Advances in Radiation Oncology最新文献

{"title":"Re-irradiation With Carbon Ion Beams for Recurrent Adenoid Cystic Carcinoma of the Tongue Base: A Case Report","authors":"Eisuke Horigome MD, PhD , Atsushi Musha DDS, PhD , Nobuteru Kubo MD, PhD , Naoko Okano MD, PhD , Hidemasa Kawamura MD, PhD , Tatsuya Ohno MD, PhD","doi":"10.1016/j.adro.2025.101761","DOIUrl":"10.1016/j.adro.2025.101761","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101761"},"PeriodicalIF":2.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799444","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":"Target Contour Consistency During Magnetic Resonance-Guided Online Adaptive Stereotactic Body Radiation Therapy","authors":"Suzanne Kirby BS ,&nbsp;Kiana Rahimi BS ,&nbsp;William Song PhD,&nbsp;Elisabeth Weiss MD","doi":"10.1016/j.adro.2025.101765","DOIUrl":"10.1016/j.adro.2025.101765","url":null,"abstract":"<div><h3>Purpose</h3><div>Adaptive magnetic resonance-guided stereotactic body radiation therapy (MRgSBRT) requires expeditious recontouring of target volumes based on daily anatomy. Contouring of the gross tumor volume (GTV) is frequently performed by covering radiation oncologists who may be less familiar with the case than the primary physician (PP). The objective of this study is to determine consistency in GTV contouring between PP and covering physician (CP) and to analyze the effect of resources to support accurate GTV delineation.</div></div><div><h3>Methods and Materials</h3><div>Between 2021 and 2023, 59 patients underwent 302 fractions of MRgSBRT at our institution. GTVs were analyzed for the effect of 3 different types of contouring support resources: (a) number of slices of the original GTV, (b) external software displaying original GTV contours, and (c) alerting if GTVs differed &gt; 10% from the original. Differences between physicians and contouring support resources were analyzed for different tumor sites and fractions using 2-tailed <em>t</em> test and analysis of variance.</div></div><div><h3>Results</h3><div>One hundred nineteen out of 302 (39.4%) MRgSBRT treatments were supervised by a CP. The difference in the mean absolute percent volume change of GTV compared with original GTV for PPs (11.1%) versus CPs (4.6%) across all treatment fractions was statistically significant (<em>P</em> = .00006). Significant differences were observed for pancreas (12.8% vs 5.0%, <em>P</em> = .03), liver (13.0% vs 4.0%, <em>P</em> = .007), and lymph nodes (12.4% vs 2.1%, <em>P</em> = .004) with larger volume differences for PPs. No significant differences were observed for tumors of the prostate (3.7% vs 3.6%) and adrenal glands (9.7% vs 12.2%). No significant GTV differences between the 3 contouring support techniques were observed.</div></div><div><h3>Conclusions</h3><div>Our results show larger GTV changes by PPs for most tumor sites with little impact from contouring support resources. Observed differences might be related to higher contouring confidence of PPs who are more familiar with the case. Further investigation into enhancing contouring support methods is warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101765"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777152","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":"Longitudinal Analyses and Predictive Factors of Radiation-Induced Lymphopenia After Postmastectomy Hypofractionated Radiation Therapy for Breast Cancer: A Pooled Cohort Study of 2 Prospective Trials","authors":"Xu-Ran Zhao MD ,&nbsp;Hui Fang MD ,&nbsp;Hao Jing MD ,&nbsp;Qiu-Zi Zhong MD ,&nbsp;Hong-Fen Wu MD ,&nbsp;Xiao-Rong Hou MD ,&nbsp;Li-Hua Dong MD ,&nbsp;Ya-Hua Zhong MD ,&nbsp;Jing Jin MD ,&nbsp;Li-Na Zhao MD ,&nbsp;Xiao-Hong Wang MD ,&nbsp;Wei-Fang Yang MD ,&nbsp;Jian Tie MD ,&nbsp;Yu-Fei Lu MD ,&nbsp;Guang-Yi Sun MD ,&nbsp;Dan-Qiong Wang MD ,&nbsp;Yu Tang MD ,&nbsp;Shu-Nan Qi MD ,&nbsp;Yong-Wen Song MD ,&nbsp;Yue-Ping Liu MD ,&nbsp;Shu-Lian Wang MD","doi":"10.1016/j.adro.2025.101750","DOIUrl":"10.1016/j.adro.2025.101750","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation-induced lymphopenia (RIL) correlates with poor prognoses in solid tumors. This study aimed to investigate the post–radiation therapy (RT) longitudinal lymphocyte changes and the impact of different RT techniques on RIL in breast cancer patients.</div></div><div><h3>Methods and Materials</h3><div>We prospectively assessed 607 breast cancer patients who received hypofractionated postmastectomy RT in 8 hospitals. Radiation therapy techniques included integrated photon-based intensity modulated technique (integrated RT) and a combination of photon irradiation of supraclavicular nodes and electron irradiation of the chest wall and/or the internal mammary node (hybrid RT). Peripheral lymphocyte counts (PLC) were determined before RT, weekly during RT, at 1 and 2 weeks, 3 and 6 months post–RT, and then every 6 months. The primary outcome was the nadir PLC during RT, for which associated factors were analyzed. Univariate, multivariable linear regression and propensity score matching analyses were performed to evaluate the effect of different RT techniques on nadir PLC.</div></div><div><h3>Results</h3><div>During RT, 121 (19.9%) patients had grade ≥3 RIL with a nadir PLC of 0.75 ± 0.33 × 10⁹/L. The PLC started to recover at 1 week and reached pre–RT levels 1 year after RT and higher than pre–RT levels 2 years later. Multivariate analysis identified young age, low body mass index, radiation therapy targets involving multiple regions, integrated RT, and low pre–radiation therapy PLC as independent risk factors for nadir PLC (<em>P</em> &lt; .005). The PLC at each time point during and after radiation therapy was lower in patients receiving integrated RT than in those receiving hybrid RT (<em>P</em> &lt; .05). Before and after propensity score matching, integrated RT was significantly associated with lower nadir PLC after adjusting for radiation therapy targets and age (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Breast cancer patients had prolonged lymphopenia post–RT. Integrated RT increased the risk of RIL and adversely affected recovery. Therefore, an appropriate RT technique should be considered to minimize RIL.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101750"},"PeriodicalIF":2.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768703","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":"Deep Learning-Based Heterogeneity Correction of the Homogeneous Dose Distribution for Single Brain Tumors in Gamma Knife Radiosurgery","authors":"Sangyoon Lee BA,&nbsp;Shubhendu Mishra MD,&nbsp;Yoichi Watanabe PhD","doi":"10.1016/j.adro.2025.101757","DOIUrl":"10.1016/j.adro.2025.101757","url":null,"abstract":"<div><h3>Purpose</h3><div>Heterogeneity correction is vital in radiation therapy treatment planning to ensure accurate dose delivery. Brain cancer stereotactic treatments, like Gamma Knife radiosurgery (GKRS), often rely on homogeneous water-based calculations despite the potential heterogeneity impact near bony structures. This study aims to develop a method for generating synthetic dose plans incorporating heterogeneity effects without additional computed tomography (CT) scans.</div></div><div><h3>Methods and Materials</h3><div>Magnetic resonance imaging and CT images, TMR10-based, and convolution-based dose distributions were used from 100 retrospectively collected and 22 prospectively collected GKRS patients. A conditional Generative Adversarial Network was trained to translate TMR10 into synthetic convolution (sConv) doses.</div></div><div><h3>Results</h3><div>The generated sConv dose demonstrated qualitative and quantitative similarity to the actual convolution (Conv) dose, showcasing better agreement of dose distributions and improved isodose volume similarity with the Conv dose in comparison to the TMR10 dose (γ pass rate; sConv dose, 92.43%; TMR10 dose, 74.18%. Prescription isodose dice; sConv dose, 91.7%; TMR10 dose, 89.7%). Skull-induced scatter and attenuation effects were accurately reflected in the sConv dose, indicating the usefulness of the new dose prediction model as an alternative to the time-consuming convolution dose calculations.</div></div><div><h3>Conclusions</h3><div>Our deep learning approach offers a feasible solution for heterogeneity-corrected dose planning in GKRS, circumventing additional CT scans and lengthy calculation times. This method's effectiveness in preserving dose distribution characteristics in a heterogeneous medium while only requiring a homogeneous dose plan highlights its utility for including the process in the routine treatment planning workflows. Further refinement and validation with diverse patient cohorts can enhance its applicability and impact in clinical settings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101757"},"PeriodicalIF":2.2,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768704","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":"Tolerance of Adjuvant Ultrahypofractionated Whole-Breast Radiation Therapy Employing Moderately Hypofractionated Sequential Boost: A Single Institution Analysis","authors":"Olga Unterkirhere MD, PhD ,&nbsp;Tino Streller PhD ,&nbsp;David Jeller MSc ,&nbsp;Philippe Logaritsch PhD ,&nbsp;Susanne Bucher MD ,&nbsp;Peter Dubsky MD, PhD ,&nbsp;Christoph Glanzmann MD, PhD ,&nbsp;Gabriela Studer MD, PhD","doi":"10.1016/j.adro.2025.101756","DOIUrl":"10.1016/j.adro.2025.101756","url":null,"abstract":"<div><h3>Purpose</h3><div>This analysis evaluates early and intermediate treatment tolerance in a prospective observational cohort study of patients who underwent adjuvant ultrahypofractionated whole-breast radiation therapy (uhWBRT), with or without moderately hypofractionated sequential boost, following breast-conserving surgery.</div></div><div><h3>Methods and Materials</h3><div>uhWBRT was introduced in our department in March 2020. Data from 436 patients with breast tumors not requiring lymphatic irradiation were analyzed, including 376 with invasive carcinomas (pT1-pT3) and 60 with ductal carcinoma in situ. The mean age was 62 years (range, 26-85). Acute reactions (Common Terminology Criteria for Adverse Events v4.03) were assessed at radiation therapy completion and after 2 to 3 weeks. Late effects and patient-reported outcomes (Late Effects in Normal Tissues–Subjective, Objective, Management and Analytic and Harvard for Cosmesis) were evaluated at 6 months after radiation therapy and annually thereafter. The prescribed uhWBRT dose was 26 Gy in 5 daily fractions. A sequential boost of 10.0 to 12.5 Gy in 4 to 5 daily fractions was administered to 338 patients (77.5%), while 98 (22.5%) did not receive a boost.</div></div><div><h3>Results</h3><div>Acute toxicity grades 0, 1, and 2 were observed in 29.8%, 59.9%, and 10.3% of patients, respectively, at radiation therapy completion and 52.1%, 40.8%, and 7.2% of patients at 2 to 3 weeks after radiation therapy. Grade 2 late effects were identified in 5.3%, 2.0%, 1.8%, 1.1%, and 0%, and grade 3 late effects were identified in 1.5%, 2.3%, 0.9%, 0%, and 0% of patients at 6 months, 1 years, 2 years, 3 years, and 4 years. Patient-reported outcomes for cosmesis were rated as good or excellent in 97.7% of patients. After a mean follow-up of 18 months (median 14, range, 0-48), 1 local failure, 2 nodal failures, and 9 distant relapses were detected. Three deaths were reported, all nontumor-related.</div></div><div><h3>Conclusions</h3><div>Early and intermediate results indicate that the treatment schedules, including the moderately hypofractionated boost, are safe and well tolerated, with acute toxicity rates comparable to those in the FAST-Forward trial. Although our study follow up is relatively short, our findings indicate that uhWBRT, with or without a moderately hypofractionated boost, is safe and well tolerated.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101756"},"PeriodicalIF":2.2,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768702","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":"Planning Automation for Treatment Techniques Comparison and Robustness Analysis: Tangential Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Whole Breast Irradiation","authors":"Livia Marrazzo MSc ,&nbsp;Deborah Chilà MSc ,&nbsp;Immacolata Vanore MSc ,&nbsp;Roberto Pellegrini MSc ,&nbsp;Peter Voet PhD ,&nbsp;Vanessa Di Cataldo MD ,&nbsp;Icro Meattini MD ,&nbsp;Margherita Zani MSc ,&nbsp;Chiara Arilli MSc ,&nbsp;Silvia Calusi PhD ,&nbsp;Marta Casati MSc ,&nbsp;Antonella Compagnucci MSc ,&nbsp;Cinzia Talamonti PhD ,&nbsp;Lorenzo Livi MD ,&nbsp;Stefania Pallotta MSc","doi":"10.1016/j.adro.2025.101719","DOIUrl":"10.1016/j.adro.2025.101719","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the use of the mCycle automated planning system integrated into the Monaco Treatment Planning System for step-and-shoot intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in whole breast irradiation (WBI). The aim was to assess whether automation can standardize plan quality across a diverse patient cohort and compare dosimetric outcomes and robustness of the 2 techniques against setup errors and anatomical variations.</div></div><div><h3>Methods and Materials</h3><div>A total of 65 patients with breast cancer who underwent postoperative WBI were selected for the study. Treatment plans were generated using mCycle, which employs multicriteria optimization with no manual intervention. Two automated planning techniques—IMRT and VMAT—were implemented and evaluated based on dosimetric outcomes, physician review, planning time, and plan robustness. The plan deliverability was verified through γ index and point dose measurements.</div></div><div><h3>Results</h3><div>The mCycle system produced clinically acceptable plans for both IMRT and VMAT across all patient cohorts. VMAT showed superior target coverage (V95% = 97.9%) and better sparing of ipsilateral organs at risks (OARs), whereas IMRT demonstrated enhanced sparing of contralateral OARs and greater robustness to anatomical changes such as breast swelling. Planning times were reduced with VMAT because of complete automation. Plan deliverability was confirmed with high γ passing rates and acceptable point dose deviations.</div></div><div><h3>Conclusions</h3><div>The use of mCycle in WBI planning successfully standardized plan quality and improved workflow efficiency. VMAT provided superior target coverage and ipsilateral OAR sparing but was more sensitive to anatomical changes. IMRT showed better contralateral OAR sparing and robustness. Both techniques are viable, with advantages depending on clinical scenarios.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101719"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509333","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":"Local Therapy for Isolated Central Nervous System Progression Among Patients Receiving Antibody-Drug Conjugate Therapy","authors":"Emily S. Lebow MD ,&nbsp;Jordan Eichholz MS ,&nbsp;Zhigang Zhang PhD ,&nbsp;Nicolas Toumbacaris MSPH ,&nbsp;Brandon Imber MD, MA ,&nbsp;Linda Chen MD ,&nbsp;Quincey LaPlant MD, PhD ,&nbsp;Josh Yamada MD ,&nbsp;Luke R.G. Pike MD, DPhil ,&nbsp;Shanu Modi MD ,&nbsp;Andrew D. Seidman MD ,&nbsp;Kathryn Beal MD ,&nbsp;Nelson S. Moss MD ,&nbsp;Yao Yu MD","doi":"10.1016/j.adro.2025.101714","DOIUrl":"10.1016/j.adro.2025.101714","url":null,"abstract":"<div><h3>Purpose</h3><div>Antibody drug conjugates (ADCs) are an increasingly important class of therapeutics among patients with breast, lung, urothelial, and other malignancies. Guidelines recommend local therapy and continuation of current systemic therapy among patients with isolated brain relapse. We describe the clinical outcomes of this approach among patients receiving ADCs.</div></div><div><h3>Methods and Materials</h3><div>We queried our institutional database for patients receiving radiation therapy (RT) in the setting of isolated brain progression on ADCs with a plan to continue same-line therapy after radiation. Patients with ≤3 brain metastases at the time of recurrence were categorized as oligoprogressive. Study endpoints included overall survival, progression-free survival (PFS), and the cumulative incidence of next therapy from the start of local therapy.</div></div><div><h3>Results</h3><div>We identified 17 patients receiving ADC therapy with isolated brain progression treated with radiation (stereotactic radiosurgery [SRS]: n = 13, whole brain radiation: n = 4). All patients received concurrent ADC and RT. The median follow-up from local therapy was 29.5 months (95% CI, 21.4-not reached). The median overall survival was 19 months (95% CI, 16-not reached), and the median PFS was 8.1 months (range, 6.7-19 months). One lesion treated with SRS had local failure 21 months after treatment, and the 24-month cumulative incidence of local failure across the entire cohort was 1.6% (95% CI, 0.13%-7.7%). The 6-month cumulative incidence of radiation necrosis was 12% (95% CI, 1.8%-32%). The cumulative incidence of next therapy at 6 and 12 months was 47% (95% CI, 22%-69%) and 71% (95% CI, 41%-87%), respectively, and was significantly lower among patients with oligoprogressive brain recurrence. After SRS, 2 patients were without evidence of disease, discontinued systemic therapy, and were stable on observation at last follow-up.</div></div><div><h3>Conclusions</h3><div>To the best of our knowledge, this is the first clinical report of outcomes using the guideline-recommended approach of local therapy for isolated brain relapse among patients receiving ADCs. Local therapy may delay the need for next line systemic therapy, particularly among patients with oligoprogressive brain relapse.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101714"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509331","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":"Association of Histologic Subtype With Radiation Response and Survival Outcomes in Synovial Sarcoma","authors":"Jennifer K. Matsui MD, PhD ,&nbsp;Scott Jackson MS ,&nbsp;Judy Fang MS ,&nbsp;David G. Mohler MD ,&nbsp;Robert J. Steffner MD ,&nbsp;Raffi S. Avedian MD ,&nbsp;Gregory W. Charville MD, PhD ,&nbsp;Matt van de Rijn MD ,&nbsp;Lynn Million MD ,&nbsp;Alexander L. Chin MD, MBA ,&nbsp;Susan M. Hiniker MD ,&nbsp;Anusha Kalbasi MD ,&nbsp;Everett J. Moding MD, PhD","doi":"10.1016/j.adro.2025.101718","DOIUrl":"10.1016/j.adro.2025.101718","url":null,"abstract":"<div><h3>Purpose</h3><div>Synovial sarcoma (SS) is a rare, aggressive soft tissue malignancy that is divided into biphasic and monophasic histologic subtypes. In addition to surgical resection, radiation therapy (RT) improves local control in patients at higher risk of recurrence. This study aimed to investigate the impact of histologic subtype on radiation response and survival outcomes in patients treated with RT as part of definitive management.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively identified patients with SS treated with RT and surgical resection from 1997 to 2020 at Stanford Medical Center. We assessed the association between histologic subtypes (biphasic vs monophasic) and response to preoperative RT based on imaging and pathology. Volumetric response was calculated using the pre-RT and post-RT/preoperative postcontrast T1-weighted magnetic resonance imaging images. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariable and multivariable analyses were conducted using Cox regression models. Variables for univariable and multivariable analyses included age, histologic subtypes, tumor location, tumor size, margin status, chemotherapy, and performance status.</div></div><div><h3>Results</h3><div>In our study, 50 patients met the inclusion criteria. The median age was 34.8 years at diagnosis, and 36% (n = 18) received concurrent chemotherapy. Biphasic (n = 18, 36%) and monophasic (n = 32, 64%) tumors exhibited significant differences in negative margin status (94% vs 66%, <em>P</em> = .036). Of the 22 patients who underwent preoperative RT, 15 patients had pre-RT and post-RT imaging to assess volumetric changes. Biphasic tumors demonstrated less necrosis at the time of surgical resection but a significantly greater volumetric decrease with preoperative RT (42% vs 5%, <em>P</em> = .004). PFS and OS were superior in biphasic tumors (<em>P</em> = .003 and <em>P</em> = .009, respectively). Multivariable analyses identified histologic subtypes (monophasic vs biphasic) as a significant factor impacting PFS (HR, 5.65; 95% CI, 1.78-17.91; <em>P</em> = .003).</div></div><div><h3>Conclusions</h3><div>Biphasic tumors exhibit an improved volumetric response to preoperative RT and improved outcomes. These findings underscore the importance of considering histology when tailoring treatment for patients with SS.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101718"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509332","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":"Comprehensive Analysis of Treatment Approaches in Chest Wall Ewing Sarcoma: The Impact of Tumor Volume on Oncologic Outcomes","authors":"Brady S. Laughlin MD ,&nbsp;Aaron Bogan MA ,&nbsp;Wendy A. Allen-Rhoades MD, PhD ,&nbsp;Peter S. Rose MD ,&nbsp;Stephanie F. Polites MD, MPH ,&nbsp;Jonathan B. Ashman MD, PhD ,&nbsp;Ivy Petersen MD ,&nbsp;Michael G. Haddock MD ,&nbsp;Anita Mahajan MD ,&nbsp;Nadia N. Laack MD ,&nbsp;Safia K. Ahmed MD","doi":"10.1016/j.adro.2025.101729","DOIUrl":"10.1016/j.adro.2025.101729","url":null,"abstract":"<div><h3>Purpose</h3><div>Local treatment with surgery (S) and radiation therapy (RT) for chest wall Ewing sarcoma (cwES) is often challenging given the extent of the tumor and the aggressiveness of local treatments needed for cure. We report tumor and treatment characteristics, oncologic outcomes, and toxicities of patients with cwES at 2 centers of a single institution.</div></div><div><h3>Methods and Materials</h3><div>Consecutive patients with cwES treated from 1997 to 2022 were retrospectively reviewed. All patients were treated with standard 5-drug chemotherapy (vincristine, doxorubicin, cyclophosphamide, alternating with ifosfamide and etoposide) before initiation of local therapy. Local treatment was S, RT, or both. The decision on modality and timing was determined by a multidisciplinary sarcoma group or by consensus between sarcoma experts regarding patient preferences.</div></div><div><h3>Results</h3><div>The cohort consisted of 39 patients. The median age at diagnosis was 19.2 years (range, 3.5-53.6 years). Median tumor volume (TV) was 235.5 mL (range, 5.3-6761.9 mL). The local control (LC) modality was S in 18 patients (46%), RT in 4 (10%), and S + RT in 17 (44%). Four (10%) patients treated with S + RT had R1 margins. The median follow-up was 3.2 years (range, 0.1-21.6 years). Grade 3 radiation-associated toxicity relative to the RT modality was 16.7% and 7.1% for photons (n = 6) and protons (n = 14), respectively. The 2-year LC by modality was 100% for RT (95% CI, 100%-100%), 88.2% (95% CI, 74.2%-100%) for S, and 73.3% (95% CI, 54.0%-99.5%) for S + RT. The 5-year LC, failure-free survival, and overall survival for all patients were 79.7% (95% CI, 67.3%-94.4%), 52.3% (95% CI, 38.1%-71.9%), and 64.2% (95% CI, 49.6%-83.1%), respectively. In univariate and multivariate analysis, TV ≥ 130 mL was associated with a significantly worse 5-year failure-free survival (31.8% TV ≥ 130 mL vs 80.8% TV &lt; 130 mL; hazard ratio, 4.94, <em>p</em> = .013 and adjusted hazard ratio, 5.43; 95% CI, 1.28-22.98; <em>p</em> = .022). The multivariate model was adjusted for age, metastatic disease at diagnosis, and S.</div></div><div><h3>Conclusions</h3><div>Outcomes for cwES tumors are highly dependent on tumor size, even with the use of combined modality local therapy. With early follow-up, smaller tumors may be well controlled with either S or RT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 4","pages":"Article 101729"},"PeriodicalIF":2.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511344","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":"Self-Reported Health Status Survey Creation and Distribution Outcomes in a Large Cohort of Pediatric Oncology Patients Treated with Proton Radiation Therapy","authors":"Miranda P. Lawell MS ,&nbsp;Melanie L. Rose MD, MS ,&nbsp;Jaitri Joshi BS ,&nbsp;Jessica A. Marinelli BS ,&nbsp;Megan J. Upton BA ,&nbsp;Sara L. Dennehy MS ,&nbsp;Soo L. Kang BSN ,&nbsp;Elizabeth A. Weyman DNP ,&nbsp;Keith W. Allison MS ,&nbsp;Nancy J. Tarbell MD ,&nbsp;Shannon M. MacDonald MD ,&nbsp;Benjamin V.M. Bajaj MS ,&nbsp;Torunn I. Yock MD, MCH","doi":"10.1016/j.adro.2025.101748","DOIUrl":"10.1016/j.adro.2025.101748","url":null,"abstract":"<div><h3>Purpose</h3><div>Most pediatric patients receiving radiation therapy at Massachusetts General Hospital are referred from outside institutions and later return to their original care providers. As quaternary care centers, proton therapy centers face unique challenges in tracking patient follow-up, yet obtaining longitudinal data is crucial for assessing radiation therapy outcomes. We implemented an annual direct-to-patient survey to improve follow-up data collection.</div></div><div><h3>Methods and Materials</h3><div>The survey was designed to be completed in &lt;5 minutes and records contact information, health status (recent follow-up and with which specialists, imaging, the status of treated disease/secondary tumors, additional treatments, and symptoms), and social updates. Surveys were sent annually as mailed letters with a quick response code or by e-mail using research electronic data capture software. Data were collected between February 2019 and June 2022. Approval was obtained to send surveys to oncology patients prospectively enrolled in a clinical trial or the Pediatric Proton/Photon Consortium Registry at our single institution.</div></div><div><h3>Results</h3><div>Of the 472 participants who were sent at least 1 survey, 236 (50%) responded. Patients who received surveys via e-mail were 1.6 times as likely to respond than those who received surveys via mail (<em>P</em> &lt; .001). The median time (days) to survey completion for mailed and e-mailed surveys were 20 and 3, respectively. Survey completion extended the last available clinical status on record for patients by a median of 8.5 (&lt;1-63.3) months.</div></div><div><h3>Conclusions</h3><div>Survey implementation improved follow-up data collection, with e-mail being more effective than mail as a distribution method. Adaptation and utilization of our survey in other tertiary and quaternary centers may improve the collection of patient outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 5","pages":"Article 101748"},"PeriodicalIF":2.2,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768705","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}