Practical Radiation Oncology最新文献

英文中文

Stereotactic Body Radiation Therapy for Oligoprogressive Pleural Mesothelioma: Fine-Tuning the Optimal Doses 立体定向体放射治疗少进展性胸膜间皮瘤：微调最佳剂量。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.05.004

There is growing evidence of a role of stereotactic body radiation therapy (SBRT) in the treatment of patients with oligoprogressive pleural mesothelioma (PM). The objective of this study was to investigate the optimal radiation therapy doses and schedules in this setting. The records of patients treated with SBRT (>5 Gy per fraction) for oligoprogression of PM at 2 institutions from June 2014 to September 2022 were reviewed. Patients were divided into 2 groups: “intermediate-dose” SBRT (i-SBRT; total dose, 30-36 Gy in 5-6 fractions) and “high-dose” SBRT (h-SBRT; total dose, 45-50 Gy in 4-8 fractions). The comparison between the 2 groups in terms of local control (LC) and toxicity was the primary endpoint of the study. Overall, 23 patients were treated for 25 pleural lesions. All had received upfront chemotherapy with platinum/pemetrexed. Fifteen patients were treated with i-SBRT and 8 patients with h-SBRT. The median equivalent dose was 40 Gy (range, 40-49.6) in the i-SBRT group and 74.46 Gy (range, 64-88) in the h-SBRT group. Six-month, 1-year, and 2-year LC were 100%, 100%, and 80% in the i-SBRT group and 100%, 100%, and 67% in the h-SBRT group, respectively (p =.94). Only 2 patients (1 for each dose group) had a recurrence in the radiation therapy field, both after experiencing a distant relapse. No severe acute and late toxicities were observed in the i-SBRT group, whereas in the h-SBRT group, 2 patients experienced G2 acute and late thoracic pain and 1 patient experienced G2 acute and G3 chronic thoracic pain. In our experience, SBRT is a safe and effective option for selected patients with oligoprogressive PM. Use of intermediate total doses keeping the dose per fraction high seems to offer an excellent LC, avoiding the risk of severe toxicity.

越来越多的证据表明，立体定向体放射治疗（SBRT）在治疗少进展性胸膜间皮瘤（PM）患者中发挥作用。本研究的目的是探讨这种情况下的最佳放射治疗剂量和计划。研究回顾了2014年6月至2022年9月期间在两家机构接受SBRT（每分> 5 Gy）治疗的少进展胸膜间皮瘤患者的记录。患者分为两组："中剂量 "SBRT（i-SBRT，总剂量30-36 Gy，分5-6次）和 "高剂量 "SBRT（h-SBRT，总剂量45-50 Gy，分4-8次）。研究的主要终点是比较两组患者的局部控制（LC）和毒性。共有 23 名患者接受了 25 例胸膜病变的治疗。所有患者都接受了铂/培美曲塞的前期化疗。15名患者接受了i-SBRT治疗，8名患者接受了h-SBRT治疗。i-SBRT组的中位当量剂量（EQD2）为40 Gy（范围40-49.6），h-SBRT组为74.46 Gy（范围64-88）。i-SBRT组6个月、1年和2年的LC分别为100%、100%和80%，h-SBRT组分别为100%、100%和67%（P=0.94）。只有两名患者（每个剂量组各一名）在RT区域内复发，均为远处复发。i-SBRT组未观察到严重的急性和晚期毒性反应，而h-SBRT组有2名患者出现G2急性和晚期胸痛，1名患者出现G2急性和G3慢性胸痛。根据我们的经验，SBRT 是一种安全有效的治疗方法，适用于选定的少进行性 PM 患者。使用中等总剂量，保持每分量的高剂量似乎提供了极佳的低密度脂蛋白胆固醇，避免了严重毒性的风险。

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引用次数: 0

PROshot: Intensity Modulated Radiation Therapy for Vulvar Cancer, Completion Axillary Dissection, Ultracentral Lung Radiation, Concurrent Chemotherapy for Endometrial cancer, and Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma PROshot：外阴癌的调强放射治疗、腋窝切除术、肺超中心放射治疗、子宫内膜癌的同期化疗以及食管鳞状细胞癌的新辅助治疗

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.08.001

Laura Dover , Caleb Dulaney

引用次数: 0

A Pilot Trial of Proton-Based Cardiac Sparing Accelerated Fractionated Radiation Therapy in Unresectable Non-small Cell Lung Cancer With Extended Durvalumab Therapy (PARTICLE-D) 基于质子的心脏疏导加速分次放射治疗不可切除非小细胞肺癌并延长 Durvalumab 治疗的试点试验 (PARTICLE-D)。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.007

Debora S. Bruno MD, MS , Carley Mitchell MD , Afshin Dowlati MD , Stephen Shamp MD , Pingfu Fu PhD , John Rindeau BS , Yiran Zheng PhD , Mitchell Machtay MD , Tithi Biswas MD

Purpose

Concurrent chemoradiation therapy is the current nonsurgical standard of care for locally advanced non-small cell lung cancer. However, this is a difficult regimen to tolerate, especially for those who are elderly, have multiple comorbidities, or have poor performance status. Alternative treatment regimens are needed for this vulnerable population. We report initial results of concurrent durvalumab, an immune checkpoint inhibitor, and hypofractionated, dose-escalating, proton external beam radiation therapy (EBRT).

Methods and Materials

This phase 1, pilot dose escalation trial enrolled 7 patients with newly diagnosed stage IIIA to IIIC non-small cell lung cancer and who were unable or unwilling to undergo concurrent chemoradiation therapy. Patients previously treated with immunotherapy were excluded. Five patients in this 3 + 3 study design received a fixed dose of durvalumab on day 1 of each 28-day cycle plus hypofractionated proton EBRT with initial dose of 60 Gy (Arm 1) in 20 fractions while 2 patients received the escalation dose of 69 Gy in 23 fractions (Arm 2). The primary objective was to assess safety and the secondary objective was to assess feasibility and adverse events.

Results

All patients experienced treatment-related adverse events, primarily grades 1 and 2. Pneumonitis and anemia were the most common. Only 1 dose-limiting toxicity occurred in arm 1, which was a grade 3 pneumonitis leading to grade 5 pneumonia. Additionally, 2 delayed-onset grade 5 tracheal necrosis events occurred >13 months after treatment initiation.

Conclusions

Concurrent durvalumab plus hypofractionated proton EBRT was well tolerated in the short term. However, 3 treatment-related deaths, including 2 delayed-onset grade 5 tracheal necroses negatively impacted overall safety. A dose de-escalation protocol of proton-based radiation therapy plus durvalumab is warranted.

目的：同期化放疗是目前治疗局部晚期非小细胞肺癌（NSCLC）的非手术标准疗法。然而，这种治疗方案很难耐受，尤其是对于老年人、有多种并发症或治疗效果不佳的患者。我们需要为这一易感人群提供替代治疗方案。我们报告了同时使用免疫检查点抑制剂durvalumab和低分次、剂量递增的质子体外放射治疗（EBRT）的初步结果：这项I期剂量递增试验招募了7名新确诊的IIIA-IIIC期NSCLC患者，这些患者无法或不愿同时接受化放疗。曾接受过免疫疗法治疗的患者被排除在外。在这项3+3研究设计的初始阶段，5名患者接受了固定剂量的durvalumab治疗，每28天为一个周期，外加低分量质子EBRT 60 Gy，20次分次治疗；2名患者接受了升级剂量69 Gy，23次分次治疗。首要目标是评估安全性，次要目标是评估可行性和不良事件：所有患者都出现了与治疗相关的不良事件，主要是 1-2 级。肺炎和贫血最为常见。只有一种剂量限制性毒性发生在第一组，即 3 级肺炎导致 5 级肺炎。此外，在开始治疗13个月后，发生了两例延迟发作的5级气管坏死事件：结论：同时使用durvalumab和低分量质子EBRT的短期耐受性良好。然而，三例治疗相关死亡（包括两例延迟发生的5级气管坏死）对总体安全性产生了负面影响。质子放疗加杜瓦鲁单抗的剂量递减方案是有必要的。

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引用次数: 0

In Regard to Tam et al. 关于 Tam 等人

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.04.026

Charlotte Rivers MD, Samuel Lewis Cooper MD, Bhishamjit Chera MD, FASTRO

引用次数: 0

Bronchiolitis Obliterans Organizing Pneumonia After Breast Radiation Therapy 乳腺放射治疗后的闭塞性支气管炎组织化肺炎（BOOP）。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.008

Mara Caroprese MD , Laura Cella MD , Angela Barillaro MD , Caterina Oliviero MD , Stefania Clemente MD , Pierpaolo Mainenti MD , Roberto Pacelli MD , Manuel Conson MD

Presented here is a case report of a 77-year-old woman affected by rheumatoid arthritis who underwent breast-conserving surgery followed by radiation therapy (RT) for left-breast cancer and developed bronchiolitis obliterans organizing pneumonia (BOOP) after RT and during a COVID-19 vaccination campaign. BOOP incidence is an uncommon morbidity after breast RT (1.2%-2.9%); however, specific predisposing factors can play a role. In this patient, both rheumatoid arthritis and the vaccine may have predisposed her to an increased risk of organizing pneumonia, probably by triggering a proinflammatory cascade. Our report highlights the importance of factors that influence the occurrence of uncommon radiation-induced morbidities, such as BOOP, in specific subsets of patients. Further studies are necessary to evaluate factors increasing radiation sensitivity.

本文报告了一例 77 岁类风湿性关节炎（RA）女性患者的病例，该患者因左乳腺癌接受了保乳手术，随后接受了放射治疗（RT），并在 RT 术后和接种 COVID-19 疫苗期间患上了阻塞性支气管炎组织化肺炎（BOOP）。BOOP的发病率在乳腺RT术后并不常见（1.2%-2.9%），但特定的易感因素可能起作用。在该患者中，RA 和疫苗可能会引发炎症级联反应，从而增加她患组织性肺炎的风险。我们的报告强调了影响辐射诱发的不常见疾病（如特定亚组患者的 BOOP）发生的因素的重要性。有必要开展进一步研究，以评估增加辐射敏感性的因素。

引用次数: 0

In Reply to Rivers et al. 答复里弗斯等人

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.07.011

Stephanie Yoon MD, MS, Andrew Tam MD, Yun Rose Li MD, PhD

引用次数: 0

Radiation Pneumonitis After Partial Breast Irradiation 乳房部分照射后的放射性肺炎

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.04.024

Abstract

This case presentation describes development of symptomatic radiation pneumonitis in a healthy woman who underwent partial breast irradiation with deep inspiration breath hold for early stage breast cancer meeting all published dose constraints. Risk factors for, diagnosis and management of radiation pneumonitis are discussed in detail. Radiation pneumonitis is rare, ranging from <1% to 1.5% (when regional nodal irradiation is included). Partial breast irradiation spares breast tissue, but may not spare lung tissue better than whole breast irradiation, depending upon treatment technique such as prone positioning. Dose constraints for normal and target structures from published trials are reviewed, however data specifically relating to pneumonitis in partial breast trials are limited.

本病例描述了一名健康女性因早期乳腺癌接受深吸气憋气乳房部分照射后，在符合所有已公布的剂量限制条件下，出现了无症状的放射性肺炎。文中详细讨论了放射性肺炎的风险因素、诊断和处理方法。放射性肺炎非常罕见，其范围从

引用次数: 0

Treatment Terminations During Radiation Therapy: A 10-Year Experience 放射治疗期间的治疗终止：十年经验

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.06.002

Purpose

Patients undergoing radiation therapy may terminate treatment for any number of reasons. The incidence of treatment termination (TT) during radiation therapy has not been studied. Herein, we present a cohort of TT at a large multicenter radiation oncology department over 10 years.

Methods and Materials

TTs between January 2013 and January 2023 were prospectively analyzed as part of an ongoing departmental quality and safety program. TT was defined as any premature discontinuation of therapy after initiating radiation planning. The rate of TT was calculated as a percentage of all patients starting radiation planning. All cases were presented at monthly morbidity and mortality conferences with a root cause reviewed.

Results

A total of 1448 TTs were identified out of 31,199 planned courses of care (4.6%). Six hundred eighty-six (47.4%) involved patients treated with curative intent, whereas 753 (52.0%) were treated with palliative intent, and 9 (0.6%) were treated for benign disease. The rate of TT decreased from 8.49% in 2013 to 3.02% in 2022, with rates decreasing yearly. The most common disease sites for TT were central nervous system (21.7%), head and neck (19.3%), thorax (17.5%), and bone (14.2%). The most common causes of TT were hospice and/or patient expiration (35.9%), patient choice unrelated to toxicity (35.2%), and clinician choice unrelated to toxicity (11.5%).

Conclusions

This 10-year prospective review of TTs identified a year-over-year decrease in TTs as a percentage of planned patients. This decrease may be associated with the addition of root cause reviews for TTs and discussions monthly at morbidity and mortality rounds, coupled with departmental upstream quality initiatives implemented over time. Understanding the reasons behind TTs may help decrease preventable TTs. Although some TTs may be unavoidable, open discourse and quality improvement changes effectively reduce TT incidents over time.

目的：接受放射治疗的患者可能会因各种原因终止治疗。关于放疗过程中治疗终止（TT）的发生率尚未进行研究。在此，我们介绍了一个大型多中心肿瘤放疗科 10 年来的治疗终止队列：我们对 2013 年 1 月 1 日至 2023 年 1 月 1 日期间的 TT 进行了前瞻性分析，这是科室质量与安全计划的一部分。TT定义为开始放射计划后任何过早中断治疗的情况。TT发生率按开始放射计划的所有患者的百分比计算。所有病例都在每月的发病率和死亡率（MM）会议上进行了病因审查（RCA）：结果：在 31199 个计划疗程中，共发现 1448 例 TT（4.6%）。其中有 686 例（47.4%）患者接受了治愈性治疗，753 例（52.0%）患者接受了姑息性治疗，9 例（0.6%）患者接受了良性疾病治疗。TT率从2013年的8.49%降至2022年的3.02%，且逐年下降。TT最常见的发病部位是中枢神经系统（21.7%）、H&N（19.3%）、胸部（17.5%）和骨骼（14.2%）。最常见的TT原因是临终关怀和/或患者过期（35.9%）、与毒性无关的患者选择（35.2%）以及与毒性无关的临床医生选择（11.5%）：这项为期 10 年的前瞻性 TT 回顾发现，TT 在计划患者中所占的比例逐年下降。这一下降可能与针对 TT 增加了 RCA 和每月在 MM 查房中进行讨论有关，也与随着时间推移实施的科室上游质量举措有关。了解 TT 背后的原因有助于减少可预防的 TT。虽然有些 TT 是不可避免的，但公开讨论和质量改进措施可有效减少 TT 事件的发生。

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引用次数: 0

Urinary Organs at Risk for Prostate Cancer External Beam Radiation Therapy: Contouring Guidelines on Behalf of the Francophone Group of Urological Radiation Therapy 前列腺癌体外放射治疗的危险泌尿器官：代表法语国家泌尿放射治疗小组（GFRU）制定的轮廓指引。

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.05.009

Purpose

The occurrence of genitourinary (GU) toxicity is a common adverse event observed after external beam radiation therapy (EBRT) for prostate cancer (PCa). Recent findings suggest that the dose delivered to specific urinary organs at risk (OARs) such as the ureters, bladder trigone, and urethra is involved in the development of GU toxicity.

Methods and Materials

A multidisciplinary task force including 3 radiation oncologists, a uroradiologist, and a urologist was created in 2022. First, OARs potentially involved in GU toxicity were identified and discussed. A literature review was performed, addressing several questions relative to urinary OARs: anatomic and radiological definition, radiation-induced injury, and dose-volume parameters. Second, results were presented and discussed with a panel of radiation oncologists and members of the “Francophone Group of Urological Radiation Therapy.” Thereafter, the “Francophone Group of Urological Radiation Therapy” experts were asked to answer a dedicated questionnaire, including 35 questions on the controversial issues related to the delineation of urinary OARs.

Results

The following structures were identified as critical for PCa EBRT: ureters, bladder, bladder neck, bladder trigone, urethra (intraprostatic, membranous, and spongious), striated sphincter, and postenucleation or posttransurethral resection of the prostate cavity. A consensus was obtained for 32 out of 35 items.

Conclusions

This consensus highlights contemporary urinary structures in both the upper and lower urinary tract to be considered for EBRT treatment planning of PCa. The current recommendations also propose a standardized definition of urinary OARs for both daily practice and future clinical trials.

目的：泌尿生殖系统（GU）毒性是前列腺癌（PCa）体外放射治疗（EBRT）后常见的不良反应。最新研究结果表明，输注到输尿管、膀胱三叉神经和尿道等特定泌尿系统危险器官（OAR）的剂量与泌尿系统毒性的发生有关：2022 年成立了一个多学科工作组，其中包括三名放射肿瘤专家、一名泌尿放射科专家和一名泌尿科专家。首先，确定并讨论了可能与 GU 毒性有关的 OAR。进行了文献综述，探讨了与泌尿系统 OARs 相关的几个问题：解剖学和放射学定义、辐射诱导的损伤、剂量-体积参数。其次，向 "法语国家泌尿放射治疗小组"（GFRU）成员组成的放射肿瘤专家小组介绍并讨论了结果。随后，法语泌尿放射治疗小组的专家们被要求回答一份专门的调查问卷，其中包括 35 个与泌尿系统 OAR 划分相关的争议问题：结果：以下结构被确定为 PCa EBRT 的关键结构：输尿管、膀胱、膀胱颈、膀胱三叉、尿道（膀胱内、膜性、海绵体）、横纹括约肌以及前列腺剜除术（TURP）后或经尿道前列腺切除术（TURP）后腔隙。在 35 个项目中，有 32 个已达成共识：结论：该共识强调了在 PCa 的 EBRT 治疗规划中应考虑的上下尿路的当代泌尿系统结构。目前的建议还为日常实践和未来的临床试验提出了泌尿系统 OAR 的标准化定义。

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Being an Oncologist—How I Evolved 作为一名肿瘤学家--我是如何进化的？

IF 3.4 3区医学 Q2 ONCOLOGY

Practical Radiation Oncology

Pub Date : 2024-11-01 DOI: 10.1016/j.prro.2024.03.002

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