Practical Radiation Oncology最新文献

英文中文

Celiac Plexus Radiosurgery for the Management of Pancreatic Cancer Pain: Key Tips and Considerations 腹腔神经丛放射外科治疗胰腺癌疼痛：关键提示和注意事项。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 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

引用次数: 0

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 mri引导下的SBRT治疗肝转移：来自MOMENTUM研究的耐受性、急性毒性和生活质量的结果

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 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.

目的/目的：立体定向体放射治疗（SBRT）是肝转移的局部治疗选择。磁共振成像（MRI）引导的SBRT的引入，通过改善肿瘤可视化、适应日常计划和减少边缘，为获得最佳治疗结果铺平了道路。本研究的目的是回顾mri引导下肝脏SBRT的耐受性，并从前瞻性多中心注册表中显示早期毒性和生活质量（QoL）结果。材料/方法：纳入动量研究（NCT04075305）的所有患者，这些患者在2019年4月至2023年4月期间接受1.5T MR-Linac治疗肝转移。采用描述性统计方法比较治疗前和治疗后3个月的耐受性、急性毒性（CTCAEv5.0）和生活质量（QLQ-C30和EQ-5D-5L）。结果：135例患者（中位年龄67岁，范围31-93岁）在4个国家的7个研究所接受治疗。最常见的原发肿瘤来源是结直肠癌（50%）和肺癌（12%）。规定的SBRT总剂量范围为20.0-67.5 Gy，分2-12份递送，每份7-22.5 Gy（平均BED为180Gy（范围59.5-540Gy））。97%的患者（n=131）完成了治疗，没有因耐受性差而中断治疗。截至3个月，12名患者（10.6%）报告了14例3级毒性，其中只有1例（0.9%）记录为放疗相关（胃炎）。未见4级以上毒性反应。在两个时间点，分别有62例和63例患者完成了QLQ-C30和EQ-5D-5L问卷。结果显示，三个月后，角色功能、恶心、疲劳、便秘和疼痛等症状加重了5-10分。结论：在这个前瞻性队列中，97%的治疗耐受性良好，并且成功完成，只有一个急性三级放疗相关毒性，没有报告≥4级毒性。生活质量结果在5个领域显示临床相关恶化（定义为≥5分），与ct引导的SBRT相当。总体而言，结果表明mri引导的SBRT对肝转移患者具有良好的耐受性和安全性。

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引用次数: 0

Staged I-125 Eye Plaque Brachytherapy for the Treatment of Large Uveal Melanoma: A Single Institution Experience I-125期眼斑近距离放疗治疗大葡萄膜黑色素瘤：单一机构经验。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 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.

目的：眼斑近距离治疗（EPBT）不常用于大葡萄膜黑色素瘤（UM），因为市售斑块通常不能确保高剂量85 Gy对肿瘤的充分覆盖。本研究的目的是报告本机构采用分阶段EPBT治疗大葡萄膜黑色素瘤的临床新方法的经验，两种治疗方法，每次治疗45 Gy。材料和方法：纳入2020年至2023年间在我院接受分阶段EPBT的患者。结果：本研究共纳入13例患者，中位年龄65岁。所有患者均接受碘-125治疗，第一阶段处方剂量为45 Gy，第二阶段治疗在中位13周后进行，处方剂量为45 Gy。中位随访时间为42个月，局部控制率为100%，没有患者因局部复发或其他辐射相关毒性而需要摘除核。最后随访所有肿瘤均缩小。11例患者视力恶化，其他辐射相关毒性包括白内障、囊样黄斑水肿、放射性视网膜病变和新生血管性青光眼。3例患者发生转移，其中1例不久后死亡，而所有其他患者在最后随访时均存活。结论：分阶段EPBT治疗大葡萄膜黑色素瘤是一种新颖可行的保全治疗方法，局部控制率高。预计会有眼部毒性，但不需要摘除眼球。应该进行进一步的前瞻性随机试验来验证这种治疗方法。

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引用次数: 0

Rare Findings of Skin and Muscle Involvement in Systemic Sclerosis With Gastric Cancer 系统性硬化症合并胃癌累及皮肤及肌肉的罕见发现

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.06.009

Qianyi Huang MM , Jie Yu MD , Min Yang PhD , Junjian Mo MM , Ying Wang MD, PhD

引用次数: 0

Quantitative Evaluation of Artificial Intelligence-Based Organ Segmentation Across Multiple Anatomic Sites Using 8 Commercial Software Platforms 利用8个商业软件平台对基于人工智能的多解剖部位器官分割进行定量评价

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 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.

目的：利用独立的多机构数据集，评估8种基于人工智能的商业分割软件的高危器官（OARs）分割变异性，并为利用人工智能分割的临床实践提供建议。方法：回顾性收集3所医院头颈、胸、腹、盆4个解剖部位的160组规划CT图像。将软件生成的31个桨的轮廓与临床轮廓进行比较，使用多个精度指标，包括：Dice相似系数（DSC）， Hausdorff距离95百分位数（HD95），表面DSC以及作为效率指标的相对附加路径长度（RAPL）。采用双因素方差分析来量化跨软件平台（软件间）和患者（患者间）轮廓精度的可变性。两两比较将软件分为不同的性能组，并计算软件间差异（ISV）作为组间的平均性能差异。结果：软件间和患者间轮廓精度差异显著（p0.9（即心脏、肝脏）），15例DSC范围为0.7至0.89（即腮腺、食道）。结论：我们的研究结果揭示了人工智能分割软件的性能在软件之间和患者之间存在显著的差异。这些发现强调了跨疾病部位、患者特定解剖结构和图像采集方案进行全面的软件调试、测试和质量保证的必要性。

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引用次数: 0

Kiss Not Goodbye 吻别再见。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.07.002

Zhaohui Su PhD

引用次数: 0

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 乳腺癌PBS质子治疗后放射性引起的急性肺肺炎：与剂量-体积参数的相关性和降低肺毒性的优化目标

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 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 (V_50Gy) and 40 Gy (V_40Gy) were 110 cc and 267 cc, respectively. By incorporating dose objectives of V_50Gy and V_40Gy 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 V_50Gy and V_40Gy 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.

使用铅笔束扫描（PBS）对乳腺癌患者进行质子治疗在获得适形剂量分布的同时也减少了心脏剂量方面具有优势。然而，当采用两个前场来减轻呼吸运动对剂量传递的影响时，由于光束远端的高线性能量转移（LET），管理同侧肺剂量变得至关重要。虽然乳房放射治疗后放射性肺炎（RP）的发生率相对较低，但必须解决质子治疗后发生RP的病例，以尽量减少肺毒性。我们进行了一项回顾性病例研究，分析了患者肺炎症状出现后1周、1.5个月和4.5个月的随访计算机断层扫描图像，以将其与质子剂量联系起来。患者的PBS治疗剂量为50戈瑞，外加10戈瑞，使用1.1的相对生物有效性（RBE），以每天2戈瑞的剂量给药。我们的直方图分析显示，在40 Gy的剂量下，Hounsfield单位显著增加（RBE = 1.1），强调潜在的剂量-体积参数可以帮助减少RP的发生。此外，与RP相关的肺体积被大于5.0 keV/μm的iso-LET水平包围，质子剂量超过40 Gy （RBE = 1.1）。在原始治疗方案中使用麦克纳马拉模型检查let依赖性rbe加权剂量时，我们发现接受超过50Gy （V50Gy）和40Gy （V40Gy）的体积分别为110 cc和267 cc。通过将V50Gy和V40Gy的剂量靶限制同侧肺体积纳入PBS计划，成功地将体积减少到0 cc和3 cc，同时保持靶剂量覆盖和稳健性。优化乳房PBS计划（RBE = 1.1），同时考虑V50Gy和V40Gy的目标，以最大限度地减少肺暴露，这在临床上是可行的，在使用PBS质子治疗乳腺癌时，应将其视为降低肺毒性的策略。

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IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/S1879-8500(25)00284-X

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In Regard to Ballas et al 关于巴拉斯等人

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.07.009

Parth Aphale PhD, Shashank Dokania BHMS, Himanshu Shekhar BHMS

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PROshot: Neoadjuvant Radiation for Pancreatic Cancer, Radiation Alone for Oligometastatic Renal Cell Carcinoma, De-escalated Head and Neck Radiation, and Immunotherapy for Glioblastoma 前瞻：胰腺癌的新辅助放疗，少转移性肾细胞癌的单独放疗，降级头颈部放疗，胶质母细胞瘤的免疫治疗

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-01-01 DOI: 10.1016/j.prro.2025.10.001

Caleb Dulaney MD , Laura Dover MD, MSPH

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