Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.04.012
Samuel C. Zhang MD , Raymond H. Mak MD , Katelyn M. Atkins MD, PhD
{"title":"In Reply to Kelefi et al","authors":"Samuel C. Zhang MD , Raymond H. Mak MD , Katelyn M. Atkins MD, PhD","doi":"10.1016/j.prro.2025.04.012","DOIUrl":"10.1016/j.prro.2025.04.012","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages 634-635"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145398540","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.03.004
Pavnesh Kumar MD , Kyle Wu MD , Daniel Prevedello MD , Edward Dodson MD , Jana Ivanidze MD , Divya Yadav MD , Rituraj Upadhyay MD , Jonathan P.S. Knisely MD , Oliver Adunka MD , TaeLor Jones BS , Evan M. Thomas MD, PhD , Raju R. Raval MD, Dphil , Sasha Beyer MD, PhD , Bingfeng Tang MD , Joshua D. Palmer MD
Vestibular schwannomas (VSs) are benign tumors arising from vestibulocochlear nerve Schwann cells. Single or multifractional stereotactic radiation therapy (SRT) is commonly used for treatment of these tumors, and accurate target delineation is critical for the focused radiation delivery, maximizing tumor control while minimizing toxicity. Contrast-enhanced magnetic resonance imaging (MRI) is the gold standard for diagnosis, monitoring of VS and is critical in precise target delineation for SRT planning. Prostate specific membrane antigen (PSMA) positron emission tomography (PET) has established clinical utility for diagnosis and monitoring of prostate cancer. However, other central nervous system neoplasms, including VS, have also been found to be PSMA tracer avid. We present the first clinical use of PSMA PET for SRT in a patient with VS who was unable to undergo MRI.
{"title":"Prostate Specific Membrane Antigen Positron Emission Tomography in Management of Vestibular Schwannoma","authors":"Pavnesh Kumar MD , Kyle Wu MD , Daniel Prevedello MD , Edward Dodson MD , Jana Ivanidze MD , Divya Yadav MD , Rituraj Upadhyay MD , Jonathan P.S. Knisely MD , Oliver Adunka MD , TaeLor Jones BS , Evan M. Thomas MD, PhD , Raju R. Raval MD, Dphil , Sasha Beyer MD, PhD , Bingfeng Tang MD , Joshua D. Palmer MD","doi":"10.1016/j.prro.2025.03.004","DOIUrl":"10.1016/j.prro.2025.03.004","url":null,"abstract":"<div><div><span><span>Vestibular schwannomas<span> (VSs) are benign tumors arising from </span></span>vestibulocochlear nerve<span> Schwann cells. Single or multifractional </span></span>stereotactic radiation therapy<span><span><span> (SRT) is commonly used for treatment of these tumors, and accurate target delineation is critical for the focused radiation delivery, maximizing tumor control while minimizing toxicity. Contrast-enhanced magnetic resonance imaging (MRI) is the gold standard for diagnosis, monitoring of VS and is critical in precise target delineation for SRT planning<span>. Prostate specific membrane antigen (PSMA) </span></span>positron emission tomography<span> (PET) has established clinical utility for diagnosis and monitoring of prostate cancer<span>. However, other central nervous system neoplasms, including VS, have also been found to be PSMA </span></span></span>tracer avid. We present the first clinical use of PSMA PET for SRT in a patient with VS who was unable to undergo MRI.</span></div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages e540-e544"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674808","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}
<div><h3>Purpose</h3><div><span>This study aims to evaluate the primary endpoint of a phase 2 prospective trial, which included a patient cohort staged with 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (CT), treated with a combination of prostate high dose-rate brachytherapy and prostate/seminal vesicles external beam radiation therapy for intermediate and high-risk </span>prostate cancer.</div></div><div><h3>Methods and Materials</h3><div><span><span>Forty-one patients with unfavorable intermediate, high risk (HR), and very HR prostate cancer were recruited to receive a combination of hypofractionated external beam radiation therapy to the prostate ± </span>seminal vesicles<span><span> of 36 Gy (12 fractions of 3 Gy each) delivered in consecutive days, followed by single-fraction real-time high-dose-rate brachytherapy of 14 Gy. Patients also received risk-adjusted androgen deprivation therapy<span> (ADT). All patients were primarily conventionally staged with prostate multiparametric magnetic resonance imaging, abdomen/pelvis </span></span>CT<span>, and bone scintigraphy, receiving an additional prostate-specific membrane antigen positron emission tomography/CT before their study inclusion. </span></span></span>Urinary<span><span>, gastrointestinal symptomatology, sexual potency and acute, as well as early late toxicity, were assessed using various questionnaires (International Prostate Symptom Score, International Index for Erectile Function, Extended Prostate cancer Index Composite for Clinical Practice, Radiation Therapy </span>Oncology Group/European Organization for Research and Treatment of Cancer).</span></div></div><div><h3>Results</h3><div><span>Forty-one patients (based on National Comprehensive Cancer Network stratification system 48.8% unfavorable intermediate, 43.9% HR, and 7.3% very HR) completed treatment and reached at least 12 months of follow-up at the time of the current analysis. Median follow-up was 20 months (IQR, 13-28). Median age was 71.7 years, median prostate specific antigen<span> before treatment was 8.4 ng/mL (5.0-28.3), and median volume of the prostate was 36.6 cc (14.9-68.2). Short-term ADT was administered to 43.9% of patients, whereas 48.8% received long-term ADT; the rest of the patients did not receive hormonal therapy. No severe (grade ≥3) acute events were recorded. An increase was observed in the prevalence of grade 2 genitourinary toxicity, owed mainly to </span></span>nocturia<span> (2.4% at 3 months, 4.9% at 6 months, and 26.8% at 12 months), with grade 1 remaining stable over this period. Regarding gastrointestinal toxicity, grade 1 and 2 incidences remained low and almost unchanged over this time interval. A significant decline from baseline compared to 3 months post treatment was observed both in hormonal and sexual domains, with high severity exhibited as a worsening from 12% to 38% and from 0% to 5%, respectively. No other domains exhibited any significant
{"title":"Combined Hypofractionated Radiation Therapy and Brachytherapy for Managing Prostate-Specific Membrane Antigen Positron Emission Tomography-Staged Organ-Confined Prostate Cancer: Primary Endpoint Analysis of a Prospective Study","authors":"Iosif Strouthos MD, PhD , Efstratios Karagiannis MD, PhD , Georgios Antorkas MSc , Yiannis Roussakis MSc, PhD , Constantina Cloconi PhD , Antria Savva MSc , Andreas Christoforou MSc , Alexis Vrachimis MD, PhD , Constantinos Zamboglou MD, PhD , Konstantinos Ferentinos MD, PhD","doi":"10.1016/j.prro.2025.03.013","DOIUrl":"10.1016/j.prro.2025.03.013","url":null,"abstract":"<div><h3>Purpose</h3><div><span>This study aims to evaluate the primary endpoint of a phase 2 prospective trial, which included a patient cohort staged with 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (CT), treated with a combination of prostate high dose-rate brachytherapy and prostate/seminal vesicles external beam radiation therapy for intermediate and high-risk </span>prostate cancer.</div></div><div><h3>Methods and Materials</h3><div><span><span>Forty-one patients with unfavorable intermediate, high risk (HR), and very HR prostate cancer were recruited to receive a combination of hypofractionated external beam radiation therapy to the prostate ± </span>seminal vesicles<span><span> of 36 Gy (12 fractions of 3 Gy each) delivered in consecutive days, followed by single-fraction real-time high-dose-rate brachytherapy of 14 Gy. Patients also received risk-adjusted androgen deprivation therapy<span> (ADT). All patients were primarily conventionally staged with prostate multiparametric magnetic resonance imaging, abdomen/pelvis </span></span>CT<span>, and bone scintigraphy, receiving an additional prostate-specific membrane antigen positron emission tomography/CT before their study inclusion. </span></span></span>Urinary<span><span>, gastrointestinal symptomatology, sexual potency and acute, as well as early late toxicity, were assessed using various questionnaires (International Prostate Symptom Score, International Index for Erectile Function, Extended Prostate cancer Index Composite for Clinical Practice, Radiation Therapy </span>Oncology Group/European Organization for Research and Treatment of Cancer).</span></div></div><div><h3>Results</h3><div><span>Forty-one patients (based on National Comprehensive Cancer Network stratification system 48.8% unfavorable intermediate, 43.9% HR, and 7.3% very HR) completed treatment and reached at least 12 months of follow-up at the time of the current analysis. Median follow-up was 20 months (IQR, 13-28). Median age was 71.7 years, median prostate specific antigen<span> before treatment was 8.4 ng/mL (5.0-28.3), and median volume of the prostate was 36.6 cc (14.9-68.2). Short-term ADT was administered to 43.9% of patients, whereas 48.8% received long-term ADT; the rest of the patients did not receive hormonal therapy. No severe (grade ≥3) acute events were recorded. An increase was observed in the prevalence of grade 2 genitourinary toxicity, owed mainly to </span></span>nocturia<span> (2.4% at 3 months, 4.9% at 6 months, and 26.8% at 12 months), with grade 1 remaining stable over this period. Regarding gastrointestinal toxicity, grade 1 and 2 incidences remained low and almost unchanged over this time interval. A significant decline from baseline compared to 3 months post treatment was observed both in hormonal and sexual domains, with high severity exhibited as a worsening from 12% to 38% and from 0% to 5%, respectively. No other domains exhibited any significant","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages e606-e616"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334422","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}
We hypothesized that online adaptive radiation therapy (oART) could eliminate errors associated with interfractional deformation in gastric mucosa-associated lymphoid tissue (MALT) lymphoma, but errors in intrafractional deformation remained in 6 directions (anterior, posterior, superior, inferior, left, and right). This study aimed to quantify the anisotropic deformation errors of the clinical target volume (CTV) for MALT lymphoma using oART to determine deformations in the planning target volume (PTV) margins.
Methods and Materials
Thirty fractional scans from 4 consecutive patients (a total of 120 cone beam computed tomography scans) with gastric MALT lymphoma treated with oART were chosen for this retrospective study. The CTV contours were manually delineated on the pretreatment and posttreatment cone beam computed tomography images. The center-of-mass matching of the CTVs was performed following the bone anatomy matching. Systematic and random errors of intrafractional deformations of the CTV were quantified using displacement vectors between the pretreatment and posttreatment CTV surfaces for each fraction. The PTV margins for oART were anisotropically calculated using the van Herk formula: 2.5Σ + 0.7σ, accounting for intrafractional errors.
Results
For intrafractional deformation, the means of standard deviations of systematic errors ranged from 1.2 mm to 2.2 mm, whereas those of random errors ranged from 2.9 mm to 3.6 mm. The PTV margins were up to 13.1 mm in the inferior direction, whereas in other directions, they ranged from 9.7 mm to 12.8 mm. The PTV margin in integer achieved posttreatment CTV coverage for 90% of the fractions, with undercoverage volumes remaining below 0.6 cm3 in all fractions.
Conclusions
This study suggests that the impact of intrafractional CTV deformation can not be eliminated even with oART. This highlights the need to set the appropriate anisotropic PTV margins.
目的：我们假设在线适应性放疗（oART）可以消除胃粘膜相关淋巴组织（MALT）淋巴瘤中与分数间变形相关的误差，但分数内变形的误差仍然存在于六个方向（前、后、上、下、左、右）。本研究旨在量化MALT淋巴瘤临床靶体积（CTV）的各向异性变形误差，使用oART来确定规划靶体积（PTV）边缘的变形。方法和材料：本回顾性研究选择了连续4例经oART治疗的胃MALT淋巴瘤患者的30次分段扫描（共120次锥束计算机断层扫描（CBCT））。在处理前和处理后的CBCT图像上手工绘制CTV轮廓。骨解剖匹配后进行ctv的质心匹配。利用每个分数处理前和处理后的CTV表面之间的位移矢量量化CTV分数内变形的系统和随机误差。oART的PTV边际使用van Herk公式进行各向异性计算：2.5Σ+0.7σ，考虑分数内误差。结果：对于分数内变形，系统误差的标准差均值为1.2 mm ~ 2.2 mm，随机误差的标准差均值为2.9 mm ~ 3.6 mm。下向PTV边缘最大13.1 mm，其他方向PTV边缘在9.7 ~ 12.8 mm之间。整型PTV余量在90%的馏分中实现了处理后CTV覆盖，所有馏分的未覆盖体积均保持在0.6 cm³以下。结论：本研究提示，即使采用oART，仍不能消除分数段内CTV变形对oART误差的影响。这突出了设置适当的各向异性PTV边界的必要性。
{"title":"Can Online Adaptive Radiation Therapy Eliminate Intrafractional Deformation in Gastric Mucosa-Associated Lymphoid Tissue Lymphoma?","authors":"Yusuke Shibayama MS , Hidetaka Arimura PhD , Taka-aki Hirose PhD , Masanori Takaki MD , Jun-ichi Fukunaga BS , Tadamasa Yoshitake MD, PhD , Toyoyuki Kato BS , Kousei Ishigami MD, PhD","doi":"10.1016/j.prro.2025.05.008","DOIUrl":"10.1016/j.prro.2025.05.008","url":null,"abstract":"<div><h3>Purpose</h3><div>We hypothesized that online adaptive radiation therapy (oART) could eliminate errors associated with interfractional deformation in gastric mucosa-associated lymphoid tissue (MALT) lymphoma, but errors in intrafractional deformation remained in 6 directions (anterior, posterior, superior, inferior, left, and right). This study aimed to quantify the anisotropic deformation errors of the clinical target volume (CTV) for MALT lymphoma using oART to determine deformations in the planning target volume (PTV) margins.</div></div><div><h3>Methods and Materials</h3><div>Thirty fractional scans from 4 consecutive patients (a total of 120 cone beam computed tomography scans) with gastric MALT lymphoma treated with oART were chosen for this retrospective study. The CTV contours were manually delineated on the pretreatment and posttreatment cone beam computed tomography images. The center-of-mass matching of the CTVs was performed following the bone anatomy matching. Systematic and random errors of intrafractional deformations of the CTV were quantified using displacement vectors between the pretreatment and posttreatment CTV surfaces for each fraction. The PTV margins for oART were anisotropically calculated using the van Herk formula: 2.5Σ + 0.7σ, accounting for intrafractional errors.</div></div><div><h3>Results</h3><div>For intrafractional deformation, the means of standard deviations of systematic errors ranged from 1.2 mm to 2.2 mm, whereas those of random errors ranged from 2.9 mm to 3.6 mm. The PTV margins were up to 13.1 mm in the inferior direction, whereas in other directions, they ranged from 9.7 mm to 12.8 mm. The PTV margin in integer achieved posttreatment CTV coverage for 90% of the fractions, with undercoverage volumes remaining below 0.6 cm<sup>3</sup> in all fractions.</div></div><div><h3>Conclusions</h3><div>This study suggests that the impact of intrafractional CTV deformation can not be eliminated even with oART. This highlights the need to set the appropriate anisotropic PTV margins.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages e621-e633"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276660","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.03.010
Sedra Mohammadi MD , Isabella R. Pompa BA , Veronica Haberman , Bashar Kako MD , Richard J. Lee MD, PhD , Philip J. Saylor MD , Xin Gao MD , Shadi A. Esfahani MD, MPH , Pedram Heidari MD , Praful Ravi MB, BChir, MRCP , Mutlay Sayan MD , Jason A. Efstathiou MD, DPhil , Heather A. Jacene MD , Sophia C. Kamran MD , Thomas S.C. Ng MD, PhD
Purpose
177Lu-PSMA-617 (LuPSMA) is an effective radiopharmaceutical therapy for patients with metastatic castration-resistant prostate cancer. While LuPSMA can treat disseminated disease, additional localized control of metastatic disease may be required. Metastasis-targeted external beam radiation therapy (M-EBRT) can be an effective adjunct. However, the indications, efficacy, and safety/toxicity of combining M-EBRT with LuPSMA are unclear. Here, we report our experience with M-EBRT in patients receiving LuPSMA and assess M-EBRT’s ability for local disease control and palliation.
Methods and Materials
This retrospective institutional review board-exempted study reviewed patients treated with LuPSMA at a multi-institutional academic cancer center within the first 2 years after United States Food and Drug Administration’s approval, receiving contemporaneous M-EBRT. Clinical factors driving the use of M-EBRT were analyzed.
Results
Treatment courses of 261 patients receiving LuPSMA were reviewed; 52 patients received M-EBRT contemporaneously. M-EBRT was administered for intracranial/epidural disease (n = 22/52; 42%), bone pain palliation (n = 17/52; 33%), prevention of pathological fractures (n = 12/52; 23%), and 12% (n = 6/52) for various other indications. M-EBRT timing varied among patients, with 54% (n = 28/52) receiving M-EBRT before, 27% (n = 14/52) after, and 13% (n = 7/52) during LuPSMA therapy. EBRT was mostly well tolerated, although lymphopenia was commonly experienced. Most patients (n = 32/52; 62%) had symptom relief following M-EBRT. Symptom relief post–M-EBRT was 68%, 85%, and 50%, and mortality rates were 32%, 29%, and 57% for patients receiving EBRT before, during, and after LuPSMA treatment, respectively, albeit not statistically significant (P > .23). Prostate-specific antigen (PSA)50 (decrease in PSA by 50% during treatment) response in this patient population was 41% compared with 50% in the general LuPSMA population, but the magnitude of PSA response was heterogeneous (P = .27).
Conclusions
In our experience, M-EBRT was used effectively with LuPSMA therapy for local tumor control and symptom management, especially for localized osseous and central nervous system lesions, and with good tolerability. M-EBRT may be an important adjunct treatment modality that facilitates the initiation and/or continuation of LuPSMA.
{"title":"Combination Metastasis-Targeted External Beam Radiation Therapy With 177Lu-PSMA-617 in Patients With Advanced Castration-Resistant Prostate Cancer","authors":"Sedra Mohammadi MD , Isabella R. Pompa BA , Veronica Haberman , Bashar Kako MD , Richard J. Lee MD, PhD , Philip J. Saylor MD , Xin Gao MD , Shadi A. Esfahani MD, MPH , Pedram Heidari MD , Praful Ravi MB, BChir, MRCP , Mutlay Sayan MD , Jason A. Efstathiou MD, DPhil , Heather A. Jacene MD , Sophia C. Kamran MD , Thomas S.C. Ng MD, PhD","doi":"10.1016/j.prro.2025.03.010","DOIUrl":"10.1016/j.prro.2025.03.010","url":null,"abstract":"<div><h3>Purpose</h3><div><sup>177</sup><span>Lu-PSMA-617 (LuPSMA) is an effective radiopharmaceutical<span><span><span><span> therapy for patients with metastatic castration-resistant prostate cancer. While LuPSMA can treat disseminated disease, additional localized control of </span>metastatic disease may be required. Metastasis-targeted </span>external beam radiation therapy (M-EBRT) can be an effective adjunct. However, the indications, efficacy, and safety/toxicity of combining M-EBRT with LuPSMA are unclear. Here, we report our experience with M-EBRT in patients receiving LuPSMA and assess M-EBRT’s ability for local disease control and </span>palliation.</span></span></div></div><div><h3>Methods and Materials</h3><div>This retrospective institutional review board-exempted study reviewed patients treated with LuPSMA at a multi-institutional academic cancer center within the first 2 years after United States Food and Drug Administration’s approval, receiving contemporaneous M-EBRT. Clinical factors driving the use of M-EBRT were analyzed.</div></div><div><h3>Results</h3><div><span><span>Treatment courses of 261 patients receiving LuPSMA were reviewed; 52 patients received M-EBRT contemporaneously. M-EBRT was administered for intracranial/epidural disease (n = 22/52; 42%), bone pain palliation (n = 17/52; 33%), prevention of pathological fractures (n = 12/52; 23%), and 12% (n = 6/52) for various other indications. M-EBRT timing varied among patients, with 54% (n = 28/52) receiving M-EBRT before, 27% (n = 14/52) after, and 13% (n = 7/52) during LuPSMA therapy. EBRT was mostly well tolerated, although </span>lymphopenia<span> was commonly experienced. Most patients (n = 32/52; 62%) had symptom relief following M-EBRT. Symptom relief post–M-EBRT was 68%, 85%, and 50%, and mortality rates were 32%, 29%, and 57% for patients receiving EBRT before, during, and after LuPSMA treatment, respectively, albeit not statistically significant (</span></span><em>P</em><span> > .23). Prostate-specific antigen (PSA)50 (decrease in PSA by 50% during treatment) response in this patient population was 41% compared with 50% in the general LuPSMA population, but the magnitude of PSA response was heterogeneous (</span><em>P</em> = .27).</div></div><div><h3>Conclusions</h3><div>In our experience, M-EBRT was used effectively with LuPSMA therapy for local tumor control and symptom management, especially for localized osseous and central nervous system<span> lesions, and with good tolerability. M-EBRT may be an important adjunct treatment modality that facilitates the initiation and/or continuation of LuPSMA.</span></div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages e597-e605"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060600","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.05.004
Vérane Achard MD , Hoda Abdel-Aty MD , Victor Duque-Santana MD , Marko Bebek MD , Tiuri E. Kroese MD , Miha Orazem MD , Piet Dirix MD , Piet Ost MD , Andrea Lancia MD
Purpose
This review aims to evaluate the efficacy and safety of combining immune checkpoint inhibitors (ICI) with RT in the treatment of non-metastatic MIBC, focusing on neoadjuvant and bladder preservation strategies.
Methods and Materials
A systematic literature review was conducted from January 2000 to December 2023 using PubMed and Clinicaltrials.gov databases. Studies investigating outcomes after combining immunotherapy with RT for non-metastatic MIBC were selected. Data extraction included study identifiers, patient characteristics, intervention and control arm details, and primary outcomes.
Results
Among 28 selected studies, diverse approaches were observed, including neoadjuvant and bladder preservation strategies. Neoadjuvant trials, such as RACE IT, explored the feasibility of combining ICI with RT before radical cystectomy, showing promising efficacy and safety outcomes. In bladder preservation strategies, completed as well as ongoing trials demonstrated acceptable toxicity profiles and promising early efficacy data for combining ICI with chemoradiotherapy or RT alone.
Conclusions
Combining ICI with RT holds significant promise as a treatment strategy for non-metastatic MIBC. Preliminary evidence suggests favorable efficacy and safety profiles, supporting further exploration and potential integration into standard care. Ongoing phase III trials will provide crucial insights into the comparative effectiveness of adding ICI to conventional definitive treatments. In the evolving landscape of MIBC management, the combination of ICI and RT has the potential to reshape therapeutic paradigms and improve outcomes for patients.
{"title":"Combining Radiation Therapy With Immune Checkpoint Inhibitors for the Management of Muscle-Invasive Bladder Cancer: A Comprehensive Systematic Review From the Y-ECI ROSC EORTC Group","authors":"Vérane Achard MD , Hoda Abdel-Aty MD , Victor Duque-Santana MD , Marko Bebek MD , Tiuri E. Kroese MD , Miha Orazem MD , Piet Dirix MD , Piet Ost MD , Andrea Lancia MD","doi":"10.1016/j.prro.2025.05.004","DOIUrl":"10.1016/j.prro.2025.05.004","url":null,"abstract":"<div><h3>Purpose</h3><div><span>This review aims to evaluate the efficacy and safety of combining immune checkpoint inhibitors (ICI) with RT in the treatment of non-metastatic </span>MIBC<span>, focusing on neoadjuvant and bladder preservation strategies.</span></div></div><div><h3>Methods and Materials</h3><div><span>A systematic literature review was conducted from January 2000 to December 2023 using PubMed and Clinicaltrials.gov databases. Studies investigating outcomes after combining </span>immunotherapy<span> with RT for non-metastatic MIBC<span> were selected. Data extraction included study identifiers, patient characteristics, intervention and control arm details, and primary outcomes.</span></span></div></div><div><h3>Results</h3><div><span>Among 28 selected studies, diverse approaches were observed, including neoadjuvant and bladder preservation strategies. Neoadjuvant trials, such as RACE<span> IT, explored the feasibility of combining ICI with RT before radical cystectomy, showing promising efficacy and safety outcomes. In bladder preservation strategies, completed as well as ongoing trials demonstrated acceptable toxicity profiles and promising early efficacy data for combining ICI with </span></span>chemoradiotherapy or RT alone.</div></div><div><h3>Conclusions</h3><div>Combining ICI with RT holds significant promise as a treatment strategy for non-metastatic MIBC. Preliminary evidence suggests favorable efficacy and safety profiles, supporting further exploration and potential integration into standard care. Ongoing phase III trials will provide crucial insights into the comparative effectiveness of adding ICI to conventional definitive treatments. In the evolving landscape of MIBC management, the combination of ICI and RT has the potential to reshape therapeutic paradigms and improve outcomes for patients.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages 610-624"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144292","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.06.010
Omer Gal MD , Jonathan T. Yang MD, PhD , Rupesh Kotecha MD
{"title":"Current Status of Proton Craniospinal Irradiation for Solid Tumor Leptomeningeal Disease","authors":"Omer Gal MD , Jonathan T. Yang MD, PhD , Rupesh Kotecha MD","doi":"10.1016/j.prro.2025.06.010","DOIUrl":"10.1016/j.prro.2025.06.010","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages 524-527"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769306","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.09.005
Shinya Neri, Masashi Nozue, Katsumasa Nakamura
Stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer achieves excellent local control but may cause radiation pneumonitis in uninvolved lung segments. Conventional SBRT planning using ring-shaped optimization structures enhances conformity but disregards segmental anatomy, allowing low-dose spillage into adjacent intact lung. We developed Segment-targeted Precision Ablative Radiotherapy with Exact delivery (SPARE), an anatomically-guided SBRT technique that confines radiation exposure to the tumor-bearing bronchopulmonary segment, essentially performing a "radiation segmentectomy." SPARE integrates three complementary strategies: segment-specific beam orientation that avoids adjacent uninvolved segments, optimization constraints that penalize dose to neighboring segments, and high-gradient dose shaping with Monte Carlo or Acuros calculation for precision near tissue interfaces. The tumor-bearing segment is identified using high-resolution CT to trace bronchial branches and vascular landmarks, defining natural intersegmental boundaries. A representative case of left upper lobe adenocarcinoma located in the S1+2b subsegment treated with 56 Gy in 4 fractions demonstrated successful dose confinement to the target segment while sparing adjacent S3. Grade 1 radiation pneumonitis at 4 months was localized exclusively to the treated subsegment, with compensatory expansion observed in uninvolved areas, confirming predictable toxicity localization. SPARE offers functional preservation through anatomically-guided dose containment, transforms diffuse lung injury into localized injury, and enables safer retreatment situations. This technique is executable with standard SBRT equipment and compatible with conventional fractionation schemes. This concept extends beyond lung to other segmented organs like liver and kidney, where anatomical units can be targeted while preserving overall organ function. SPARE represents a paradigm shift in SBRT planning that aligns radiation therapy with surgical principles of anatomical preservation while maintaining oncologic efficacy.
{"title":"Segment-Targeted Precision Ablative Radiation Therapy With Exact Delivery (SPARE): A Novel Anatomically Guided Stereotactic Body Radiation Therapy Technique.","authors":"Shinya Neri, Masashi Nozue, Katsumasa Nakamura","doi":"10.1016/j.prro.2025.09.005","DOIUrl":"10.1016/j.prro.2025.09.005","url":null,"abstract":"<p><p>Stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer achieves excellent local control but may cause radiation pneumonitis in uninvolved lung segments. Conventional SBRT planning using ring-shaped optimization structures enhances conformity but disregards segmental anatomy, allowing low-dose spillage into adjacent intact lung. We developed Segment-targeted Precision Ablative Radiotherapy with Exact delivery (SPARE), an anatomically-guided SBRT technique that confines radiation exposure to the tumor-bearing bronchopulmonary segment, essentially performing a \"radiation segmentectomy.\" SPARE integrates three complementary strategies: segment-specific beam orientation that avoids adjacent uninvolved segments, optimization constraints that penalize dose to neighboring segments, and high-gradient dose shaping with Monte Carlo or Acuros calculation for precision near tissue interfaces. The tumor-bearing segment is identified using high-resolution CT to trace bronchial branches and vascular landmarks, defining natural intersegmental boundaries. A representative case of left upper lobe adenocarcinoma located in the S1+2b subsegment treated with 56 Gy in 4 fractions demonstrated successful dose confinement to the target segment while sparing adjacent S3. Grade 1 radiation pneumonitis at 4 months was localized exclusively to the treated subsegment, with compensatory expansion observed in uninvolved areas, confirming predictable toxicity localization. SPARE offers functional preservation through anatomically-guided dose containment, transforms diffuse lung injury into localized injury, and enables safer retreatment situations. This technique is executable with standard SBRT equipment and compatible with conventional fractionation schemes. This concept extends beyond lung to other segmented organs like liver and kidney, where anatomical units can be targeted while preserving overall organ function. SPARE represents a paradigm shift in SBRT planning that aligns radiation therapy with surgical principles of anatomical preservation while maintaining oncologic efficacy.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433188","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.05.012
Savino Cilla PhD , Carmela Romano PhD , Gabriella Macchia MD , Donato Pezzulla MD , Marica Ferro MD , Pietro Viola RTT , Erika Galietta MD , Costanza M. Donati MD , Alessio G. Morganti MD , Francesco Deodato MD
Accurate tumor and organ-at-risk contouring is a critical step in radiation therapy. Contouring procedures, both manual and automated, are prone to errors and to a large degree of interobserver and intraobserver variability. Radiation oncologists and/or medical physicists have to perform independent reviews of all contours for each patient before using them for treatment planning, which is a time-consuming, labor-intensive, and still not error-free process. We presented the tracing of a subtle near-miss event because of the presence of a random outlier in the contours of a lung tumor, very far from the actual gross tumor volume. The treatment plan was performed with an automated treatment engine using the volumetric-modulated arc therapy technique. Despite the implementation and adoption of systematic procedures of quality assurance in our clinical routine, the error crossed the barriers of peer review and was identified subsequently only in the step of pretreatment dosimetric verification. The error was corrected, and the patient was replanned before treatment initiation. In this case study, we showed that the random creation of false-positive target outliers may have a detrimental impact on patient dose when automated planning is performed. This risk is not negligible, and all strategies for improving the robustness of target segmentation should be pursued.
{"title":"Near-miss Event in Lung Cancer Radiation Therapy Because of a Random Outlier of Target Volume","authors":"Savino Cilla PhD , Carmela Romano PhD , Gabriella Macchia MD , Donato Pezzulla MD , Marica Ferro MD , Pietro Viola RTT , Erika Galietta MD , Costanza M. Donati MD , Alessio G. Morganti MD , Francesco Deodato MD","doi":"10.1016/j.prro.2025.05.012","DOIUrl":"10.1016/j.prro.2025.05.012","url":null,"abstract":"<div><div><span>Accurate tumor and organ-at-risk contouring is a critical step in radiation therapy. Contouring procedures, both manual and automated, are prone to errors and to a large degree of interobserver and intraobserver variability. Radiation oncologists and/or </span>medical physicists have to perform independent reviews of all contours for each patient before using them for treatment planning, which is a time-consuming, labor-intensive, and still not error-free process. We presented the tracing of a subtle near-miss event because of the presence of a random outlier in the contours of a lung tumor, very far from the actual gross tumor volume. The treatment plan was performed with an automated treatment engine using the volumetric-modulated arc therapy technique. Despite the implementation and adoption of systematic procedures of quality assurance in our clinical routine, the error crossed the barriers of peer review and was identified subsequently only in the step of pretreatment dosimetric verification. The error was corrected, and the patient was replanned before treatment initiation. In this case study, we showed that the random creation of false-positive target outliers may have a detrimental impact on patient dose when automated planning is performed. This risk is not negligible, and all strategies for improving the robustness of target segmentation should be pursued.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages 533-539"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295290","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}
Pub Date : 2025-11-01DOI: 10.1016/j.prro.2025.04.008
Samantha Skubish MS, RTRT , Shaun Caldwell EdD, RTRT , Sandra Hayden MA, RTT , Melissa Culp MEd , John Culbertson MA, MEd , Jason Paisley MS DABR , Sheryl Green MBBCh , Nora Uricchio MEd, RTRT
Purpose
In 2023, the American Society of Radiologic Technologists and the American Registry of Radiologic Technologists conducted a Professional Workforce Survey to define current and assess future practices of radiation therapists. The survey focused on the evolving role of radiation therapists, amid staffing constraints and advancements in radiation oncology technologies, exploring clinical duties, knowledge levels, comfort with specific tasks, and the call for advanced practice roles.
Methods and Materials
In October 2023, the American Registry of Radiologic Technologists sent 14,822 survey invitations to certified radiation therapists, using a questionnaire based on the American Society of Radiologic Technologists’ 2016 pilot survey and current trends in technology and practice. By November 2023, 403 responses were received, resulting in a 2.7% response rate. With an estimated 23,000 radiation therapists, the sample size of 403 provides a ±4.8% margin of error at a 95% confidence level.
Results
The survey identifies areas where radiation therapist’s excel with high knowledge, comfort, and low supervision while highlighting opportunities to strengthen clinical and technical skills to meet evolving technology and standards. It emphasized the need to define advanced practice roles (advanced practice radiation therapist) for radiation therapists to improve care delivery, address staffing shortages, and provide career growth. Expanding radiation therapy’s scope in research and care coordination could help fill gaps, alleviate workforce challenges, and improve outcomes.
Conclusions
The findings suggest that the future of radiation therapy practice lies in maximizing the potential of radiation therapists, with additional development needed to define new clinical career pathways and improve patient outcomes. Further research and resources are necessary to establish evidence-based models that leverage radiation therapists' expertise to the level of advanced practice.
目的：2023年，美国放射技师协会（ASRT）和美国放射技师注册协会（ARRT）进行了一项专业劳动力调查，以定义当前和评估放射治疗师的未来实践。该调查主要关注放射治疗师在人员配备限制和放射肿瘤学技术进步的背景下角色的演变，探索临床职责、知识水平、对特定任务的适应程度以及对高级实践角色的需求。方法和材料：2023年10月，美国放射技师注册协会（American Registry of Radiologic Technologists， ARRT）使用基于ASRT 2016年试点调查和当前技术和实践趋势的问卷，向认证放射治疗师发送了14,822份调查邀请17。截至2023年11月，收到403份回复，回复率为2.7%。估计有23,000名放射治疗师，403名的样本容量在95%的置信水平上提供了±4.8%的误差范围。结果：该调查确定了放射治疗师擅长的领域，具有高知识，舒适和低监管，同时强调了加强临床和技术技能以满足不断发展的技术和标准的机会。它强调需要为放射治疗师定义高级实践角色（APRT），以改善护理服务，解决人员短缺问题，并提供职业发展。扩大RT在研究和护理协调方面的范围有助于填补空白，缓解劳动力挑战，并改善结果。结论：研究结果表明，放射治疗实践的未来在于最大限度地发挥放射治疗师的潜力，需要进一步发展以定义新的临床职业道路并改善患者预后。需要进一步的研究和资源来建立基于证据的模型，以利用放射治疗师的专业知识达到高级实践的水平。
{"title":"The Current and Future State of Radiation Therapy Practice—An Analysis of the Professional Workforce Survey","authors":"Samantha Skubish MS, RTRT , Shaun Caldwell EdD, RTRT , Sandra Hayden MA, RTT , Melissa Culp MEd , John Culbertson MA, MEd , Jason Paisley MS DABR , Sheryl Green MBBCh , Nora Uricchio MEd, RTRT","doi":"10.1016/j.prro.2025.04.008","DOIUrl":"10.1016/j.prro.2025.04.008","url":null,"abstract":"<div><h3>Purpose</h3><div>In 2023, the American Society of Radiologic Technologists and the American Registry of Radiologic Technologists conducted a Professional Workforce Survey to define current and assess future practices of radiation therapists. The survey focused on the evolving role of radiation therapists, amid staffing constraints and advancements in radiation oncology technologies, exploring clinical duties, knowledge levels, comfort with specific tasks, and the call for advanced practice roles.</div></div><div><h3>Methods and Materials</h3><div>In October 2023, the American Registry of Radiologic Technologists sent 14,822 survey invitations to certified radiation therapists, using a questionnaire based on the American Society of Radiologic Technologists’ 2016 pilot survey and current trends in technology and practice. By November 2023, 403 responses were received, resulting in a 2.7% response rate. With an estimated 23,000 radiation therapists, the sample size of 403 provides a ±4.8% margin of error at a 95% confidence level.</div></div><div><h3>Results</h3><div>The survey identifies areas where radiation therapist’s excel with high knowledge, comfort, and low supervision while highlighting opportunities to strengthen clinical and technical skills to meet evolving technology and standards. It emphasized the need to define advanced practice roles (advanced practice radiation therapist) for radiation therapists to improve care delivery, address staffing shortages, and provide career growth. Expanding radiation therapy’s scope in research and care coordination could help fill gaps, alleviate workforce challenges, and improve outcomes.</div></div><div><h3>Conclusions</h3><div>The findings suggest that the future of radiation therapy practice lies in maximizing the potential of radiation therapists, with additional development needed to define new clinical career pathways and improve patient outcomes. Further research and resources are necessary to establish evidence-based models that leverage radiation therapists' expertise to the level of advanced practice.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 6","pages":"Pages e511-e518"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026365","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}
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