of times from reconstruction to RT (5-11 weeks) and a wide range of times from RT to surgical revision (2-28 months).</div></div><div><h3>Conclusions</h3><div>The risk of surgical revision after adjuvant hypofractionated RT to a surgical reconstruction involving a graft, flap, or skin substitute is low. Half of graft failures occurred before adjuvant RT and half after, which suggests that adjuvant RT only marginally increases the risk of postreconstruction complications if adequate time for healing is given.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 2","pages":"Pages e71-e77"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745711","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

Identifying the Axillary Substructure at Risk for Lymphedema in Operable Patients With Breast Cancer Receiving Regional Nodal Irradiation 确定接受局部淋巴结照射的可手术乳腺癌患者腋窝亚结构中淋巴水肿的风险。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-01-13 DOI: 10.1016/j.prro.2025.12.003

Jia-Qi Huang MD , Si-Yue Zheng MD , Mao-Chen Zhang MD , Shu-Jun Zhang MMed , Jing-Jing Cao BEng , Kun-Wei Shen MD, PhD , Wei-Xiang Qi MD, PhD , Gang Cai MD, PhD , Lu Cao MD, PhD , Jia-Yi Chen MD, PhD

Purpose

Axillary substructures may contribute to the development of breast cancer-related lymphedema (BCRL). This study aimed to compare dose-volume parameters of various substructures to identify high-risk regions associated with BCRL and to evaluate the clinical applicability of these findings.

Methods and Materials

Cohort-Initial included 336 patients with pT1-3N0-1M0 breast cancer who underwent mastectomy or lumpectomy with axillary lymph node dissection (ALND) and regional nodal irradiation (RNI) between August 2018 and February 2021. The Norman questionnaire was used to assess BCRL. Thirteen dose-volume parameters across 8 axillary substructures were assessed for association with BCRL. Cohort-Recurrence comprised 50 consecutive ALND-treated patients with regional nodal recurrence diagnosed using positron emission tomography/computed tomography, used to evaluate the recurrence risk in the candidate substructures. Cohort-Reoptimization involved 20 patients from the Cohort-Initial who received excessive radiation doses in the candidate substructure. Their treatment plans were reoptimized to assess the feasibility of dose reduction while maintaining target coverage and organ dose.

Results

The patient-reported cumulative incidence of BCRL was 33.9% during a median follow-up of 60 months. Significant baseline risk factors included body mass index ≥ 27.18 kg/m², tumor size ≥ 1.9 cm, premenopausal status, and ≥ 18 lymph nodes removed (all P < .05). The most significant dosimetric parameter was axillary-lateral thoracic vessel juncture (ALTJ)-V35_Gy ≥ 79.2%. A predictive nomogram incorporating these clinicopathologic factors and the ALTJ parameter was developed with reasonable accuracy, as confirmed by self-training (area under the curve value, 0.780) and internal validation (area under the curve value, 0.769). None of the 196 fluorodeoxyglucose-avid regional nodes in Cohort-Recurrence were located within the ALTJ. Reoptimization of ALTJ-V35_Gy was feasible without compromising the radiation therapy plan quality.

Conclusions

ALTJ-V35_Gy < 79.2% may serve as a recommended dose constraint for patients undergoing RNI after ALND. Avoiding excessive radiation to the ALTJ is clinically feasible and safe, potentially mitigating BCRL risk without compromising dose coverage to high-risk nodal regions.

目的：腋窝亚结构可能与乳腺癌相关淋巴水肿（BCRL）的发展有关。本研究旨在比较不同亚结构的剂量-体积参数，以确定与BCRL相关的高危区域，并评估这些发现的临床适用性。方法和材料：队列初始纳入了336例pT1-3N0-1M0乳腺癌患者，这些患者在2018年8月至2021年2月期间接受了乳房切除术或乳房肿瘤切除术并腋窝淋巴结清扫（ALND）和区域淋巴结照射（RNI）。诺曼问卷用于评估BCRL。评估了8个腋窝亚结构的13个剂量-体积参数与BCRL的相关性。复发队列包括50例连续接受alnd治疗的局部淋巴结复发患者，使用正电子发射断层扫描/计算机断层扫描诊断，用于评估候选亚结构的复发风险。队列重新优化纳入了来自队列初始的20例患者，他们在候选亚结构中接受了过量的辐射剂量。他们的治疗方案被重新优化，以评估在保持靶覆盖和器官剂量的同时减少剂量的可行性。结果：在中位随访60个月期间，患者报告的BCRL累积发病率为33.9%。显著基线危险因素包括体重指数≥27.18 kg/m2、肿瘤大小≥1.9 cm、绝经前状态和≥18个淋巴结切除（均P < 0.05）。最显著的剂量学参数为腋窝-胸外侧血管接点(ALTJ)-V35Gy≥79.2%。通过自我训练（曲线下面积，0.780）和内部验证（曲线下面积，0.769），我们建立了一个包含这些临床病理因素和ALTJ参数的预测nomogram。在队列复发的196个氟脱氧葡萄糖阳性区域淋巴结中，没有一个位于ALTJ内。在不影响放射治疗计划质量的情况下，重新优化ALTJ-V35Gy是可行的。结论：ALTJ-V35Gy < 79.2%可作为ALND后RNI患者的推荐剂量限制。避免对ALTJ的过度辐射在临床上是可行和安全的，可以在不影响对高危淋巴结区域的剂量覆盖的情况下潜在地降低BCRL风险。

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引用次数: 0

Association of Patient Comorbidities With Treatment Regret Among Patients With Localized Prostate Cancer – Results From a Population-Based Cohort 局限性前列腺癌患者合并症与治疗后悔的关系——基于人群的队列研究结果

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-08-31 DOI: 10.1016/j.prro.2025.07.007

Rahul D. Mali MD, MPH , Ying Cao MS , Aaron J. Katz PhD , Katelyn Kane MD , Yahui Xie BA , Deborah S. Usinger BA , Xinglei Shen MD, MS , Ronald C. Chen MD, MPH

Purpose

Decision regret is a well-established negative outcome in prostate cancer. We hypothesized that baseline comorbidities, which impact treatment tolerability, are associated with regret.

Methods and Materials

In a prospective, population-based cohort of patients with prostate cancer, patient-reported regret was assessed at 12 months after treatment using a validated measure. Comorbidities were assessed using medical record abstraction and scored using the validated National Cancer Institute Comorbidity Index. Multivariable logistic regression was used to assess the association between the comorbidity score and regret, accounting for treatment-related symptoms, treatment received, and sociodemographic measures.

Results

This was a diverse cohort, comprising 25.3% Black patients and 24.2% living in rural areas. A total of 108 out of 981 patients (11%) reported regret. In multivariable analysis, comorbidity score (odds ratio [OR], 1.58; p < .05), not being married (OR, 1.72; p = .04), worsening of bowel symptoms (OR, 2.12; p < .01), and worsening of urinary obstruction/irritation (OR, 1.60; p = .05) were associated with decision regret. In addition, radiation therapy was associated with less regret compared with radical prostatectomy (OR, 0.48; p = .015).

Conclusions

Among men with localized prostate cancer, baseline comorbidity burden was associated with increased decision regret. These results illustrate the importance of assessing baseline comorbidities and incorporating their consideration into the treatment decision-making process, ensuring that patients have realistic expectations and make informed decisions.

目的：决策后悔是前列腺癌的一个公认的阴性结果。我们假设影响治疗耐受性的基线合并症与后悔有关。材料和方法：在一项前瞻性的、以人群为基础的前列腺癌患者队列研究中，采用一种有效的测量方法，在治疗后12个月评估患者报告的后悔。使用病历摘要评估合并症，并使用经过验证的NCI合并症指数评分。多变量逻辑回归评估了共病评分与后悔、治疗相关症状、接受治疗和社会人口学测量之间的关系。结果：这是一个多样化的队列，其中25.3%是黑人，24.2%生活在农村地区。981名患者中有108名（11%）表示后悔。结论：在局限性前列腺癌患者中，基线共病负担与决策后悔增加相关。这些结果说明了评估基线合并症并将其纳入治疗决策过程的重要性，以确保患者有现实的期望并做出明智的决定。

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引用次数: 0

“What Would You Do If You Were Me?” Reflections on Autonomy in Clinic “如果你是我，你会怎么做？”对临床自主性的思考。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-09-20 DOI: 10.1016/j.prro.2025.08.008

Jamiluddin J. Qazi MD, Brian P. Quaranta MD, MA

引用次数: 0

Radiation Therapy Outcomes of the National Protocol in Childhood Neuroblastomas: Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology, and TBI Working Group Study (TROD 03-004) 儿童神经母细胞瘤国家方案的放疗结果：土耳其放射肿瘤学、血液肿瘤学、儿科肿瘤学和TBI工作组研究（TROD 03-004）。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-11-04 DOI: 10.1016/j.prro.2025.10.003

Melis Gultekin MD , Melek Tugce Yilmaz MD , Ferah Yildiz MD , Serra Kamer MD , Ayse Nur Demiral MD , Bilge Gursel MD , Zeynep Gural MD , Fulya Agaoglu MD , Sumerya Duru Birgi MD , Vuslat Yurut Caloglu MD , Nur Olgun MD , Serap Aksoylar MD , Yavuz Anacak MD

Purpose

The Turkish Pediatric Oncology Group (TPOG) established a risk-adapted national neuroblastoma (NBL) treatment strategy in 2003 and updated it in 2009 and 2020 to optimize outcomes in NBL. With this study, we aimed to evaluate the oncological outcomes of our national protocol with a special emphasis on local control.

Methods and Materials

We retrospectively evaluated 135 NBL patients who received adjuvant radiation therapy between May 2004 and May 2018 from 7 tertiary pediatric oncology centers in Türkiye. Patients were treated according to TPOG-NBL2003 and TPOG-NBL2009 protocols. All statistical analyses were performed using SPSS 23.0 software (SPSS).

Results

The median age was 42 months, and 58 (43%) patients were female. The adrenal medulla was the primary tumor location in 103 (76%) patients. Only 14 patients had intermediate-risk disease, whereas 121 had high-risk disease. The median follow-up was 67.3 months. The 2- and 5-year overall survival (OS) rates were 84% and 68%, locoregional recurrence-free survival (LRRFS) rates were 81% and 66%, distant metastasis-free survival rates were 76% and 56%, and event-free survival (EFS) rates were 74% and 54%, respectively. The International Neuroblastoma Staging System stage was a significant predictor of OS, while the International Neuroblastoma Staging System stage and lactate dehydrogenase level at diagnosis predicted EFS, and the lactate dehydrogenase level at diagnosis predicted LRRFS. There were no differences in OS, EFS, or LRRFS based on radiation therapy doses.

Conclusions

In this study, we evaluated the outcomes of our TPOG-NBL2003 and TPOG-NBL2009 protocols. Our survival outcomes are consistent with the current literature, which emphasizes the importance of establishing a national protocol. Effective NBL treatment necessitates a multidisciplinary approach, and standardization of treatment should be accomplished through protocols.

目的：XXX儿科肿瘤小组（XXX）于2003年制定了一项适应风险的国家神经母细胞瘤（NBL）治疗策略，并于2009年和2020年对其进行了更新，以优化NBL的预后。在这项研究中，我们旨在评估我们国家方案的肿瘤学结果，特别强调局部控制。材料和方法：我们回顾性评估了2004年5月至2018年5月在XXX的7个三级儿科肿瘤中心接受辅助放疗的135例NBL患者。患者按照XXX-NBL2003和XXX-NBL2009方案进行治疗。所有统计分析均采用SPSS 23.0软件（SPSS, Chicago， IL）。结果：中位年龄为42个月，女性58例（43%）。103例（76%）患者的原发肿瘤部位为肾上腺髓质。只有14例患者有中危（IR）疾病，121例有高危（HR）疾病。中位随访时间为67.3个月。2年和5年总生存率（OS）分别为84%和68%，局部无复发生存率（LRRFS）分别为81%和66%，远处无转移生存率（DMFS）分别为76%和56%，无事件生存率（EFS）分别为74%和54%。INSS分期是OS的显著预测因子，INSS分期和诊断时LDH水平预测EFS，诊断时LDH水平预测LRRFS。放疗剂量不同，OS、EFS或LRRFS均无差异。结论：在本研究中，我们评估了我们的XXX-NBL2003和XXX-NBL2009方案的结果。我们的生存结果与当前的文献一致，这些文献强调了建立国家协议的重要性。有效的NBL治疗需要多学科的方法和标准化的治疗应该通过协议来完成。

{"title":"Radiation Therapy Outcomes of the National Protocol in Childhood Neuroblastomas: Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology, and TBI Working Group Study (TROD 03-004)","authors":"Melis Gultekin MD , Melek Tugce Yilmaz MD , Ferah Yildiz MD , Serra Kamer MD , Ayse Nur Demiral MD , Bilge Gursel MD , Zeynep Gural MD , Fulya Agaoglu MD , Sumerya Duru Birgi MD , Vuslat Yurut Caloglu MD , Nur Olgun MD , Serap Aksoylar MD , Yavuz Anacak MD","doi":"10.1016/j.prro.2025.10.003","DOIUrl":"10.1016/j.prro.2025.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The Turkish Pediatric Oncology Group (TPOG) established a risk-adapted national neuroblastoma (NBL) treatment strategy in 2003 and updated it in 2009 and 2020 to optimize outcomes in NBL. With this study, we aimed to evaluate the oncological outcomes of our national protocol with a special emphasis on local control.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively evaluated 135 NBL patients who received adjuvant radiation therapy between May 2004 and May 2018 from 7 tertiary pediatric oncology centers in Türkiye. Patients were treated according to TPOG-NBL2003 and TPOG-NBL2009 protocols. All statistical analyses were performed using SPSS 23.0 software (SPSS).</div></div><div><h3>Results</h3><div>The median age was 42 months, and 58 (43%) patients were female. The adrenal medulla was the primary tumor location in 103 (76%) patients. Only 14 patients had intermediate-risk disease, whereas 121 had high-risk disease. The median follow-up was 67.3 months. The 2- and 5-year overall survival (OS) rates were 84% and 68%, locoregional recurrence-free survival (LRRFS) rates were 81% and 66%, distant metastasis-free survival rates were 76% and 56%, and event-free survival (EFS) rates were 74% and 54%, respectively. The International Neuroblastoma Staging System stage was a significant predictor of OS, while the International Neuroblastoma Staging System stage and lactate dehydrogenase level at diagnosis predicted EFS, and the lactate dehydrogenase level at diagnosis predicted LRRFS. There were no differences in OS, EFS, or LRRFS based on radiation therapy doses.</div></div><div><h3>Conclusions</h3><div>In this study, we evaluated the outcomes of our TPOG-NBL2003 and TPOG-NBL2009 protocols. Our survival outcomes are consistent with the current literature, which emphasizes the importance of establishing a national protocol. Effective NBL treatment necessitates a multidisciplinary approach, and standardization of treatment should be accomplished through protocols.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"16 2","pages":"Pages 176-187"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459840","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

A universal multimodal female pelvic phantom with brachytherapy applications. 一种通用的多模态女性盆腔幻象与近距离治疗应用。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 DOI: 10.1016/j.prro.2026.02.012

Tiana Trumpour, Jessica R Rodgers, Jamiel Nasser, Rachael Driediger, Ye Young Shin, Larissa Zhu, Kathleen Surry, Aaron Fenster

Purpose: Anthropomorphic phantoms are needed to support training, workflow validation, and imaging studies in gynecologic brachytherapy, particularly in settings with limited access to commercial models. This study describes the design and validation of a low-cost multimodal female pelvic phantom that replicates pelvic anatomy and tissue properties relevant to brachytherapy.

Methods and materials: A custom phantom was constructed with embedded uterus, cervix, bladder, rectum/sigmoid, and tumor structures using agar tissue-mimicking materials and 3D-printed molds derived from patient contours. The phantom was designed to be compatible with computed tomography (CT), magnetic resonance imaging (MRI), planar ultrasound (US), and 3D transabdominal and transrectal ultrasound, and to accommodate standard intracavitary and interstitial applicators. Imaging properties including speed of sound (SoS), Hounsfield units (HU), and electron density (ED) were measured and compared to clinical reference values. Three trained raters performed repeated segmentations on all modalities to assess segmentation properties and variability.

Results: The phantom provided clear visualization of internal structures on all imaging modalities and maintained structural integrity during repeated use and applicator insertion. Measured SoS values differed by less than 2.6% from the 1540 m/s reference, with the largest deviation producing an axial measurement uncertainty of 1.3 mm. HU values ranged from 31.7 to 53.4 and ED values differed by under 0.5% from institutional standards. The most consistent segmentations were produced with MRI, while the greatest variability was observed in 3D transrectal US for small structures. The total material cost to create the phantom was approximately $150 CAD.

Conclusions: The developed phantom supports realistic brachytherapy applicator placement, multimodal imaging, image segmentation, and has potential for future integration into dose planning studies.

目的：在妇科近距离放射治疗中，特别是在商业模型有限的情况下，需要拟人化的幻影来支持培训、工作流程验证和成像研究。本研究描述了一个低成本的多模态女性骨盆假体的设计和验证，该假体复制了与近距离治疗相关的骨盆解剖和组织特性。方法和材料：使用琼脂组织模拟材料和根据患者轮廓衍生的3d打印模具，构建嵌入子宫、宫颈、膀胱、直肠/乙状结肠和肿瘤结构的定制假体。该假体可与计算机断层扫描（CT）、磁共振成像（MRI）、平面超声（US）、3D经腹和经直肠超声兼容，并可容纳标准腔内和间质应用器。测量声速（SoS）、霍斯菲尔德单位（HU）和电子密度（ED）等成像特性，并与临床参考值进行比较。三名训练有素的评分员对所有模式进行重复分割，以评估分割特性和可变性。结果：在所有成像模式下，假体提供了清晰的内部结构可视化，并在重复使用和涂抹器插入期间保持结构完整性。测量的SoS值与1540 m/s参考值相差不到2.6%，最大偏差产生1.3 mm的轴向测量不确定度。HU值介于31.7至53.4之间，ED值与机构标准相差不到0.5%。最一致的分割是由MRI产生的，而最大的变化是在三维经直肠超声检查中观察到的小结构。制造幻影的总材料成本约为150美元 CAD。结论：开发的假体支持真实的近距离治疗涂抹器放置，多模态成像，图像分割，并有可能在未来整合到剂量计划研究中。

{"title":"A universal multimodal female pelvic phantom with brachytherapy applications.","authors":"Tiana Trumpour, Jessica R Rodgers, Jamiel Nasser, Rachael Driediger, Ye Young Shin, Larissa Zhu, Kathleen Surry, Aaron Fenster","doi":"10.1016/j.prro.2026.02.012","DOIUrl":"https://doi.org/10.1016/j.prro.2026.02.012","url":null,"abstract":"<p><strong>Purpose: </strong>Anthropomorphic phantoms are needed to support training, workflow validation, and imaging studies in gynecologic brachytherapy, particularly in settings with limited access to commercial models. This study describes the design and validation of a low-cost multimodal female pelvic phantom that replicates pelvic anatomy and tissue properties relevant to brachytherapy.</p><p><strong>Methods and materials: </strong>A custom phantom was constructed with embedded uterus, cervix, bladder, rectum/sigmoid, and tumor structures using agar tissue-mimicking materials and 3D-printed molds derived from patient contours. The phantom was designed to be compatible with computed tomography (CT), magnetic resonance imaging (MRI), planar ultrasound (US), and 3D transabdominal and transrectal ultrasound, and to accommodate standard intracavitary and interstitial applicators. Imaging properties including speed of sound (SoS), Hounsfield units (HU), and electron density (ED) were measured and compared to clinical reference values. Three trained raters performed repeated segmentations on all modalities to assess segmentation properties and variability.</p><p><strong>Results: </strong>The phantom provided clear visualization of internal structures on all imaging modalities and maintained structural integrity during repeated use and applicator insertion. Measured SoS values differed by less than 2.6% from the 1540 m/s reference, with the largest deviation producing an axial measurement uncertainty of 1.3 mm. HU values ranged from 31.7 to 53.4 and ED values differed by under 0.5% from institutional standards. The most consistent segmentations were produced with MRI, while the greatest variability was observed in 3D transrectal US for small structures. The total material cost to create the phantom was approximately $150 CAD.</p><p><strong>Conclusions: </strong>The developed phantom supports realistic brachytherapy applicator placement, multimodal imaging, image segmentation, and has potential for future integration into dose planning studies.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348959","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

Direct Splenic Invasion by Pancreatic Tail Carcinoma: Imaging Features and Significance of the "Mushroom Sign". 胰尾癌直接侵犯脾：“蘑菇征”的影像学特征及意义。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 DOI: 10.1016/j.prro.2026.01.016

Tianyu Li, Siyuan Lu, Jing Ye

引用次数: 0

Identification and Management of Late Toxicities After Radiation Therapy for Vulvar Cancer 外阴癌放疗后晚期毒性的识别与处理。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-06-23 DOI: 10.1016/j.prro.2025.05.010

Cristina DeCesaris MD , Sabrina Bedell MD , David Gaffney MD, PhD , Gita Suneja MD, MS , Lindsay Burt MD , Jeffrey Brower MD, PhD

Vulvar cancer is a rare malignancy, with an estimated 6.900 cases diagnosed in 2024, though incidence has been rising in recent years. Radiation plays a critical role in definitive and adjuvant management, however late toxicities including pelvic insufficiency fractures (PIFs), anal/fecal incontinence, sexual dysfunction, cutaneous and sub-cutaneous fibrosis, and lymphedema may significantly impact quality of life in long-term survivors. This article will describe the most commonly encountered late radiation-induced toxicities seen in the management of vulvar cancers and provide practical guidance regarding work-up, and evidence-based management.

外阴癌是一种罕见的恶性肿瘤，据估计，2024年确诊病例为6900例，尽管近年来发病率一直在上升。放疗在最终和辅助治疗中起着关键作用，然而晚期毒性包括骨盆功能不全骨折（pif）、肛门/粪便失禁、性功能障碍、皮肤和皮下纤维化以及淋巴水肿可能会显著影响长期幸存者的生活质量。本文将描述在外阴癌治疗中最常见的晚期辐射引起的毒性，并提供有关检查和循证管理的实用指导。

引用次数: 0

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