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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 低分割放疗和近距离放疗联合治疗前列腺特异性膜抗原正电子发射断层扫描分期器官局限性前列腺癌:一项前瞻性研究的主要终点分析。
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 10.1016/j.prro.2025.03.013
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
<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
目的:本研究旨在评估一项2期前瞻性试验的主要终点,该试验包括采用18f前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描(CT)分期的患者队列,采用前列腺高剂量率近距离放疗和前列腺/精囊外束放射治疗联合治疗中高危前列腺癌。方法与材料:选取41例不良中、高危(HR)、高危(very HR)前列腺癌患者,连续接受36 Gy(每3 Gy 12次)低分次前列腺±精囊外束放射治疗,随后接受14 Gy单分次实时高剂量率近距离放射治疗。患者还接受了风险调整雄激素剥夺治疗(ADT)。所有患者首先采用前列腺多参数磁共振成像、腹部/骨盆CT和骨显像进行常规分期,并在纳入研究前接受前列腺特异性膜抗原正电子发射断层扫描/CT。通过各种问卷(国际前列腺症状评分、国际勃起功能指数、临床实践扩展前列腺癌指数复合、放射治疗肿瘤组/欧洲癌症研究和治疗组织)评估泌尿、胃肠道症状、性能力和急性以及早期和晚期毒性。结果:在本分析时,41例患者(基于国家综合癌症网络分层系统,48.8%为不良中度,43.9%为高危,7.3%为极高危)完成治疗并随访至少12个月。中位随访时间为20个月(IQR, 13-28)。中位年龄为71.7岁,治疗前中位前列腺特异性抗原为8.4 ng/mL(5.0-28.3),前列腺中位体积为36.6 cc(14.9-68.2)。43.9%的患者接受短期ADT治疗,48.8%的患者接受长期ADT治疗;其余患者未接受激素治疗。无严重(≥3级)急性事件记录。2级泌尿生殖系统毒性发生率增加,主要原因是夜尿症(3个月时为2.4%,6个月时为4.9%,12个月时为26.8%),1级在此期间保持稳定。在胃肠道毒性方面,1级和2级的发生率仍然很低,在这段时间内几乎没有变化。与治疗后3个月相比,在激素和性方面均观察到基线的显著下降,严重程度分别从12%到38%和从0%到5%恶化。没有其他领域表现出明显的下降(尿失禁、刺激/烦恼和肠道)。结论:对前瞻性2期试验的主要结果的评估表明,这种低分割联合放疗方案耐受性良好,未出现早期严重不良事件。此外,患者报告的结果证实了这些结果,因为没有记录到任何领域比基线值显著下降。
{"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 ,&nbsp;Efstratios Karagiannis MD, PhD ,&nbsp;Georgios Antorkas MSc ,&nbsp;Yiannis Roussakis MSc, PhD ,&nbsp;Constantina Cloconi PhD ,&nbsp;Antria Savva MSc ,&nbsp;Andreas Christoforou MSc ,&nbsp;Alexis Vrachimis MD, PhD ,&nbsp;Constantinos Zamboglou MD, PhD ,&nbsp;Konstantinos Ferentinos MD, PhD","doi":"10.1016/j.prro.2025.03.013","DOIUrl":"10.1016/j.prro.2025.03.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;&lt;span&gt;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 &lt;/span&gt;prostate cancer.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and Materials&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;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 ± &lt;/span&gt;seminal vesicles&lt;span&gt;&lt;span&gt; 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&lt;span&gt; (ADT). All patients were primarily conventionally staged with prostate multiparametric magnetic resonance imaging, abdomen/pelvis &lt;/span&gt;&lt;/span&gt;CT&lt;span&gt;, and bone scintigraphy, receiving an additional prostate-specific membrane antigen positron emission tomography/CT before their study inclusion. &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;Urinary&lt;span&gt;&lt;span&gt;, 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 &lt;/span&gt;Oncology Group/European Organization for Research and Treatment of Cancer).&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;span&gt;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&lt;span&gt; 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 &lt;/span&gt;&lt;/span&gt;nocturia&lt;span&gt; (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}
引用次数: 0
Can Online Adaptive Radiation Therapy Eliminate Intrafractional Deformation in Gastric Mucosa-Associated Lymphoid Tissue Lymphoma? 在线适应性放疗能消除胃黏膜相关淋巴组织淋巴瘤的局部变形吗?
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 10.1016/j.prro.2025.05.008
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

Purpose

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。
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引用次数: 0
Combination Metastasis-Targeted External Beam Radiation Therapy With 177Lu-PSMA-617 in Patients With Advanced Castration-Resistant Prostate Cancer 177Lu-PSMA-617联合转移靶向外束放射治疗晚期去势抵抗性前列腺癌患者
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 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.
177Lu-PSMA-617 (LuPSMA)是一种有效的治疗转移性去势抵抗性前列腺癌(mCRPC)的放射性药物。虽然LuPSMA可以治疗播散性疾病,但可能需要对转移性疾病进行额外的局部控制。转移靶向外束放射治疗(M-EBRT)是一种有效的辅助治疗。然而,M-EBRT联合LuPSMA的适应症、疗效和安全性/毒性尚不清楚。在这里,我们报告了我们在接受LuPSMA的患者中使用M-EBRT的经验,并评估了M-EBRT对局部疾病控制和缓解的能力。方法:这项回顾性的irb豁免研究回顾了在fda批准后的前两年在多机构学术癌症中心接受同步M-EBRT治疗的LuPSMA患者。分析了驱动M-EBRT使用的临床因素。结果:回顾了261例LuPSMA患者的治疗过程;52例患者同时接受M-EBRT治疗。M-EBRT用于颅内/硬膜外疾病(n=22/52;42%),骨痛缓解(n=17/52;33%),预防病理性骨折(n=12/52;23%),其他适应症为12% (n=6/52)。M-EBRT的时间因患者而异,54% (n=28/52)的患者在LuPSMA治疗前接受M-EBRT, 27% (n=14/52)的患者在治疗后接受M-EBRT, 13% (n=7/52)的患者在治疗期间接受M-EBRT。EBRT大多耐受良好,尽管淋巴细胞减少症很常见。大多数患者(n=32/ 52,62%)在M-EBRT后症状缓解。在LuPSMA治疗前、治疗期间和治疗后接受EBRT的患者,m -EBRT后症状缓解率分别为68%、85%和50%,死亡率分别为32%、29%和57%,尽管没有统计学意义(p>0.23)。该患者群体的PSA50(治疗期间前列腺特异性抗原减少50%)应答为41%,而一般LuPSMA人群为50%,但PSA应答的大小是异质性的(p=0.27)。结论:根据我们的经验,M-EBRT与LuPSMA治疗一起有效地控制了局部肿瘤和症状,特别是局部骨和中枢神经系统病变,并且具有良好的耐受性。M-EBRT可能是一种重要的辅助治疗方式,促进了LuPSMA的开始和/或持续。
{"title":"Combination Metastasis-Targeted External Beam Radiation Therapy With 177Lu-PSMA-617 in Patients With Advanced Castration-Resistant Prostate Cancer","authors":"Sedra Mohammadi MD ,&nbsp;Isabella R. Pompa BA ,&nbsp;Veronica Haberman ,&nbsp;Bashar Kako MD ,&nbsp;Richard J. Lee MD, PhD ,&nbsp;Philip J. Saylor MD ,&nbsp;Xin Gao MD ,&nbsp;Shadi A. Esfahani MD, MPH ,&nbsp;Pedram Heidari MD ,&nbsp;Praful Ravi MB, BChir, MRCP ,&nbsp;Mutlay Sayan MD ,&nbsp;Jason A. Efstathiou MD, DPhil ,&nbsp;Heather A. Jacene MD ,&nbsp;Sophia C. Kamran MD ,&nbsp;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> &gt; .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}
引用次数: 0
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 放射治疗联合免疫检查点抑制剂治疗肌肉侵袭性膀胱癌:来自Y-ECI ROSC EORTC组的综合系统综述
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 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.
目的:本综述旨在评价免疫检查点抑制剂(ICI)联合RT治疗非转移性MIBC的疗效和安全性,重点关注新辅助和膀胱保留策略。证据获取:从2000年1月到2023年12月,使用PubMed和Clinicaltrials.gov数据库进行了系统的文献综述。选择了研究非转移性MIBC联合免疫治疗与RT治疗的结果的研究。数据提取包括研究标识、患者特征、干预组和对照组细节以及主要结果。证据综合:在28项选定的研究中,观察到不同的方法,包括新辅助和膀胱保留策略。RACE IT等新辅助试验探索了根治性膀胱切除术前ICI联合RT的可行性,显示出良好的疗效和安全性。在膀胱保存策略方面,已完成的和正在进行的试验表明,ICI联合放化疗或单独放疗的毒性特征和早期疗效数据是可以接受的。结论:ICI联合RT作为非转移性MIBC的治疗策略具有重要的前景。初步证据显示良好的疗效和安全性,支持进一步的探索和潜在的纳入标准治疗。正在进行的III期试验将为将ICI添加到常规决定性治疗的比较有效性提供重要见解。在不断发展的MIBC管理领域,ICI和RT的结合有可能重塑治疗范式并改善患者的预后。
{"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 ,&nbsp;Hoda Abdel-Aty MD ,&nbsp;Victor Duque-Santana MD ,&nbsp;Marko Bebek MD ,&nbsp;Tiuri E. Kroese MD ,&nbsp;Miha Orazem MD ,&nbsp;Piet Dirix MD ,&nbsp;Piet Ost MD ,&nbsp;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}
引用次数: 0
Current Status of Proton Craniospinal Irradiation for Solid Tumor Leptomeningeal Disease 质子颅脊髓照射治疗实体瘤性脑膜轻脑病的现状。
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 10.1016/j.prro.2025.06.010
Omer Gal MD , Jonathan T. Yang MD, PhD , Rupesh Kotecha MD
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引用次数: 0
Segment-Targeted Precision Ablative Radiation Therapy With Exact Delivery (SPARE): A Novel Anatomically Guided Stereotactic Body Radiation Therapy Technique. 节段靶向精确消融放疗与精确递送(SPARE):一种新的解剖引导的SBRT技术。
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 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.

立体定向体放射治疗(SBRT)对早期非小细胞肺癌取得了良好的局部控制,但可能导致未受病灶肺段的放射性肺炎。传统的SBRT规划采用环形优化结构,提高了一致性,但忽略了节段性解剖,允许低剂量的泄漏到邻近的完整肺。我们开发了一种解剖导向的精确消融放疗(SPARE)技术,该技术将辐射暴露限制在携带肿瘤的支气管肺段,本质上是一种“放射性肺段切除术”。SPARE集成了三种互补策略:避开相邻未参与段的特定段束定向,惩罚相邻段剂量的优化约束,以及使用蒙特卡罗或Acuros计算的高梯度剂量整形,以获得组织界面附近的精度。利用高分辨率CT追踪支气管分支和血管标志,确定肿瘤段间的自然边界。一个位于S1+2b亚段的左侧上叶腺癌的代表性病例,用56 Gy分4段治疗,成功地限制了靶段的剂量,同时保留了邻近的S3。4个月时,1级放射性肺炎仅局限于治疗亚段,未受累区域观察到代偿性扩张,证实了可预测的毒性定位。SPARE通过解剖引导的剂量控制提供功能保护,将弥漫性肺损伤转化为局部损伤,并使再治疗更加安全。该技术可在标准SBRT设备上执行,并与常规分馏方案兼容。这个概念从肺扩展到其他分割器官,如肝和肾,在保留整体器官功能的同时,可以针对解剖单位。SPARE代表了SBRT计划的范式转变,使放射治疗与解剖保存的手术原则保持一致,同时保持肿瘤疗效。
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引用次数: 0
Near-miss Event in Lung Cancer Radiation Therapy Because of a Random Outlier of Target Volume 靶体积随机离群引起的肺癌放射治疗中的未遂事件。
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 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.
准确的肿瘤和危险器官轮廓是放射治疗的关键步骤。轮廓程序,无论是手动的还是自动的,都容易出错,并且在很大程度上存在观察者之间和观察者内部的可变性。放射肿瘤学家和/或医学物理学家在制定治疗计划之前,必须对每位患者的所有轮廓进行独立审查,这是一个耗时、费力且仍然不是没有错误的过程。我们提出了一个微妙的未遂事件的追踪,由于在肺肿瘤的轮廓中存在一个随机的离群值,离实际的总肿瘤体积很远。使用VMAT技术的自动处理引擎执行治疗计划。尽管在我们的临床常规中实施和采用了系统的质量保证程序,但错误跨越了同行评审的障碍,随后仅在治疗前剂量学验证的步骤中被识别出来。错误得到了纠正,并且在开始治疗之前对患者进行了重新计划。在本案例研究中,我们表明,当进行自动化计划时,随机产生的假阳性目标异常值可能会对患者剂量产生有害影响。这种风险是不可忽视的,所有提高目标分割鲁棒性的策略都应该追求。
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引用次数: 0
The Current and Future State of Radiation Therapy Practice—An Analysis of the Professional Workforce Survey 放射治疗实践的现状和未来-专业劳动力调查的分析。
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 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。
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引用次数: 0
PRO Top 20 Reviewers and Reviewer Apprentice Program Graduates in 2023 and 2024 2023年和2024年PRO前20名评审员和评审员学徒计划毕业生。
IF 3.5 3区 医学 Q2 ONCOLOGY Pub Date : 2025-11-01 DOI: 10.1016/j.prro.2025.08.001
Robert Amdur MD
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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 Pub Date : 2025-11-01 DOI: 10.1016/S1879-8500(25)00229-2
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引用次数: 0
期刊
Practical Radiation Oncology
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