Practical Radiation Oncology最新文献_第4页

Target Volume Optimization for Localized Prostate Cancer 局部前列腺癌的靶体积优化

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.006

Krishnan R. Patel MD, MHS , Uulke A. van der Heide PhD , Linda G.W. Kerkmeijer MD, PhD , Ivo G. Schoots MD , Baris Turkbey MD , Deborah E. Citrin MD , William A. Hall MD

Purpose

To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition.

Methods

Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer.

Results

Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes.

Conclusion

Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.

一直以来，前列腺癌的治疗除了需要前列腺和邻近精囊的位置外，几乎不需要其他解剖信息。由于手术标本中多灶性癌症的发生率较高，且无法通过成像精确定位单个肿瘤病灶的边界，因此放射治疗通常针对整个前列腺。前列腺磁共振成像（MRI）和使用前列腺特异性放射性同位素的正电子发射断层扫描（PET）的发展开创了一个时代，使放射肿瘤学家能够对前列腺中的高风险灶进行定位和局部剂量递增。最近的 III 期数据表明，采用病灶剂量升级可提高生化控制率，而不会显著增加毒性。然而，关于最佳靶体积定义和处方策略，仍有许多问题有待解决。在这篇综述中，我们总结了目前关于基于图像的 MRI 和 PET 病灶靶点划分的文献。我们的综述包括关于扩散解剖模式的可用数据总结，为临床目标体积定义的临床判断提供依据。我们指出了主要的知识差距，并对新的实施策略提出了建议。

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引用次数: 0

Salvage Breast-Conserving Surgery and Reirradiation With Intraoperative Electrons for Recurrent Breast Cancer: A Multicentric Study on Behalf of Italian Association of Radiotherapy and Clinical Oncology (AIRO) 针对复发性乳腺癌的抢救性保乳手术和术中电子再照射：代表意大利放射治疗和临床肿瘤学协会（AIRO）进行的一项多中心研究。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.05.012

Maria Cristina Leonardi MD , Alexandru David Fodor MD , Samuele Frassoni MSc , Damaris Patricia Rojas MD , Alessandra Fozza MD , Gladys Blandino MD , Antonella Ciabattoni MD , Marina Alessandro MD , Gianpiero Catalano MD , Giovanni Battista Ivaldi MD , Stefania Martini MD , Fiorenza De Rose MD , Cristiana Fodor MSc , Paolo Veronesi MD , Viviana Enrica Galimberti MD , Mattia Intra MD , Luigi Cornacchia MD , Francesca Braga MD , Stefano Durante MD , Samantha Dicuonzo MD , Barbara Alicja Jereczek-Fossa MD, PhD

Purpose

Intraoperative radiation therapy with electrons (IOERT) may represent a viable choice for partial breast reirradiation after repeat quadrantectomy for local recurrence (LR) for primary breast cancer (BC) in lieu of mastectomy.

Methods and Materials

A database collecting data on partial breast reirradiation with IOERT from 8 Italian centers was set up in 2016 to 2018, providing data on cumulative incidence (CumI) of second LR and survival with a long follow-up.

Results

From 2002 to 2015, 109 patients underwent the conservative retreatment. The median primary BC first LR interval was 11.1 years (range, 2.4-27.7). The median first LR size was 0.9 cm (range, 0.3-3.0), and 43.6% cases were luminal A. Median IOERT dose was 18 Gy (range, 12-21), and median collimator diameter was 4 cm (range, 3-6). Median follow-up duration was 11.7 years (IQR, 7.7-14.6). The second LR CumI was 12.2% (95% CI, 6.8%-19.2%) at 5 years and 32.3% at 10 years (95% CI, 22.8%-42.2%), occurring in the same site as the first LR in about half of the cases. Human epidermal growth factor receptor 2 status and collimator size were independent LR predictors. The 5- and 10-year overall survival rates were 95.2% and 88.3%, respectively, whereas 5- and 10-year BC-specific survival rates were 98% and 94.5%, respectively. The development of a second LR significantly reduced BC-specific survival (hazard ratio, 9.40; P < .001). Grade ≥3 fibrosis rate was 18.9%. Patient-reported cosmesis was good/excellent in 59.7% of the cases.

Conclusions

Second LR CumI was within the range of the literature but higher than expected, opening questions on radiation field extension and fractionation schedule. Because a second LR worsened the outcome, salvage modality must be carefully planned.

目的：术中电子放疗（IOERT）可能是原发性乳腺癌（BC）局部复发（LR）重复四维切除术后乳房部分再照射（rePBI）的可行选择，以代替乳房切除术：2016年至2018年，建立了一个数据库，收集了8个意大利中心的IOERT再照射数据，提供了第2次局部复发的累积发生率（CumI）和长期随访的生存率（FU）数据。结果：2002年至2015年，109名患者接受了保守再治疗。原发性 BC-1 1stLR 的中位间隔为 11.1 年（范围：2.4-27.7）。IOERT 中位剂量为 18 Gy（范围：12-21），中位准直器为 4 cm（范围：3-6）。中位FU为11.7年（四分位间范围：7.7-14.6）。5年后第2次LR的CumI为12.2%（95% CI：6.8-19.2），10年后为32.3%（95% CI：22.8-42.2），约半数病例的第2次LR发生在第1次LR的同一部位。HER2状态和准直器大小是独立的LR预测因素。5年和10年总生存率分别为95.2%和88.3%，5年和10年BC特异性生存率分别为98%和94.5%。第2次LR的出现明显降低了BCSS（HR=9.40，PConclusion）：第2次LR的CumI在文献范围内，但高于预期，这对放射野扩展和分次计划提出了质疑。由于第2次LR会使结果恶化，因此必须仔细规划挽救方式。

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引用次数: 0

International Federation of Gynecology and Obstetrics Endometrial 2023 Is Better For Radiation Oncology Patients FIGO 子宫内膜 2023 更适合放射肿瘤患者。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.05.010

David Gaffney MD, PhD , Gita Suneja MD, MS , Chris Weil MD , Carien Creutzberg MD

The International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system for endometrial cancer has marked changes from the previous staging system instituted 14 years prior in 2009. The new staging system includes nonanatomic factors for the first time (lymphovascular space invasion and histology) and molecular classification, which impacts the stage in early-stage disease (IAm_POLE_mut and IICm_p53abn). The purpose of these changes was to provide (1) high accuracy in the predictive prognosis for patients and (2) identification of distinct treatment-relevant subgroups. Our understanding of the biology and natural history of endometrial cancer has undergone a radical transformation since the Cancer Genome Atlas results in 2013. The 2023 FIGO staging system harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features. Moreover, FIGO 2023 has distinct substages that improve adjuvant treatment decision making. Although the practicality of the new staging system has been debated, we postulate that FIGO 2023 is more useful for radiation oncologists aiming to provide personalized care recommendations. FIGO 2023 requires a change in our perception of a staging system, from a traditional anatomic borders-based system to a staging system integrating anatomy and tumor biology as pivotal prognostic factors for patients while providing important information for treatment decision making.

FIGO 2023 子宫内膜癌分期系统与 14 年前（2009 年）制定的分期系统相比发生了显著变化。新的分期系统首次纳入了非解剖因素（淋巴管间隙侵犯和组织学）和分子分类，这影响了早期疾病的分期（IAmPOLEmut 和 IICmp53abn）。这些变化的目的是：1）高精度预测患者的预后；2）识别不同的治疗相关亚组。自 2013 年 TGCA（癌症基因组图谱）结果公布以来，我们对子宫内膜癌生物学和自然病史的认识发生了翻天覆地的变化。2023 FIGO 分期系统协调并整合了解剖学、组织病理学和分子特征方面的新旧知识。此外，FIGO 2023 还具有不同的子分期，可改善辅助治疗决策。尽管对新分期系统的实用性存在争议，但我们推测 FIGO 2023 对旨在提供个性化治疗建议的放射肿瘤专家更有用。FIGO 2023 要求我们改变对分期系统的认识，从传统的以解剖边界为基础的系统转变为将解剖学和肿瘤生物学作为患者关键预后因素的分期系统，同时为治疗决策提供重要信息。

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引用次数: 0

Peer-to-Peer Phone Calls and Letters Appealing Insurance Denials of Service: Practical Tips and Resources 点对点电话和信件上诉保险拒绝服务：实用技巧和资源。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.015

Jared Pasetsky MD , J. Alex Garcia-Young MD , Emilio Beatley BS , James B. Yu MD, MHS

The approval of radiation oncology care by insurance companies is burdensome for providers. In this topic discussion, we attempt to provide practical recommendations for how to deal with peer-to-peer phone calls as well as how to improve the timeliness and quality of subsequent letters of appeal.

保险公司批准放射肿瘤治疗是医疗服务提供者的负担。在本专题讨论中，我们将尝试就如何处理同行电话以及如何提高后续申诉信的及时性和质量提供实用建议。

引用次数: 0

Masthead/Sub page 刊头/分页

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/S1879-8500(24)00227-3

引用次数: 0

Financial Improvements From Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared With Standard of Care, “SAVE” Trial 与标准疗法相比，"SAVE "试验为早期子宫内膜癌患者提供的短程阴道袖带近距离治疗可改善经济效益。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.07.006

Cristina DeCesaris MD , Trevor Wilson MD , Jaewhan Kim MD , Lindsay Burt MD , Jonathan Grant MD , Matthew M. Harkenrider MD , Jessica Huang PhD , Anuja Jhingran MD, FASTRO, FACR , Elizabeth Kidd MD , Andre Konski MD, MBA, MA, FACR, FASTRO , Lilie Lin MD , William Small Jr. MD, FACRO, FACR, FASTRO , Gita Suneja MD, MS , David Gaffney MD, PhD, FACR, FABS, FASTRO

Purpose

Early-stage endometrial cancer is often treated with hysterectomy followed by adjuvant vaginal cuff brachytherapy (VCB). Financial toxicity from cancer treatment can impact treatment completion. The Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared to Standard of Care trial is a multicenter, prospective randomized trial of standard of care (SoC) VCB doses delivered in 3 to 5 fractions per the physician's discretion compared with a 2-fraction course. We report on secondary cost endpoints, quantifying the financial impacts of shorter treatment courses on institutions and participating patients.

Methods and Materials

Technical (TechCs), professional, and total charges (TotCs) were collected prospectively and are reported as raw and Medicare-adjusted charges per patient. Distance to the treatment center and the median income for each patient's zip code were estimated. The Mann-Whitney U statistic, t test, and X² test were used to compare characteristics between the 2 groups.

Results

One hundred eight patients were analyzed. SoC VCB was delivered in 3, 4, and 5 fractions for 27 of 54 patients (50%), 11 of 54 (20%), and 16 of 54 (30%), respectively. The median total distance traveled per patient for SoC versus experimental arms was 213 versus 137 miles (p = .12), and the median cost of commute for patients was $36.3 versus $18.0 (p = .11). Compared with 2-fraction treatment, 5-fraction treatment resulted in longer travel distances (median, 462 vs 137 miles; p < .01) and increased travel costs (median, $59.3 vs $18.0; p ≤ .01). Unadjusted raw professional charges in USD per patient did not differ between SoC versus experimental arms ($9159 vs $7532; p = .19). TechCs were significantly higher in the SoC arm ($35,734 vs $24,696; p ≤ .01), as were TotCs ($44,892 vs $32,228; p < .01;). Medicare-adjusted TechCs and TotCs were higher for the SoC arm.

Conclusions

Two-fraction VCB resulted in fewer treatments per patient, reduced cost of travel compared with longer courses, and an adjusted reduction in health care expenditures compared with SoC.

目的：早期子宫内膜癌通常采用子宫切除术，然后进行阴道袖带近距离辅助治疗（VCB）。癌症治疗的经济毒性会影响治疗的完成。早期子宫内膜癌的短程阴道袖带近距离辅助治疗与标准治疗相比试验是一项多中心、前瞻性的随机试验，将医生决定的标准治疗（SoC）VCB 剂量分为 3 至 5 个疗程与 2 个疗程进行比较。我们报告了次要成本终点，量化了缩短疗程对医疗机构和参与患者的经济影响：前瞻性地收集了技术费用（TechCs）、专业费用和总费用（TotCs），并以每位患者的原始费用和医疗保险调整后费用的形式进行报告。对每位患者所在邮政编码的治疗中心距离和收入中位数进行了估算。采用 Mann-Whitney U 统计、t 检验和 X2 检验来比较两组患者的特征：结果：分析了 108 名患者。54 位患者中分别有 27 位（50%）、11 位（20%）和 16 位（30%）的 SoC VCB 分 3、4 和 5 次进行。SoC与实验臂相比，每位患者的总路程中位数分别为213英里和137英里（P = .12），患者的通勤成本中位数分别为36.3美元和18.0美元（P = .11）。与 2 分段治疗相比，5 分段治疗导致旅行距离延长（中位数为 462 英里对 137 英里；p < .01），旅行成本增加（中位数为 59.3 美元对 18.0 美元；p ≤ .01）。以美元计算的每位患者未经调整的原始专业费用在SoC组和实验组之间没有差异（9159美元 vs 7532美元；p = .19）。SoC治疗组的TechCs明显更高（35734美元 vs 24696美元；p≤.01），TotCs也更高（44892美元 vs 32228美元；p <.01；）。SoC治疗组的医疗保险调整后TechCs和TotCs更高：结论：与SoC相比，两分次VCB可减少每位患者的治疗次数，与长疗程相比可降低差旅费用，调整后的医疗支出也有所减少。

{"title":"Financial Improvements From Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared With Standard of Care, “SAVE” Trial","authors":"Cristina DeCesaris MD , Trevor Wilson MD , Jaewhan Kim MD , Lindsay Burt MD , Jonathan Grant MD , Matthew M. Harkenrider MD , Jessica Huang PhD , Anuja Jhingran MD, FASTRO, FACR , Elizabeth Kidd MD , Andre Konski MD, MBA, MA, FACR, FASTRO , Lilie Lin MD , William Small Jr. MD, FACRO, FACR, FASTRO , Gita Suneja MD, MS , David Gaffney MD, PhD, FACR, FABS, FASTRO","doi":"10.1016/j.prro.2024.07.006","DOIUrl":"10.1016/j.prro.2024.07.006","url":null,"abstract":"<div><h3>Purpose</h3><div>Early-stage endometrial cancer is often treated with hysterectomy followed by adjuvant vaginal cuff brachytherapy (VCB). Financial toxicity from cancer treatment can impact treatment completion. The Short Course Adjuvant Vaginal Cuff Brachytherapy in Early Endometrial Cancer Compared to Standard of Care trial is a multicenter, prospective randomized trial of standard of care (SoC) VCB doses delivered in 3 to 5 fractions per the physician's discretion compared with a 2-fraction course. We report on secondary cost endpoints, quantifying the financial impacts of shorter treatment courses on institutions and participating patients.</div></div><div><h3>Methods and Materials</h3><div>Technical (TechCs), professional, and total charges (TotCs) were collected prospectively and are reported as raw and Medicare-adjusted charges per patient. Distance to the treatment center and the median income for each patient's zip code were estimated. The Mann-Whitney U statistic, <em>t</em> test, and X<sup>2</sup> test were used to compare characteristics between the 2 groups.</div></div><div><h3>Results</h3><div>One hundred eight patients were analyzed. SoC VCB was delivered in 3, 4, and 5 fractions for 27 of 54 patients (50%), 11 of 54 (20%), and 16 of 54 (30%), respectively. The median total distance traveled per patient for SoC versus experimental arms was 213 versus 137 miles (<em>p</em> = .12), and the median cost of commute for patients was $36.3 versus $18.0 (<em>p</em> = .11). Compared with 2-fraction treatment, 5-fraction treatment resulted in longer travel distances (median, 462 vs 137 miles; <em>p</em> < .01) and increased travel costs (median, $59.3 vs $18.0; <em>p</em> ≤ .01). Unadjusted raw professional charges in USD per patient did not differ between SoC versus experimental arms ($9159 vs $7532; <em>p</em> = .19). TechCs were significantly higher in the SoC arm ($35,734 vs $24,696; <em>p</em> ≤ .01), as were TotCs ($44,892 vs $32,228; <em>p</em> < .01;). Medicare-adjusted TechCs and TotCs were higher for the SoC arm.</div></div><div><h3>Conclusions</h3><div>Two-fraction VCB resulted in fewer treatments per patient, reduced cost of travel compared with longer courses, and an adjusted reduction in health care expenditures compared with SoC.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages e500-e506"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300800","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

Fibrosis or Recurrence After Lung Stereotactic Body Radiation Therapy: A Proposed Decision Tree 肺立体定向体放射治疗后纤维化或复发：拟议的决策树

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.07.004

Arya Amini MD , Henry S. Park MD, MPH

引用次数: 0

Biochemical Relapse-Free Survival in Postprostatectomy Patients Receiving 18F-Fluciclovine-Guided Prostate Bed-Only Radiation: Post Hoc Analysis of a Prospective Randomized Trial 前列腺切除术后仅接受 18F - 氟尿嘧啶引导的前列腺床放射治疗患者的无生化复发生存率：前瞻性随机试验的事后分析。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.05.011

Vishal R. Dhere MD , David M. Schuster MD , Subir Goyal PhD , Eduard Schreibmann PhD , Bruce W. Hershatter MD , Sagar A. Patel MD, MSCR , Joseph W. Shelton MD , Sheela Hanasoge MBBS, PhD , Pretesh R. Patel MD , Nikhil T. Sebastian MD , Omotayo A. Adediran MBBS , Ismaheel O. Lawal MBBS, PhD , Ashesh B. Jani MD, MSEE

Purpose

Whole-pelvis (WP) radiation therapy (radiation) improved biochemical relapse-free survival (bRFS) compared with prostate bed (PB)-only radiation in the Radiation Therapy Oncology Group 0534, but was performed in an era prior to positron emission tomography (PET) staging. Separately, 18F-fluciclovine PET/CT-guided postprostatectomy radiation improved 3-year bRFS versus radiation guided by conventional imaging alone. We hypothesized that patients who were changed from WP to PB-only radiation after PET would have bRFS that was: (a) no higher than patients initially planned for PB-only radiation; and (b) lower than patients planned for WP radiation without PET guidance.

Methods and Materials

We conducted a post hoc analysis of a prospective, randomized trial comparing conventional (arm 1) versus PET-guided (arm 2) postprostatectomy radiation. In arm 2, pre-PET treatment field decisions were recorded and post-PET fields were defined per protocol; pathologic node negative (pN0) without pelvic or extrapelvic PET uptake received PB-only radiation. Three-year bRFS was compared in patients planned for WP with change to PB-only radiation (arm 2 [WP:PB]) vs arm 2 patients planned for PB-only with final radiation to PB-only (arm 2 [PB:PB]) and arm 1 pN0 patients treated with WP radiation (arm 1 [WP]) using the Z test and log-rank test. Demographics were compared using the chi-square test, Fisher exact test, or analysis of variance, as appropriate.

Results

We identified 10 arm 2 (WP:PB), 31 arm 2 (PB:PB) and 11 arm 1 (WP) patients. Androgen deprivation was used in 50.0% of arm 2 (WP:PB) and 3.2% of arm 2 (PB:PB) patients, P < .01. Median preradiation prostate-specific antigen was higher in arm 2 (WP:PB) vs arm 2 (PB:PB) patients (0.4 vs 0.2 ng/mL, P = .03); however, there were no significant differences in T stage, Gleason score, or margin positivity. Three-year bRFS was 80% in arm 2 (WP:PB) vs 87.4% in arm 2 (PB:PB), P = .47, respectively. Arm 1(WP) patients had significantly worse 3-year (23%) bRFS vs arm 2 (WP:PB), P < .01.

Conclusions

Patients initially planned for WP radiation with field decision change to PB-only radiation after PET showed (1) no significant difference in 3-year bRFS compared with patients initially planned for PB-only radiation; and (2) improved bRFS compared with patients receiving WP radiation without PET guidance. PET-guided volume de-escalation in selected patients may be 1 approach to mitigating toxicity without compromising outcomes.

目的：在RTOG 0534研究中，与单纯前列腺床（PB）放射治疗相比，全盆腔（WP）放射治疗（放疗）提高了无生化复发生存率（bRFS），但这是在PET分期之前的时代进行的。另外，18F-呋喃妥因 PET/CT （PET）引导的前列腺切除术后放射治疗与仅由传统成像引导的放射治疗相比，可提高 3 年无复发生存率（bRFS）。我们假设，在 PET 之后从 WP 改为纯 PB 放射治疗的患者的 bRFS3 将（a）不高于最初计划接受纯 PB 放射治疗的患者，（b）低于计划接受 WP 放射治疗但未接受 PET 指导的患者：我们对一项前瞻性随机试验进行了事后分析，比较了前列腺切除术后常规放射治疗（第 1 组）与 PET 指导下放射治疗（第 2 组）。在Arm 2中，记录了PET前治疗野的决定，并根据方案定义了PET后治疗野：病理结节阴性（pN0）且无盆腔或盆腔外PET摄取的患者接受纯PB放射治疗。使用 Z 检验和对数秩检验比较了计划接受 WP 放射治疗但最终改为纯 PB 放射治疗的患者[Arm 2 (WP:PB)] 与计划接受纯 PB 放射治疗但最终改为纯 PB 放射治疗的患者[Arm 2(PB:PB)] 和接受 WP 放射治疗的前臂 pN0 患者[Arm 1(WP)]的三年 bRFS。人口统计学数据采用卡方检验（Chi-square test）、费雪精确检验（Fisher's exact test）或方差分析（ANOVA）进行比较：我们确定了 10 名 Arm 2（WP：PB）、31 名 Arm 2（PB：PB）和 11 名 Arm 1（WP）患者。50.0%的Arm 2（WP:PB）和3.2%的Arm 2（PB:PB）患者使用了雄激素剥夺疗法，P结论：与最初计划接受纯PB放射治疗的患者相比，(a)3年bRFS无显著差异；(b)与未接受PET指导的WP放射治疗的患者相比，bRFS有所改善。在 PET 的指导下，对选定的患者减量可能是减轻毒性而不影响疗效的一种方法。

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引用次数: 0

Benchmarking a Foundation Large Language Model on its Ability to Relabel Structure Names in Accordance With the American Association of Physicists in Medicine Task Group-263 Report 根据美国医学物理学家协会工作组-263 报告，对基础大型语言模型重新标注结构名称的能力进行基准测试。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.04.017

Jason Holmes PhD , Lian Zhang PhD , Yuzhen Ding PhD , Hongying Feng PhD , Zhengliang Liu MS , Tianming Liu PhD , William W. Wong MD , Sujay A. Vora MD , Jonathan B. Ashman MD, PhD , Wei Liu PhD

Purpose

To introduce the concept of using large language models (LLMs) to relabel structure names in accordance with the American Association of Physicists in Medicine Task Group-263 standard and to establish a benchmark for future studies to reference.

Methods and Materials

Generative Pretrained Transformer (GPT)-4 was implemented within a Digital Imaging and Communications in Medicine server. Upon receiving a structure-set Digital Imaging and Communications in Medicine file, the server prompts GPT-4 to relabel the structure names according to the American Association of Physicists in Medicine Task Group-263 report. The results were evaluated for 3 disease sites: prostate, head and neck, and thorax. For each disease site, 150 patients were randomly selected for manually tuning the instructions prompt (in batches of 50), and 50 patients were randomly selected for evaluation. Structure names considered were those that were most likely to be relevant for studies using structure contours for many patients.

Results

The per-patient accuracy was 97.2%, 98.3%, and 97.1% for prostate, head and neck, and thorax disease sites, respectively. On a per-structure basis, the clinical target volume was relabeled correctly in 100%, 95.3%, and 92.9% of cases, respectively.

Conclusions

Given the accuracy of GPT-4 in relabeling structure names as presented in this work, LLMs are poised to become an important method for standardizing structure names in radiation oncology, especially considering the rapid advancements in LLM capabilities that are likely to continue.

目的：介绍使用大型语言模型（LLM）按照美国物理学家协会医学工作组-263 标准重新标注结构名称的概念，并为今后的研究建立一个参考基准：生成式预训练变换器（GPT）-4 在医学数字成像与通信服务器中实施。服务器接收到结构集数字成像与医学通信文件后，会提示 GPT-4 根据美国物理学家协会医学工作组-263 报告重新标注结构名称。评估结果针对 3 个疾病部位：前列腺、头颈部和胸部。针对每个疾病部位，随机抽取 150 名患者手动调整指示提示（每批 50 人），并随机抽取 50 名患者进行评估。所考虑的结构名称是那些最有可能与对许多患者使用结构轮廓进行研究相关的名称：前列腺、头颈部和胸部疾病部位的每位患者准确率分别为 97.2%、98.3% 和 97.1%。就每个结构而言，分别有 100%、95.3% 和 92.9% 的病例正确地重新标记了临床靶体积：鉴于 GPT-4 在重新标注结构名称方面的准确性，LLM 将成为放射肿瘤学中标准化结构名称的重要方法，特别是考虑到 LLM 功能可能会继续快速发展。

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引用次数: 0

Evolution of Proton Radiation Therapy Brainstem Constraints on the Pediatric Proton/Photon Consortium Registry 儿科质子/光子联盟登记处质子放疗脑干制约因素的演变。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.05.013

Dora Correia MD , Daniel J. Indelicato MD , Arnold C. Paulino MD , Ralph Ermoian MD , Stephen Mihalcik MD , Stephanie M. Perkins MD , Christine Hill-Kayser MD , Victor S. Mangona MD , Jae Lee MD , John Han-Chih Chang MD , Nadia N. Laack MD, MS , Young Kwok MD , John Perentesis MD , Ralph Vatner MD , Ronak Dave MD , Sara L. Gallotto MS , Miranda P. Lawell MS , Benjamin V.M. Bajaj MA , Keith W. Allison MS , Alisa Perry BSN , Torunn I. Yock MD, MCH

Purpose

Increasing concern that brainstem toxicity incidence after proton radiation therapy might be higher than with photons led to a 2014 University of Florida (UF) landmark paper identifying its risk factors and proposing more conservative dose constraints. We evaluated how practice patterns changed among the Pediatric Proton/Photon Consortium Registry (PPCR).

Material and Methods

This prospective multicenter cohort study gathered data from patients under the age of 22 years enrolled on the PPCR, treated between 2002 and 2019 for primary posterior fossa brain tumors. After standardizing brainstem contours, we garnered dosimetry data and correlated those meeting the 2014 proton-specific brainstem constraint guidelines by treatment era, histology, and extent of surgical resection.

Results

A total of 467 patients with evaluable proton radiation therapy plans were reviewed. Median age was 7.1 years (range: <1-21.9), 63.0% (n = 296) were men, 76.0% (n = 357) were White, and predominant histology was medulloblastoma (55.0%, n = 256), followed by ependymoma (27.0%, n = 125). Extent of resection was mainly gross total resection (GTR) (67.0%, n = 312), followed by subtotal resection (STR) or biopsy (20.0%, n = 92), and near total resection (NTR) (9.2%, n = 43). The UF brainstem constraint metrics most often exceeded were the goal D_50% of 52.4 gray relative biological equivalents (43.3%, n = 202) and maximal D_50% of 54 gray relative biological equivalents (12.6%, n = 59). The compliance rate increased after the new guidelines (2002-2014: 64.0% vs 2015-2019: 74.6%, P = .02), except for ependymoma (46.3% pre- vs 50.0% post-guidelines, P = .86), presenting lower compliance (48.8%) in comparison to medulloblastoma/ primitive neuroectodermal tumors/pineoblastoma (77.7%), glioma (89.1%), and atypical teratoid/rhabdoid tumors (90.9%) (P < .001). Degree of surgical resection did not affect compliance rates (GTR/NTR 71.0% vs STR/biopsy 72.8%, P = .45), even within the ependymoma subset (GTR/NTR 50.5% vs STR/biopsy 38.1%, P = .82).

Conclusion

Since the publication of the UF guidelines, the pediatric proton community has implemented more conservative brainstem constraints in all patients except those with ependymoma, irrespective of residual disease after surgery. Future work will evaluate if this change in practice is associated with decreased rates of brainstem toxicity.

导言：质子放疗（PRT）后脑干毒性发生率可能高于光子放疗，这一问题日益受到关注，因此，2014 年 XXXX（XX）发表了一篇具有里程碑意义的论文，确定了脑干毒性的风险因素，并提出了更为保守的剂量限制。我们评估了 XXXX（XXXX）的实践模式是如何变化的：这项前瞻性多中心队列研究收集了 2002-2019 年间在 XXXX 接受治疗的 22 岁以下原发性后窝脑肿瘤患者的数据。在对脑干轮廓进行标准化后，我们收集了剂量测定数据，并按照治疗年代、组织学和手术切除范围对符合2014年质子特异性脑干限制指南的患者进行了关联：共审查了467例可评估PRT计划的患者。中位年龄为 7.1 岁（范围：52.4 GyRBE 的 50%）：50%为52.4 GyRBE（43.3%，n=202），最大D50%为54 GyRBE（12.6%，n=59）。新指南发布后，符合率有所提高（2002-2014 年：64.0% vs. 2015-2019 年：74.6%，p=0.02），但上皮瘤除外（指南发布前 46.3% vs. 发布后 50.0%，p=0.86），其符合率（48.8%）低于髓母细胞瘤/PNET/松母细胞瘤（77.7%）、胶质瘤（89.1%）和 ATRT（90.9%）（p结论：自 XX 指南发布以来，儿科质子治疗界对除上皮瘤以外的所有患者都实施了更为保守的脑干限制，无论术后是否有残留疾病。未来的工作将评估这种做法的改变是否与脑干毒性发生率的降低有关。

{"title":"Evolution of Proton Radiation Therapy Brainstem Constraints on the Pediatric Proton/Photon Consortium Registry","authors":"Dora Correia MD , Daniel J. Indelicato MD , Arnold C. Paulino MD , Ralph Ermoian MD , Stephen Mihalcik MD , Stephanie M. Perkins MD , Christine Hill-Kayser MD , Victor S. Mangona MD , Jae Lee MD , John Han-Chih Chang MD , Nadia N. Laack MD, MS , Young Kwok MD , John Perentesis MD , Ralph Vatner MD , Ronak Dave MD , Sara L. Gallotto MS , Miranda P. Lawell MS , Benjamin V.M. Bajaj MA , Keith W. Allison MS , Alisa Perry BSN , Torunn I. Yock MD, MCH","doi":"10.1016/j.prro.2024.05.013","DOIUrl":"10.1016/j.prro.2024.05.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Increasing concern that brainstem toxicity incidence after proton radiation therapy might be higher than with photons led to a 2014 University of Florida (UF) landmark paper identifying its risk factors and proposing more conservative dose constraints. We evaluated how practice patterns changed among the Pediatric Proton/Photon Consortium Registry (PPCR).</div></div><div><h3>Material and Methods</h3><div>This prospective multicenter cohort study gathered data from patients under the age of 22 years enrolled on the PPCR, treated between 2002 and 2019 for primary posterior fossa brain tumors. After standardizing brainstem contours, we garnered dosimetry data and correlated those meeting the 2014 proton-specific brainstem constraint guidelines by treatment era, histology, and extent of surgical resection.</div></div><div><h3>Results</h3><div>A total of 467 patients with evaluable proton radiation therapy plans were reviewed. Median age was 7.1 years (range: <1-21.9), 63.0% (n = 296) were men, 76.0% (n = 357) were White, and predominant histology was medulloblastoma (55.0%, n = 256), followed by ependymoma (27.0%, n = 125). Extent of resection was mainly gross total resection (GTR) (67.0%, n = 312), followed by subtotal resection (STR) or biopsy (20.0%, n = 92), and near total resection (NTR) (9.2%, n = 43). The UF brainstem constraint metrics most often exceeded were the goal D<sub>50%</sub> of 52.4 gray relative biological equivalents (43.3%, n = 202) and maximal D<sub>50%</sub> of 54 gray relative biological equivalents (12.6%, n = 59). The compliance rate increased after the new guidelines (2002-2014: 64.0% vs 2015-2019: 74.6%, <em>P</em> = .02), except for ependymoma (46.3% pre- vs 50.0% post-guidelines, <em>P</em> = .86), presenting lower compliance (48.8%) in comparison to medulloblastoma/ primitive neuroectodermal tumors/pineoblastoma (77.7%), glioma (89.1%), and atypical teratoid/rhabdoid tumors (90.9%) (<em>P</em> < .001). Degree of surgical resection did not affect compliance rates (GTR/NTR 71.0% vs STR/biopsy 72.8%, <em>P</em> = .45), even within the ependymoma subset (GTR/NTR 50.5% vs STR/biopsy 38.1%, <em>P</em> = .82).</div></div><div><h3>Conclusion</h3><div>Since the publication of the UF guidelines, the pediatric proton community has implemented more conservative brainstem constraints in all patients except those with ependymoma, irrespective of residual disease after surgery. Future work will evaluate if this change in practice is associated with decreased rates of brainstem toxicity.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"14 6","pages":"Pages e507-e514"},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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