Practical Radiation Oncology最新文献

英文中文

Jackstone Calculus 小卵石微积分。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-11-01 DOI: 10.1016/j.prro.2025.10.007

Brian P. Quaranta MD, MA , Edward T. Wright MD

引用次数: 0

Prospective Integration of Patient Preferences Into Adjuvant Therapy Decisions for Older Women With Early-Stage Hormone Receptor-Positive Breast Cancer Adjuvant Therapy Decisions in Breast Cancer 早期激素受体阳性乳腺癌老年妇女辅助治疗决策中患者偏好的前瞻性整合

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-11-18 DOI: 10.1016/j.prro.2025.10.013

Andrea Brown MD , Sara Alcorn MD, PhD , Victoria Croog MD , Keara English MD , Mary Wilkinson MD , Princess Mark-Adjeli MD , Larissa Korde MD, MPH , Maureen O’Donnell MD , Hanh-Tam Tran MD , Catherine Westin BSN, RN , Jean L. Wright MD

Purpose

Guidelines for women aged ≥65 years with early-stage, hormone receptor-positive cancer allow for a range of adjuvant strategies following breast-conserving surgery. These include hormone therapy (HT) with or without radiation therapy (RT), RT alone if HT is not desired or feasible, or even no adjuvant therapy. Although these options offer flexibility, they can also create uncertainty. To address this, we implemented a simple multidisciplinary clinic (s-MDC) with same-day medical and radiation oncology consultations, alongside a previsit questionnaire assessing decision-making preferences and treatment attitudes.

Methods and Materials

We evaluated 95 patients aged ≥65 years with stage I, hormone receptor-positive breast cancer seen in the s-MDC from August 2020 to December 2023. All completed the Decision Autonomy Preference Scale, Medical Maximizing-Minimizing Scale, and e-Prognosis 10-year mortality risk estimates. We retrospectively reviewed demographics, clinical variables, and chosen treatments, examining associations using χ² tests, t tests, and regressions.

Results

Among 95 patients, adjuvant treatments included no therapy (16.8%), HT alone (16.8%), RT alone (20.0%), and HT+RT (45.3%). Older age, higher mortality risk, and a preference for decision autonomy correlated with omission of all therapy or omission of HT. “Minimizers” favored HT alone, whereas “maximizers” often chose RT or HT+RT. Neither baseline patient-reported data nor most clinicopathologic factors predicted the use of RT alone. The only clinicopathologic factor associated with choice was tumor size: patients with larger (T1b/T1c) tumors more commonly received HT+RT.

Conclusions

In this s-MDC setting, treatment decisions were driven largely by patient preferences, life expectancy, and treatment inclinations, rather than by baseline patient-reported measures or tumor features. These findings underscore the importance of integrating patient values into decision-making and support further research into RT-alone approaches for those forgoing HT, given the prevalence of this treatment choice.

目的：65岁及以上早期，激素受体（HR）阳性癌症患者的指南允许在保乳手术（BCS）后采取一系列辅助策略。这些包括内分泌治疗（ET）加或不加放疗（RT），如果ET不需要或不可行，单独放疗，甚至不进行辅助治疗。虽然这些选择提供了灵活性，但它们也会产生不确定性。为了解决这一问题，我们实施了一个简单的多学科诊所（s-MDC），提供当日医疗和放射肿瘤学咨询，以及评估决策偏好和治疗态度的会诊前问卷。患者和方法：我们评估了2020年8月至2023年12月在s-MDC中发现的95例年龄≥65岁的I期hr阳性乳腺癌患者。所有受试者均完成决策自主偏好量表、医疗最大化-最小化量表和e-Prognosis 10年死亡率风险评估。我们回顾性地回顾了人口统计学、临床变量和选择的治疗方法，使用卡方检验、t检验和回归检验了它们之间的联系。结果：95例患者中，辅助治疗包括不治疗（16.8%）、单独ET治疗（16.8%）、单独RT治疗（20.0%）和ET+RT治疗（45.3%）。年龄较大、死亡风险较高、偏好自主决策与遗漏所有治疗或遗漏ET相关。“最小化者”喜欢单独的ET，而“最大化者”通常选择RT或ET+RT。基线患者报告的数据和大多数临床病理因素都不能预测单独使用放疗。唯一与选择相关的临床病理因素是肿瘤大小：较大（T1b/T1c）肿瘤的患者更常接受ET+RT。结论：在s-MDC环境中，治疗决定主要由患者偏好、预期寿命和治疗倾向驱动，而不是由患者报告的基线测量或肿瘤特征驱动。这些发现强调了将患者价值纳入决策的重要性，并支持进一步研究放弃ET的患者单独rt治疗方法，因为这种治疗选择很普遍。

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引用次数: 0

Digitally Reconstructed Radiograph Dosimetry: Introducing a New Application of Digitally Reconstructed Radiographs for Evaluation of Dose Distribution in Radiation Therapy DRR剂量测定法;介绍了数字重建x线片在放射治疗剂量分布评估中的新应用。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2025-11-24 DOI: 10.1016/j.prro.2025.11.002

Mohammad Yasin Mohammadi PhD , Mehdi Momennezhad PhD , Hamid Gholamhosseinian PhD , Erfan Saatchian PhD , Azam Eskandari PhD , Shahrokh Nasseri PhD

Purpose

The digitally reconstructed radiograph (DRR) has traditionally been used for geometric radiation therapy (RT) treatment verification, with no reported dosimetric applications to date. This study aimed to introduce a methodology for the first time, allowing us to derive a dose distribution within an RT treatment plan using the DRR image.

Methods and Materials

Initially, the correlation between the pixel values of the DRR image and the depth of the water phantom was established. Subsequently, the relationship between depth and absorbed dose was derived. By combining these 2 equations, the connection between the pixel values of the DRR and the absorbed dose was established. This approach was then used to calculate the dose distribution for homogeneous and RANDO phantoms. To verify the accuracy of this technique, the results were compared with the dose distribution from the treatment planning system.

Results

The comparison of point doses at the isocenter of the RANDO phantom indicated differences of 1% and 2.4% for energies of 6 and 15 MV, respectively. A region-based dose distribution comparison using gamma analysis (3%-3 mm criteria) resulted in agreements of 98% and 95% for energies of 6 and 15 MV, respectively.

Conclusions

DRR dosimetry is an innovative method that employs DRR images to calculate dose distribution in RT planning, enhancing their traditional geometric use. It operates independently of a treatment planning system, making it a cost-effective solution that can run on personal computers. This approach acts as a supplementary tool, ensuring dosimetric verification and quality control in RT treatments.

数字重建x线摄影（DRR）传统上用于几何放射治疗验证，迄今为止没有剂量学应用的报道。本研究旨在首次引入一种方法，使我们能够利用DRR图像推导出放射治疗计划中的剂量分布。方法：首先建立DRR图像像素值与水影深度的相关性。随后，导出了辐射深度与吸收剂量的关系。结合这两个方程，建立了DRR像素值与吸收剂量之间的关系。然后用这种方法计算均匀和随机幻像的剂量分布。为了验证该技术的准确性，将结果与治疗计划系统（TPS）的剂量分布进行了比较。结果：RANDO模体等中心点剂量比较，能量为6 MV和15 MV时，差异分别为1%和2.4%。使用伽玛分析（3%-3mm标准）进行基于区域的剂量分布比较，对6 MV和15 MV能量的一致性分别为98%和95%。结论：DRR剂量学是一种利用DRR图像计算放射治疗计划中剂量分布的创新方法，增强了传统的几何用途。它独立于TPS运行，使其成为一种经济有效的解决方案，可以在个人电脑上运行。该方法作为辅助工具，确保放射治疗中的剂量学验证和质量控制。

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引用次数: 0

Masthead/Sub page 报头/订阅页面

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-03-01 Epub Date: 2026-03-11 DOI: 10.1016/S1879-8500(26)00019-6

引用次数: 0

Integrating Locoregional Therapies Into Oncology Value Frameworks to Improve Patient-Centered Decision-Making and Outcomes. 将局部治疗纳入肿瘤学价值框架以改善以患者为中心的决策和结果。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-02-28 DOI: 10.1016/j.prro.2026.02.009

Kwabena B Asare, Benjamin W Corn, Ronald D Ennis, Eli Sapir, Nirav Kapadia, Cary P Gross, James B Yu

引用次数: 0

Left Phrenic Nerve Paralysis after single fraction Lung Stereotactic Body Radiotherapy. 单段肺立体定向放射治疗后左膈神经麻痹。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-02-28 DOI: 10.1016/j.prro.2026.02.011

Joseph A Adedigba, Jake Tenewitz, Osagie S Igiebor, Guillermo O Rangel Rivera, Aleksei Kornienko, William F Lewis, Mariam Alexander, Brian Lally, Bhishamjit Chera

引用次数: 0

Cold-Induced Transient Anisocoria Following Skull-Base Proton Therapy. 颅底质子治疗后冷致短暂性色差。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-02-27 DOI: 10.1016/j.prro.2026.02.010

Tugce Kutuk, Marshall Harrell, Alexander Crum, Kari Flaute, Amit Tandon, Kyle Wu, Joshua Palmer

引用次数: 0

Management and Outcomes for Hodgkin's Lymphoma Patients with Partial Metabolic Response after First-Line Systemic Therapy. 一线全身治疗后部分代谢反应的霍奇金淋巴瘤患者的管理和结果

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-02-27 DOI: 10.1016/j.prro.2026.01.017

Donna Liao, Mahmood Aminilari, Xiang Y Ye, Ur Metser, Amit Singnurkar, Sita Bhella, Michael Crump, Robert Kridel, Vishal Kukreti, John Kuruvilla, Anca Prica, Abi Vijenthira, Matthew Cheung, Danielle Rodin, May Tsao, David Hodgson

Purpose: To evaluate real-world management strategies and outcomes for Hodgkin lymphoma (HL) patients with a partial metabolic response (PMR) on end-of-chemotherapy FDG-PET (EOC-PET) and assess if dynamic changes in maximum standardized uptake value (SUVmax) could refine risk stratification.

Methods and materials: Multi-centre, retrospective cohort study of HL patients treated January 1, 2009 - September 30, 2021. PMR was defined as Deauville score 4 on EOC-PET, with SUVmax lower than staging PET. First-line chemotherapy was predominantly ABVD (62.7%) or ABVD-escalated BEACOPP (28.4%). The primary endpoint was progression-free survival (PFS). Cox proportional-hazards models adjusted for stage and EOC-avid sites quantified outcomes; SUVmax kinetics (interim-to-EOC) were explored within RT cohort.

Results: Among 836 patients with EOC-PET, 67 met PMR criteria; median follow-up was 3.2 years (range 0.1-12.6). Post-EOC-PET management included involved-site radiotherapy (RT, n=38), salvage chemotherapy ± autologous stem-cell transplantation (n=14), or observation with serial PET (n=12). RT recipients had more early-stage disease (55.3% vs 21.4%), fewer EOC-avid sites (median 1 vs 2), and lower EOC SUVmax (median 4.7 vs 10.2) than those receiving systemic therapy. Two-year PFS was 84.2% after RT, 52.7% after salvage chemotherapy, and 74.1% with observation (log-rank p=0.057). On multivariable analysis, salvage chemotherapy (hazard ratio [HR] 5.82, 95% CI 1.14-29.81, p=0.03) and observation (HR 5.74, 95% CI 1.12-29.39, p=0.03) were associated with higher progression risk versus RT. Within the RT cohort, rising SUVmax between interim and EOC-PET (HR 7.21, 95% CI 1.17-44.35, p=0.033) and higher absolute EOC SUVmax (HR per unit 1.35, 95% CI 1.02-1.79, p=0.036) predicted inferior PFS.

Conclusions: Most HL patients with PMR achieve durable remission with consolidative RT alone, avoiding salvage chemotherapy and transplantation. Dynamic changes in SUVmax -especially a rising SUVmax between interim and EOC PET-identify a high-risk subset potentially warranting treatment intensification. Prospective studies integrating novel agents and PET metrics are needed to personalize therapy for this population.

目的：评估化疗末期FDG-PET （EOC-PET）有部分代谢反应（PMR）的霍奇金淋巴瘤（HL）患者的现实世界管理策略和结果，并评估最大标准化摄取值（SUVmax）的动态变化是否可以细化风险分层。方法和材料：2009年1月1日至2021年9月30日治疗的HL患者的多中心、回顾性队列研究。PMR定义为EOC-PET多维尔评分4分，SUVmax低于分期PET。一线化疗主要是ABVD（62.7%）或ABVD升级的BEACOPP（28.4%）。主要终点为无进展生存期（PFS）。Cox比例风险模型对分期和EOC-avid站点进行了调整，量化了结果；在RT队列中探讨了SUVmax动力学（中期至eoc）。结果：836例EOC-PET患者中，67例符合PMR标准；中位随访时间为3.2年（0.1-12.6年）。eoc -PET后治疗包括受累部位放疗（RT, n=38），补救性化疗±自体干细胞移植（n=14），或连续PET观察（n=12）。与接受全身治疗的患者相比，接受RT治疗的患者有更多的早期疾病（55.3% vs 21.4%），更少的EOC活跃位点（中位数1 vs 2），以及更低的EOC SUVmax（中位数4.7 vs 10.2）。化疗后2年PFS为84.2%，补救性化疗后为52.7%，观察后为74.1% （log-rank p=0.057）。在多变量分析中，补救性化疗（危险比[HR] 5.82, 95% CI 1.14-29.81, p=0.03）和观察（危险比[HR] 5.74, 95% CI 1.12-29.39, p=0.03）与RT相比具有更高的进展风险。在RT队列中，中期和EOC- pet之间增加的SUVmax（危险比7.21,95% CI 1.17-44.35, p=0.033）和更高的绝对EOC SUVmax（单位危险比1.35,95% CI 1.02-1.79, p=0.036）预测较差的PFS。结论：大多数合并PMR的HL患者仅通过巩固性放疗即可获得持久缓解，避免了补救性化疗和移植。SUVmax的动态变化-特别是中期和EOC pet之间SUVmax的上升-确定了可能需要加强治疗的高风险亚群。需要前瞻性研究结合新型药物和PET指标来个性化治疗这一人群。

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引用次数: 0

Safety and Efficacy of Hypofractionated Preoperative Radiotherapy in Retroperitoneal Sarcoma: A Comparative Study with Conventional Fractionation. 低分割术前放疗治疗腹膜后肉瘤的安全性和有效性：与常规分割的比较研究。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-02-27 DOI: 10.1016/j.prro.2026.02.008

Jong Yun Baek, Jeong Il Yu, Kyo Won Lee, Jae Berm Park, Nalee Kim

Purpose: The role of preoperative radiotherapy (RT) in retroperitoneal sarcoma (RPS) remains controversial across histological subtypes. Conventional fractionated RT (ConvRT) is the current standard, but hypofractionated RT (HypoRT) is gaining interest, particularly for soft tissue sarcomas. This study aimed to compare the safety and efficacy of HypoRT (10 fractions) with ConvRT in RPS patients.

Methods: We retrospectively reviewed 55 patients with RPS who received preoperative RT followed by surgery at a single tertiary institution between 2017 and 2024. All patients underwent intensity-modulated RT with simultaneous integrated boost techniques. The HypoRT group (n=15) received 50/35 Gy in 10 fractions, and the ConvRT group (n=40) received 62.5/45 Gy in 25 fractions. We assessed surgical complications (Clavien-Dindo grade ≥3) and prolonged postoperative hospitalization (≥14 days).

Results: Baseline characteristics were comparable. HypoRT did not increase grade ≥3 complications (33.3% vs. 25.0%, p=0.735) or hospital stay (median, 16 vs. 13 days; p=0.684). Older age was associated with severe complications (p=0.027), while larger tumors and longer operation time correlated with extended hospitalization (p=0.018 and p=0.024, respectively). With a median follow-up of 33 months, 3-year local recurrence-free survival (71.5% vs. 48.9%, p=0.329), progression-free survival (59.3% vs. 44.4%, p=0.612), and overall survival (84.9% vs. 80.0%, p=0.578) were comparable between groups.

Conclusion: HypoRT in 10 fractions appears feasible, without an apparent increase in perioperative morbidity, and may offer an potential alternative to ConvRT in patients with resectable RPS.

目的：术前放疗（RT）在腹膜后肉瘤（RPS）中的作用在组织学亚型中仍然存在争议。传统的分割RT （ConvRT）是目前的标准，但低分割RT （HypoRT）正在获得关注，特别是对于软组织肉瘤。本研究旨在比较HypoRT（10组分）与ConvRT治疗RPS患者的安全性和有效性。方法：我们回顾性分析了2017年至2024年间在一所高等教育机构接受术前RT和手术治疗的55例RPS患者。所有患者都接受了强度调节RT和同时集成的增强技术。HypoRT组（n=15）分为10组接受50/35 Gy治疗，ConvRT组（n=40）分为25组接受62.5/45 Gy治疗。我们评估了手术并发症（Clavien-Dindo分级≥3）和术后住院时间（≥14天）。结果：基线特征可比较。HypoRT没有增加≥3级并发症（33.3% vs. 25.0%, p=0.735）或住院时间（中位数，16 vs. 13天，p=0.684）。年龄越大并发症越严重（p=0.027），肿瘤越大、手术时间越长住院时间越长（p=0.018、p=0.024）。中位随访时间为33个月，3年局部无复发生存率（71.5% vs. 48.9%, p=0.329）、无进展生存率（59.3% vs. 44.4%, p=0.612）和总生存率（84.9% vs. 80.0%, p=0.578）组间具有可比性。结论：10份的HypoRT似乎是可行的，没有明显增加围手术期发病率，并且可能为可切除RPS患者提供一个潜在的替代方案。

{"title":"Safety and Efficacy of Hypofractionated Preoperative Radiotherapy in Retroperitoneal Sarcoma: A Comparative Study with Conventional Fractionation.","authors":"Jong Yun Baek, Jeong Il Yu, Kyo Won Lee, Jae Berm Park, Nalee Kim","doi":"10.1016/j.prro.2026.02.008","DOIUrl":"https://doi.org/10.1016/j.prro.2026.02.008","url":null,"abstract":"<p><strong>Purpose: </strong>The role of preoperative radiotherapy (RT) in retroperitoneal sarcoma (RPS) remains controversial across histological subtypes. Conventional fractionated RT (ConvRT) is the current standard, but hypofractionated RT (HypoRT) is gaining interest, particularly for soft tissue sarcomas. This study aimed to compare the safety and efficacy of HypoRT (10 fractions) with ConvRT in RPS patients.</p><p><strong>Methods: </strong>We retrospectively reviewed 55 patients with RPS who received preoperative RT followed by surgery at a single tertiary institution between 2017 and 2024. All patients underwent intensity-modulated RT with simultaneous integrated boost techniques. The HypoRT group (n=15) received 50/35 Gy in 10 fractions, and the ConvRT group (n=40) received 62.5/45 Gy in 25 fractions. We assessed surgical complications (Clavien-Dindo grade ≥3) and prolonged postoperative hospitalization (≥14 days).</p><p><strong>Results: </strong>Baseline characteristics were comparable. HypoRT did not increase grade ≥3 complications (33.3% vs. 25.0%, p=0.735) or hospital stay (median, 16 vs. 13 days; p=0.684). Older age was associated with severe complications (p=0.027), while larger tumors and longer operation time correlated with extended hospitalization (p=0.018 and p=0.024, respectively). With a median follow-up of 33 months, 3-year local recurrence-free survival (71.5% vs. 48.9%, p=0.329), progression-free survival (59.3% vs. 44.4%, p=0.612), and overall survival (84.9% vs. 80.0%, p=0.578) were comparable between groups.</p><p><strong>Conclusion: </strong>HypoRT in 10 fractions appears feasible, without an apparent increase in perioperative morbidity, and may offer an potential alternative to ConvRT in patients with resectable RPS.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328201","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

Lymph Node Management of Patients With Breast Cancer in the Era of Therapy De-escalation. 治疗降级时代乳腺癌患者的淋巴结管理。

IF 3.5 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2026-02-27 DOI: 10.1016/j.prro.2025.12.012

Melissa Mitchell, Taiwo Adesoye, Simona Shaitelman, Carlos Barcenas, Rosario Hwang

引用次数: 0

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