Advances in Radiation Oncology最新文献

{"title":"Advances in Radiation Oncology in 2023.","authors":"Rachel B Jimenez","doi":"10.1016/j.adro.2024.101578","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101578","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"101578"},"PeriodicalIF":2.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASTRO's Advances in Radiation Oncology Outstanding Reviewers for 2023.","authors":"Rachel B Jimenez","doi":"10.1016/j.adro.2024.101686","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101686","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"101686"},"PeriodicalIF":2.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perceptions of Radiation Therapy Prior to Initial Consultation With a Radiation Oncologist","authors":"Jennifer Novak MD, MS ,&nbsp;Colton Ladbury MD ,&nbsp;Tariq Abuali BS ,&nbsp;Andrew Tam MD ,&nbsp;Jeffrey Brower MD, PhD ,&nbsp;Brett Evans BS ,&nbsp;Virginia Sun PhD, RN ,&nbsp;Matthew J. Loscalzo LCSW ,&nbsp;Arya Amini MD","doi":"10.1016/j.adro.2024.101676","DOIUrl":"10.1016/j.adro.2024.101676","url":null,"abstract":"<div><h3>Purpose</h3><div>There are currently limited data regarding patient perceptions and fears related to radiation therapy (RT). This study sought to identify and quantify patient concerns regarding RT and to determine the potential value of assessing these expectations prior to initial consultation.</div></div><div><h3>Methods and Materials</h3><div>Patients with no prior history of RT were invited to complete an investigator-developed anonymous electronic survey prior to consultation. Patients were queried about their perceptions of RT and potential fears/concerns. The content validity index for survey items were scored with adequate construct validity. Survey items were scored descriptively through summary statistics. Relationships between respondent variables and responses to survey questions were analyzed by univariate and multivariate logistic regression.</div></div><div><h3>Results</h3><div>From September 2020 through June 2022, 214 patients completed the survey and were included in the analysis. Fifty percent of respondents reported a complete lack of knowledge regarding RT. Twenty-seven percent of patients reported that RT is their most worrisome cancer treatment, compared to chemotherapy or surgery. The most common self-reported fears of RT included general side effects, skin burns, not knowing what to expect regarding RT, pain, and organ damage. The most frequently reported concerns of physical side effects of RT included pain (67%), memory loss (62%), nausea/vomiting (60%), and skin reactions (58%). Sixty-two percent of respondents reported being either moderately or very concerned about their ability to perform daily activities. Thirty-six percent of respondents reported at least moderate concern over the financial cost of RT. Twenty-six percent of respondents reported at least moderate concern regarding transportation to RT. Forty-eight percent of respondents reported concern about emitting radiation to others.</div></div><div><h3>Conclusions</h3><div>Patient concerns related to RT toxicities and impact on daily life were common, as were misconceptions of RT. Pre-consultation assessment of patient expectations regarding RT is feasible and may be helpful in addressing patients concerns early and in real-time.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101676"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Synchrotron Microbeam Radiation Therapy Combined With Broad Beam in a Preclinical Breast Cancer Model","authors":"Elette Engels PhD ,&nbsp;Helen Forrester PhD ,&nbsp;Mitzi Klein VMD ,&nbsp;Caroline Bell BSc ,&nbsp;Indi Balderstone MD ,&nbsp;Kirsty Brunt ,&nbsp;Micah J. Barnes MSc ,&nbsp;Matthew Cameron PhD ,&nbsp;Jeffrey C. Crosbie PhD ,&nbsp;Ryan Middleton PhD ,&nbsp;Cristian Fernandez-Palomo PhD ,&nbsp;Bettina de Breuyn Dietler BSc ,&nbsp;Verdiana Trappetti PhD ,&nbsp;Jennifer M. Fazzari PhD ,&nbsp;Daniel Hausermann PhD ,&nbsp;Robin L. Anderson PhD ,&nbsp;Valentin G. Djonov MD ,&nbsp;Olga A. Martin PhD","doi":"10.1016/j.adro.2024.101680","DOIUrl":"10.1016/j.adro.2024.101680","url":null,"abstract":"<div><h3>Purpose</h3><div>Both local tumor control and distant metastasis are important indicators of the efficacy of radiation therapy treatment. Synchrotron microbeam radiation therapy (MRT), spatially fractionated radiation delivered at ultrahigh dose rates, shows remarkable normal tissue sparing with excellent local control in some models. Some MRT regimens trigger an antitumor immune response that contributes not only to the local but also to systemic treatment efficacy. Despite recent advances in the treatment of primary breast cancer, metastatic disease is still the major cause of treatment failure in the clinic. Here, in an aggressive preclinical triple-negative breast cancer model, we compared local tumor response and metastasis following different MRT treatment programs.</div></div><div><h3>Methods and Materials</h3><div>4T1.2 mouse mammary tumors were treated with 300 Gy peak/7 Gy valley dose MRT and/or 8 Gy broad beam (BB) radiation, all delivered as daily fractionated programs (3 consecutive daily sessions of either MRT or BB or 1 MRT combined with 2 BB sessions, the first or last of the 3 fractions). The mice were euthanized on day 9 post last irradiation, when unirradiated control animals reached an ethical endpoint. Primary tumors were collected to evaluate immune cell prevalence, while lungs, spinal cords, and locoregional lymph nodes were collected to measure metastatic burden. In parallel, local tumor growth and survival were monitored.</div></div><div><h3>Results</h3><div>The combined MRT/BB treatment shifted the balance between pro- and antitumorigenic macrophages toward the accumulation of antitumorigenic macrophages in the tumor. Monitoring of the tumor volume and animal health indicated the benefit of the combined MRT/BB treatment for local control and treatment tolerance, while animal survival was only marginally longer for one combined schedule. The metastatic burden was similar for all 4 treatment schedules.</div></div><div><h3>Conclusions</h3><div>The addition of a single MRT to BB treatment improved the primary tumor response. This provides a basis for future experiments incorporating adjuvant immunotherapy or chemotherapy to improve local and systemic treatment outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101680"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy","authors":"Garrett K. Harada MD ,&nbsp;Steven N. Seyedin MD ,&nbsp;Olivia Heutlinger BS ,&nbsp;Armon Azizi BS ,&nbsp;Audree Hsu BS ,&nbsp;Arash Rezazadeh MD ,&nbsp;Michael Daneshvar MD, MS ,&nbsp;Greg E. Gin MD ,&nbsp;Edward M. Uchio MD ,&nbsp;Giovanna A. Giannico MD ,&nbsp;Jeremy P. Harris MD ,&nbsp;Aaron B. Simon MD, PhD ,&nbsp;Jeffrey V. Kuo MD ,&nbsp;Nataliya Mar MD","doi":"10.1016/j.adro.2024.101671","DOIUrl":"10.1016/j.adro.2024.101671","url":null,"abstract":"<div><h3>Purpose</h3><div>Pelvic lymph node metastases (ypN+) after multiagent neoadjuvant chemotherapy (NAC) is a poor prognostic sign in nonmetastatic muscle-invasive bladder cancer (nmMIBC). We sought to create a nomogram predicting probability of ypN+ after NAC for cN0 nmMIBC and determine association with overall survival (OS).</div></div><div><h3>Methods and Materials</h3><div>We reviewed the National Cancer Database for patients with cT2-4N0M0 urothelial carcinoma of the bladder receiving multiagent NAC and surgery from 2004 to 2020. Following a data split, univariate logistic regression identified variables associated with ypN+ at <em>P</em> &lt; .05. Eligible variables were used for multivariate logistic regression and nomogram generation. A threshold for 95% sensitivity defined high- and low-risk groups for ypN+. Fine–Gray models assessed ypN+ risk group and OS, accounting for competing risks of surgical mortality.</div></div><div><h3>Results</h3><div>A total of 6194 patients were identified with a median follow-up of 39.5 months (interquartile range [IQR], 20.5-67.2 months). Most patients had high-grade (97.7%) cT2 disease (70.8%) with nonpapillary urothelial histology (67.3%) and initiated NAC at a median of 41.0 days after diagnosis (IQR, 28.0-59.0 days).The nomogram included age in decades (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.87–1.03; <em>P</em> = .172), weeks from diagnosis to NAC (OR, 1.02; 95% CI, 1.01-1.04; <em>P</em> = .004), nonpapillary histology (OR, 1.17; 95% CI, 0.99-1.39; <em>P</em> = .068), and clinical T-stage. Within the testing cohort, ypN+ was found in 392 (22.8%) high-risk and 12 (8.0%) low-risk patients (<em>P</em> &lt; .001), with median OS of 36.1 and 74.0 months, respectively (<em>P</em> &lt; .001). High-risk patients had worse OS despite competing risks of 30-day (subdistribution hazard ratio [SHR], 1.80; 95% CI, 1.49-2.18; <em>P</em> &lt; .001) and 90-day surgical mortality (SHR, 1.68; 95% CI, 1.39-2.04; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>This is the first study to provide a tool for predicting ypN+ and prognosticate worse OS in primarily high-grade nmMIBC and could select patients for alternative neoadjuvant therapy and facilitate future study.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101671"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of Avasopasem Manganese on Severe Oral Mucositis in Head and Neck Cancer in the ROMAN Trial: Unplanned Secondary Analysis","authors":"Carryn Anderson MD ,&nbsp;Samuel Salvaggio PhD ,&nbsp;Mickaël De Backer PhD ,&nbsp;Jean-Christophe Chiem PhD ,&nbsp;Gary Walker MD, MPH, MS ,&nbsp;Deborah Saunders DMD, BSc ,&nbsp;Christopher M. Lee MD ,&nbsp;Neal Dunlap MD ,&nbsp;Eugene Kennedy MD ,&nbsp;Robert Beardsley PhD ,&nbsp;Benton Schoen BA ,&nbsp;Marc Buyse ScD","doi":"10.1016/j.adro.2024.101674","DOIUrl":"10.1016/j.adro.2024.101674","url":null,"abstract":"<div><h3>Purpose</h3><div>Oral mucositis (OM) is a debilitating side effect of cisplatin and intensity-modulated radiation therapy (IMRT) in patients with head and neck cancer. The phase 3 ROMAN trial showed avasopasem manganese (AVA) significantly decreased individual endpoints of incidence and duration of severe oral mucositis (SOM, World Health Organization [WHO] grade 3-4), with nominal decrease in severity (WHO grade 4) and significant increase in the delay in onset of SOM. We sought to determine the Net Treatment Benefit (NTB) of AVA versus placebo (PBO) using the generalized pairwise comparisons (GPC) method.</div></div><div><h3>Methods and Materials</h3><div>GPC is a statistical method that permits simultaneous analysis of several prioritized outcomes, comparing all possible pairs of a patient in the active (ie, AVA) group and a patient from the control (ie, PBO) group. NTB is the net benefit across all the outcomes for AVA compared to PBO. Key clinically relevant outcomes from ROMAN were prioritized: (1) WHO grade 4 OM incidence; (2) SOM incidence; (3) days of SOM; (4) days to SOM onset, with 7 days difference defined as the clinical relevance threshold for SOM days and SOM onset.</div></div><div><h3>Results</h3><div>GPC analysis of 407 patients (AVA = 241, placebo = 166) stratified by cisplatin schedule and treatment setting resulted in 13,969 pairwise comparisons. AVA showed statistically significant net benefit on all 4 key outcomes with a 53.9% probability that AVA would benefit patients versus a 35.0% probability that PBO would; the difference between these probabilities was a NTB of 18.9% (<em>P</em> = .0012), translating to an AVA number needed to treat of 5.3 patients. All outcomes contributed to NTB, reflecting improvements in SOM incidence, onset and duration, and in grade 4 OM incidence seen in the original ROMAN analysis.</div></div><div><h3>Conclusions</h3><div>This GPC analysis shows compelling evidence from the ROMAN trial of AVA's clinical benefit across key parameters of SOM burden.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101674"},"PeriodicalIF":2.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of a Pregnant Patient With a Brain Tumor Using Pencil Beam Scanning Proton Therapy","authors":"Justine M. Dupere PhD,&nbsp;William G. Breen MD,&nbsp;John J. Lucido PhD,&nbsp;Nicholas B. Remmes PhD","doi":"10.1016/j.adro.2024.101673","DOIUrl":"10.1016/j.adro.2024.101673","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101673"},"PeriodicalIF":2.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and Toxicities After Treatment for Men Diagnosed With Localized Prostate Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.","authors":"Doris Kitson-Mills, Andrew Donkor, Yaw Ampem Amoako, Kofi Adesi Kyei, Ernest Barwuah Osei Bonsu, Verna Vanderpuye, Yaw Amo Wiafe","doi":"10.1016/j.adro.2024.101670","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101670","url":null,"abstract":"<p><strong>Purpose: </strong>Current management for clinically localized prostate cancer in low- and middle-income countries (LMICs) includes surgery, external beam radiation therapy (EBRT), and brachytherapy either alone or in combination, with plus or minus hormone therapy. The toxicity profiles and oncological outcomes of these treatment modalities vary. This systematic review and meta-analysis aimed to determine the prevalence of treatment-related outcomes and toxicities for men diagnosed with localized prostate cancer in LMICs.</p><p><strong>Methods and materials: </strong>The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane Library, Embase, and Medline were searched for eligible articles. Meta-analysis was performed with Review Manager version 5.4.1 using a random effects model at a 95% confidence interval.</p><p><strong>Results: </strong>A total of 2,820 patients were analyzed from 24 articles that met the inclusion criteria. Following 3-dimensional conformal radiation therapy (3D-CRT), the most common clinician-reported toxicities were acute skin grade 1, acute genitourinary grade 1, acute gastrointestinal grade 1, and late gastrointestinal grade 1, with 46%, 29%, 24%, and 18%, respectively. Acute and late genitourinary grade 3 and gastrointestinal grade 3 toxicities were below 3% with no grade 4 toxicities reported after 3D-CRT. In the brachytherapy group, the prevalence of acute genitourinary grade 1 toxicity was 19%. Perioperative rectal injury was the least prevalent (2%) after retropubic radical prostatectomy. Following 3D-CRT, the 5-year overall survival rate was 87%, and for the combined brachytherapy and EBRT group, it increased to 96%. The prevalence of 5-year biochemical failure following EBRT and brachytherapy was 18% and 30%, respectively. The 4- and 3-year biochemical failure after radical prostatectomy and combined EBRT with brachytherapy were 22% and 2%, respectively.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis indicate that in LMICs, EBRT, brachytherapy, and radical prostatectomy, either alone or in combination has an excellent potential for localized prostate cancer control with low toxicities and good oncological outcomes. Results of treatment-related toxicities and outcomes can support policymakers, patients, and clinicians on informed decision-making to strengthen prostate cancer care in the region. However, efforts are required to improve early detection, treatment accessibility, regular post-treatment follow-up care, consistent quality assurance practices, and staff continues development to help minimize treatment toxicities and improve outcomes of localized prostate cancer in LMICs.</p>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"101670"},"PeriodicalIF":2.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delta-Radiomics Approach Using Contrast-Enhanced and Noncontrast-Enhanced Computed Tomography Images for Predicting Distant Metastasis in Patients With Borderline Resectable Pancreatic Carcinoma","authors":"Takanori Adachi PhD ,&nbsp;Mitsuhiro Nakamura PhD ,&nbsp;Takahiro Iwai PhD ,&nbsp;Michio Yoshimura MD, PhD ,&nbsp;Takashi Mizowaki MD, PhD","doi":"10.1016/j.adro.2024.101669","DOIUrl":"10.1016/j.adro.2024.101669","url":null,"abstract":"<div><h3>Purpose</h3><div>To predict distant metastasis (DM) in patients with borderline resectable pancreatic carcinoma using delta-radiomics features calculated from contrast-enhanced computed tomography (CECT) and non-CECT images.</div></div><div><h3>Methods and Materials</h3><div>Among 250 patients who underwent radiation therapy at our institution between February 2013 and December 2021, 67 patients were deemed eligible. A total of 11 clinical features and 3906 radiomics features were incorporated. Radiomics features were extracted from CECT and non-CECT images, and the differences between these features were calculated, resulting in delta-radiomics features. The patients were randomly divided into the training (70%) and test (30%) data sets for model development and validation. Predictive models were developed with clinical features (clinical model), radiomics features (radiomics model), and a combination of the abovementioned features (hybrid model) using Fine-Gray regression (FG) and random survival forest (RSF). Optimal hyperparameters were determined using stratified 5-fold cross-validation. Subsequently, the developed models were applied to the remaining test data sets, and the patients were divided into high- or low-risk groups based on their risk scores. Prognostic power was assessed using the concordance index, with 95% CIs obtained through 2000 bootstrapping iterations. Statistical significance between the above groups was assessed using Gray's test.</div></div><div><h3>Results</h3><div>At a median follow-up period of 23.8 months, 47 (70.1%) patients developed DM. The concordance indices of the FG-based clinical, radiomics, and hybrid models were 0.548, 0.603, and 0.623, respectively, in the test data set, whereas those of the RSF-based models were 0.598, 0.680, and 0.727, respectively. The RSF-based model, including delta-radiomics features, significantly divided the cumulative incidence curves into two risk groups (<em>P</em> &lt; .05). The feature map of the gray-level size-zone matrix showed that the difference in feature values between CECT and non-CECT images correlated with the incidence of DM.</div></div><div><h3>Conclusions</h3><div>Delta-radiomics features obtained from CECT and non-CECT images using RSF successfully predict the incidence of DM in patients with borderline resectable pancreatic carcinoma.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101669"},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implementation of Cone Beam Computed Tomography-Guided Online Adaptive Radiation Therapy in Whole Breast Irradiation","authors":"Koen J. Nelissen MS ,&nbsp;Wilko F.A.R. Verbakel PhD ,&nbsp;Judith G. Middelburg–van Rijn MD ,&nbsp;Barbara L.T. Rijksen MD ,&nbsp;Marjan A. Admiraal PhD ,&nbsp;Jorrit Visser PhD ,&nbsp;Jessica van der Himst ,&nbsp;Karin N. Goudschaal MS ,&nbsp;Ewa Bucko ,&nbsp;Ben J. Slotman MD ,&nbsp;Angelique R.W. van Vlaenderen MS ,&nbsp;Desiree H.J.G. van den Bongard PhD, MD ,&nbsp;BREAST-ART study group","doi":"10.1016/j.adro.2024.101664","DOIUrl":"10.1016/j.adro.2024.101664","url":null,"abstract":"<div><h3>Purpose</h3><div>In postoperative breast irradiation, changes in the breast contour and arm positioning can result in patient positioning errors and offline replanning. This can lead to increased treatment burden and strain on departmental logistics because of the need for additional cone beam computed tomography (CBCT) images or even a new radiation therapy treatment plan (TP). Online daily adaptive radiation therapy (oART) could provide a solution to these challenges. We have clinically implemented and evaluated the feasibility of oART for whole breast irradiation.</div></div><div><h3>Methods and Materials</h3><div>Twenty patients treated with postoperative whole breast right irradiation (5 × 5.2 Gy) were included in BREAST-ART, a prospective single-arm trial. The dosimetry of the reference TP calculated on the daily anatomy and adaptive TP were compared. Duration of the oART workflow, in-house satisfaction questionnaires, and acute toxicity (National Cancer Institute Common Terminology Criteria for Adverse Event v5.0) were collected. The oART workflow was evaluated by investigating the impact of manual corrections of influencer and target contours on treatment time and quality.</div></div><div><h3>Results</h3><div>In the first 17 patients (85 fractions), the on-couch time, ie, the time between the end of CBCT1 and CBCT3, was a median of 13.8 minutes (range, 11–25). Retrospective evaluation of the use of the influencer (ie, breast) in 4 patients (20 fractions) and manual correction of the most cranial and caudal target contours (ie, 4 mm) in 10 patients (36 fractions) was done. This resulted in a reduced on-couch time in the last 3 clinical patients to a median of 13.0 minutes (range, 11–19). No grade 3 or higher toxicity was observed, and 19 of 20 patients indicated that they preferred the same treatment again. Skin marks for patient positioning during treatment were no longer necessary.</div></div><div><h3>Conclusions</h3><div>This study showed the feasibility, challenges, and practical solutions for the implementation of oART for breast cancer patients. Future work will focus on more complex breast indications, such as whole breast, including axillary nodes, to further investigate the benefits and challenges of oART in breast cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 1","pages":"Article 101664"},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}