Advances in Radiation Oncology最新文献

{"title":"Is Ultrahigh Dose Rate Critical for the Effectiveness of Microbeam Radiation Therapy in a Broad-Beam Combined Treatment?","authors":"Elette Engels PhD ,&nbsp;Helen B. Forrester PhD ,&nbsp;Verdiana Trappetti PhD ,&nbsp;Kellie Mouchemore PhD ,&nbsp;Mitzi Klein VMD ,&nbsp;Alice H. Sprung ,&nbsp;Kirsty Brunt ,&nbsp;Micah J. Barnes PhD ,&nbsp;Matthew Cameron PhD ,&nbsp;Vincent de Rover BSc ,&nbsp;Bettina de Breuyn Dietler BSc ,&nbsp;Anatoly B. Rosenfeld PhD ,&nbsp;Michael L.F. Lerch PhD ,&nbsp;Robin L. Anderson PhD ,&nbsp;Olga A. Martin PhD ,&nbsp;Valentin G. Djonov MD","doi":"10.1016/j.adro.2025.101949","DOIUrl":"10.1016/j.adro.2025.101949","url":null,"abstract":"<div><h3>Purpose</h3><div>The superior therapeutic index of preclinical synchrotron microbeam radiation therapy (MRT) over conventional broad-beam (BB) radiation therapy (RT) has been clearly established. Published data demonstrate that a combination of 1 MRT session with 2 consecutive daily BB-RT sessions effectively controls the primary tumor and triggers an antitumor immune response. Here, we aimed to establish whether an ultrahigh dose rate of MRT, available exclusively on the synchrotron, is essential for effective treatment of murine triple-negative mammary carcinoma.</div></div><div><h3>Methods and Materials</h3><div>The in vitro response of mammary tumor cells was investigated using a clonogenic survival assay at different MRT dose rates (∼1000, 100, or 10 Gy/s). The in vivo tumor responses at the same dose rates, with an MRT/BB/BB treatment schedule, were evaluated by measuring tumor volume and the induced immune response. Animal survival and normal skin reactions were also assessed.</div></div><div><h3>Results</h3><div>Clonogenic survival decreased with decreasing MRT dose rate, with most cell sparing at the highest dose rate (1000 Gy/s), indicating that lower dose rates could be more effective against tumors. However, no significant differences in in vivo tumor growth delay were observed in response to dose-rate variations. Decreased infiltration of irradiated tumors with leucocytes and their subpopulations was observed at the lower dose rates, including decreased expression of immune checkpoints PD-1/PD-L1 and prognostic marker CD103, which could impact the overall tumor response in vivo. The higher dose rates were associated with increased antitumor immunity. Early euthanasia of mice, as dictated by ethical endpoints, prevented long-term observation of differences in animal survival. Skin toxicity in the vicinity of irradiated tumors was mild and developed later at the highest MRT dose rate. Overall, MRT at 10 to 1000 Gy/s was tolerated similarly, despite dramatic changes in the dose rate.</div></div><div><h3>Conclusions</h3><div>These findings are promising for the clinical translation of MRT in combination with conventional RT, using emerging compact x-ray MRT sources with dose rates lower than those delivered by synchrotron sources.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101949"},"PeriodicalIF":2.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to Sengul and Sengul","authors":"Rong-Tse Hsu MD,&nbsp;Ting-Chun Lin MD","doi":"10.1016/j.adro.2025.101841","DOIUrl":"10.1016/j.adro.2025.101841","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101841"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Regard to Hsu et al","authors":"Ilker Sengul MD ,&nbsp;Demet Sengul MD","doi":"10.1016/j.adro.2025.101840","DOIUrl":"10.1016/j.adro.2025.101840","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101840"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radioenhancing Hafnium Oxide Nanoparticles (NBTXR3) Followed by Stereotactic Body Radiation Therapy in Patients With Hepatocellular Carcinoma and Liver Metastases (NBTXR3-103): Phase 1 Dose-Escalation Trial","authors":"Enrique Chajon MD, PhD ,&nbsp;Marc Pracht MD ,&nbsp;Yan Rolland MD, PhD ,&nbsp;France Nguyen MD ,&nbsp;Jean-Pierre Bronowicki MD, PhD ,&nbsp;Jérôme Durand-Labrunie MD ,&nbsp;Véronique Vendrely MD, PhD ,&nbsp;Antonio Sa Cunha MD ,&nbsp;Valérie Laurent MD, PhD ,&nbsp;Emmanuel Rio MD ,&nbsp;Samuel Le Sourd MD ,&nbsp;Pierre Gustin MD ,&nbsp;Patricia C. Said MSc ,&nbsp;Mikaela Dimitriu PhD ,&nbsp;Benjin D. Facer MD ,&nbsp;Omar I. Vivar PhD ,&nbsp;Didier Peiffert MD, PhD ,&nbsp;Eric Deutsch MD, PhD ,&nbsp;Thierry de Baère MD","doi":"10.1016/j.adro.2025.101937","DOIUrl":"10.1016/j.adro.2025.101937","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic body radiation therapy (SBRT) is a common treatment for unresectable liver cancers; however, delivering ablative doses while minimizing normal tissue toxicity is challenging. NBTXR3, a novel radioenhancer, demonstrated enhanced radiation therapy (RT) efficacy with minimal toxicity in healthy tissue. We evaluated NBTXR3 intratumoral injection followed by SBRT for hepatocellular carcinoma (HCC) or liver metastases.</div></div><div><h3>Methods and Materials</h3><div>This phase 1, multicenter, dose-escalation trial enrolled adults with unresectable HCC or liver metastases. Five dose levels of NBTXR3 were evaluated (3 + 3 design): 10%, 15%, 22%, 33% and 42% of gross tumor volume (GTV) determined by magnetic resonance imaging. Patients received RT (15 Gy × 3 or 10 Gy × 5 over 5-15 days) starting 1 to 5 days after NBTXR3 injection. Primary endpoints included: incidence of early dose-limiting toxicities (DLTs) and determination of the recommended phase 2 dose (RP2D) of NBTXR3.</div></div><div><h3>Results</h3><div>Between December 2015 and May 2020, 26 liver lesions in 23 patients with HCC (17 lesions in 15 patients) or liver metastases (9 lesions in 8 patients) were treated. No early DLTs were reported, and the maximum tolerated dose was not reached. The RP2D of NBTXR3 was 42% of GTV. During the treatment period, 6 patients experienced grade ≥3 toxicities; none were NBTXR3-related, one was RT-related (grade 3 fatigue), and 2 were injection procedure–related (grade 3 abdominal pain). During the follow-up period, 2 patients experienced treatment-related grade ≥3 AEs (grade 3 bile duct stenosis related to cancer/RT/NBTXR3, and grade 3 anemia related to cancer/RT/underlying liver disease). No treatment-related deaths were reported. The 12-week objective response rate in treated lesions was 58.3% (7/12) in patients with HCC, and 50.0% (4/8) in patients with liver metastases.</div></div><div><h3>Conclusions</h3><div>NBTXR3 + RT has a manageable safety profile with no DLTs identified during dose escalation. The RP2D for treatment of HCC or liver metastases is 42% of GTV. Future studies will further evaluate efficacy.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101937"},"PeriodicalIF":2.7,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Boron Neutron Capture Therapy in Recurrent High-Grade Gliomas: Safety, Efficacy, and Pharmacokinetics From a Multicenter, Dose-Escalation Phase 1 Trial","authors":"Woohyoung Kim MD, PhD ,&nbsp;Jae-Sung Park MD, PhD ,&nbsp;Jin-Ho Song MD, PhD ,&nbsp;Heon Yoo MD, PhD ,&nbsp;Kawngwoo Park MD, PhD ,&nbsp;Hyun Ju Kim MD ,&nbsp;Dong-Won Shin MD, PhD ,&nbsp;Sung Uk Lee MD, PhD ,&nbsp;Stephen Ahn MD, PhD ,&nbsp;Seunggyun Ha MD, PhD ,&nbsp;JunGyu Yi MS ,&nbsp;Kwan Cho MD ,&nbsp;Hyo Jung Seo MD, PhD ,&nbsp;Hyung-Seok Lim MD, PhD ,&nbsp;Gi-Taek Yee MD, PhD","doi":"10.1016/j.adro.2025.101947","DOIUrl":"10.1016/j.adro.2025.101947","url":null,"abstract":"<div><h3>Purpose</h3><div>Boron neutron capture therapy (BNCT) is an advanced radiation therapy delivering highly selective tumor cell destruction via localized fission reactions. This phase 1 study evaluated the safety and efficacy of BNCT using [B-10]L-4-boronophenylalanine (BPA) in patients with recurrent high-grade gliomas, mostly glioblastomas.</div></div><div><h3>Methods and Materials</h3><div>A 3 + 3 dose-escalation design was used to determine the maximum tolerated dose of BNCT across 3 planned cohorts (D_max: 9, 11, and 13 Gy-Eq), with 3 additional subjects enrolled at any dose level where dose-limiting toxicity (DLT) occurred. DLT was defined as BNCT-related grade 3+ toxicities within 90 days posttreatment, with protocol-defined exclusions. Patients underwent a single session: intravenous BPA administration (500 mg/kg/3 h) and neutron irradiation 1 hour later. The primary endpoint was the recommended phase 2 radiation dose, based on DLT incidence. Secondary endpoint included safety, efficacy, and pharmacokinetics: treatment-emergent adverse events (TEAEs), progression-free survival, objective response rate, and overall survival (OS).</div></div><div><h3>Results</h3><div>Six patients were treated between December 2022 and January 2024: 3 in the 9 Gy-Eq and 3 in the 11 Gy-Eq cohort. No DLTs or grade ≥4 TEAEs occurred. Two patients experienced grade 3 TEAEs (brain edema, seizure). Common adverse events were alopecia, aphasia, brain edema, and seizures. One serious adverse event (grade 3 seizure) was reported. Median follow-up was 9.03 months. Median progression-free survival was 1.87 months by response assessment in neuro-oncology; not reached by modified response assessment in neuro-oncology. Objective response was not observed. All patients survived to study completion; median OS not reached, maximum OS was 16.56 months. BPA pharmacokinetics were within expected ranges. The safety monitoring committee selected 11 Gy-Eq as the recommended phase 2 radiation dose, balancing tumoricidal effects with risks of necrosis and bevacizumab requirements.</div></div><div><h3>Conclusions</h3><div>This study demonstrates the acceptable safety profile of BNCT and suggests potential survival benefits in recurrent high-grade glioma. However, given the limited sample size and follow-up period, extended observation is required to validate long-term efficacy and safety.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101947"},"PeriodicalIF":2.7,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Dedicated Inpatient Radiation Oncology Consult Service on Goal-Concordant Care","authors":"Morgan E. Freret MD, PhD ,&nbsp;Divya Yerramilli MD ,&nbsp;Victoria S. Brennan MBBch, BAO ,&nbsp;Lillian A. Boe PhD ,&nbsp;C. Jillian Tsai MD ,&nbsp;Oren Cahlon MD ,&nbsp;Simon N. Powell MD, PhD, FRCP ,&nbsp;Jonathan T. Yang MD, PhD ,&nbsp;Sean McBride MD, MA ,&nbsp;Puneeth Iyengar MD, PhD ,&nbsp;Daniel R. Gomez MD, MBA ,&nbsp;Amy J. Xu MD, PhD","doi":"10.1016/j.adro.2025.101939","DOIUrl":"10.1016/j.adro.2025.101939","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy has an increasing role in the management of metastatic cancers. Integrating radiation with surgical and systemic approaches is complex, and inappropriate management can lead to prolonged hospitalizations inconsistent with palliative goals. An inpatient radiation oncology consult (IROC) service was created in January 2020 to provide rapid access to specialized care for hospitalized patients. Here, we report outcomes of the IROC service, focusing on quality-of-care metrics including hospital length of stay (LOS), use of hypofractionated approaches, and treatments for patients discharged to hospice.</div></div><div><h3>Methods and Materials</h3><div>We conducted a pre-post observational study to compare inpatient consults placed before (<em>N</em> = 1507) and after (<em>N</em> = 1509) IROC, from 2019 to 2021. Continuous variables were analyzed using the Mann-Whitney test and categorical variables using Fisher’s exact test.</div></div><div><h3>Results</h3><div>We found that IROC was associated with reductions in hospital LOS (mean difference 1.0 days, <em>P</em> = .045). Under IROC, inpatient treatment courses were shorter (5.8 vs 5.0 days, <em>P</em> = .007), in part driven by increased adoption of palliative hypofractionated radiation therapy approaches (74% vs 82%, <em>P</em> = .001). The reduction in LOS was greatest for patients discharged to hospice (5.1 vs 3.7 days, <em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>The IROC service was associated with reduced hospital LOS, increased use of hypofractionated approaches, and decreased treatments for patients discharged to hospice. Our findings demonstrate the value of a dedicated program addressing radiation delivery to hospitalized patients to improve goal-concordant treatments. The financial impact of reducing low-value care is an important subject for future investigations.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101939"},"PeriodicalIF":2.7,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Very High Cumulative Equivalent Dose in 2 Gy Fraction in Locally Advanced Central/Ultracentral Nonsmall Cell Lung Cancer Treated With Conventional Chemoradiation Therapy and a Stereotactic Boost","authors":"Anna Gueiderikh MD, PhD ,&nbsp;Baptiste Lhomel ,&nbsp;Renaud Schiappa ,&nbsp;Médéric Barret MD ,&nbsp;Victoria Ferrari MD ,&nbsp;Arash O. Naghavi MD, MS ,&nbsp;Bastien Chanoux ,&nbsp;Pierre-Yves Bondiau MD, PhD ,&nbsp;Jérôme Doyen MD, PhD","doi":"10.1016/j.adro.2025.101925","DOIUrl":"10.1016/j.adro.2025.101925","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the cumulative equivalent dose in 2 Gy fractions (EQD2) to organs at risk and its potential correlation with toxicities in patients with locally advanced nonsmall cell lung cancer treated with very high mediastinal radiation therapy doses using mixed fractionation.</div></div><div><h3>Methods and Materials</h3><div>Patients from a previously reported phase 1 trial (PMID: 29650404) were included (n = 26). They received a stereotactic boost (3 × 7-12 Gy) following chemoradiation therapy (cisplatin-based chemotherapy and 23 × 2 Gy using three-dimensional conformal radiation therapy). Seventeen treatment plans were available for dosimetric analysis. Doses delivered at each point of the planning computed tomography scan from each treatment phase were converted to EQD2 based on the α:β ratios, which are shown in asterisks following each converted dose. The 3-dimensional conformal radiation therapy and stereotactic body radiation therapy plans were each converted to EQD2, and their summation was used to estimate the total dose delivered to organs at risk.</div></div><div><h3>Results</h3><div>In the entire cohort (n = 26), 77% of tumors were ultracentral, 19% peripheral, and 4% central. We observed 1 grade 3 toxicity (bronchial stenosis/fibrosis), 1 grade 4 toxicity (esophagitis with fistula), and 1 grade 5 toxicity (fatal hemoptysis). Dosimetric evaluation of the proximal bronchovascular (PBV) tree and esophagus revealed no severe late toxicity with PBV tree D1cc &lt; 150 Gy *2* and esophageal D1cc &lt; 100 Gy *10*. Median maximal EQD2 D1cc for organs at risk were as follows: aorta, 84.3 Gy *3* (range, 53.3-190.6); pulmonary arteries, 136.9 Gy *3* (range, 47.2-232.3); superior vena cava, 70.6 Gy *3* (range, 16.2-192.8); pulmonary veins, 69.0 Gy *3* (range, 3.5-231); esophagus, 67.9 Gy *10* (range, 15.7-161); PBV tree, 153.4 Gy *2* (range, 20.3-235.9).</div></div><div><h3>Conclusions</h3><div>The following preliminary dose constraints—PBV tree D1cc &lt; 150 Gy *2* and esophageal D1cc &lt; 100 Gy *10*—may be safe and are currently being prospectively evaluated in an ongoing phase 2 trial (NCT06627738). The correlation between toxicities and the degree of initial tumor infiltration of organs at risk requires further prospective evaluation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101925"},"PeriodicalIF":2.7,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Radiation Therapy in Breast Cancer Patients With Neurofibromatosis Type 1: Safety and Long-Term Outcomes","authors":"Carla Benmatallah MD ,&nbsp;Youlia Kirova MD ,&nbsp;Pierre Loap MD","doi":"10.1016/j.adro.2025.101931","DOIUrl":"10.1016/j.adro.2025.101931","url":null,"abstract":"<div><h3>Purpose</h3><div>Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disorder associated with an increased risk of cancer, including a 5-fold higher incidence of breast cancer. Preclinical data suggest heightened radiosensitivity in NF1, raising concerns about toxicity and secondary malignancies after radiation therapy. Clinical data, however, are lacking. This study aimed to evaluate long-term outcomes and treatment-related toxicities in NF1 patients receiving adjuvant radiation therapy for breast cancer.</div></div><div><h3>Methods and Materials</h3><div>This retrospective single-center study included 27 NF1 patients with nonmetastatic breast cancer treated with surgery and adjuvant radiation therapy between 1995 and 2023. Clinical, pathologic, treatment, and toxicity data were analyzed. Survival was assessed using Kaplan-Meier estimates, and toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events.</div></div><div><h3>Results</h3><div>Among 27 patients (30 tumors), the median follow-up was 79 months. The 10-year overall and cancer-specific survival rates were 68.3% each, and the metastasis-free survival rate was 68.4%. Local and locoregional control exceeded 92%. Acute radiodermatitis occurred in 83.3% of patients (grade 1-2); no grade ≥ 3 acute or late toxicity was observed. Late toxicities were rare and mild. No radiation-induced malignancy or cardiopulmonary events were reported. Nodal involvement and lymphovascular invasion were significantly associated with poorer survival.</div></div><div><h3>Conclusions</h3><div>Adjuvant radiation therapy is safe and effective in NF1 patients with breast cancer, despite a notably high incidence of low-grade acute skin toxicity. No serious long-term toxicity or radiation-induced malignancy was observed. Modern dose-sparing techniques should be prioritized, and further prospective studies are needed to refine treatment approaches in this high-risk group.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101931"},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT Versus DeepSeek: Assessing Artificial Intelligence Performance on Radiation Oncology Examination Questions","authors":"Ronald Chow MD MS, MEng, FACE, FRSPH ,&nbsp;Ajay Zheng BS ,&nbsp;Chenxi Gao BS ,&nbsp;Milo Vermeulen PhD ,&nbsp;Francis Yu MS ,&nbsp;Irini Yacoub MD ,&nbsp;Arpit M. Chhabra MD ,&nbsp;J. Isabelle Choi MD ,&nbsp;Haibo Lin PhD ,&nbsp;Gilmer Valdes PhD ,&nbsp;Charles B. Simone II MD, FASTRO, FACRO","doi":"10.1016/j.adro.2025.101929","DOIUrl":"10.1016/j.adro.2025.101929","url":null,"abstract":"<div><h3>Purpose</h3><div>Large language models have been assessed for their ability to receive and answer medical questions. Recently, there has been a new large language model named DeepSeek released, which has not been assessed for medical accuracy. This is the first study to assess DeepSeek for accuracy in responding to medical questions.</div></div><div><h3>Methods and Materials</h3><div>We prompted DeepSeek-R1 and several models of ChatGPT with 600 radiation oncology examination questions from national radiation oncology in-service multiple-choice examinations. These questions are used by medical residents in preparation for their certifying board examination and assess knowledge on anatomy, treatment planning, cancer epidemiology, and landmark trials. We recorded each model’s accuracy, total prompt and completion tokens used, and total run time. Accuracy was compared across question categories and between models. Type I error was set at 0.05.</div></div><div><h3>Results</h3><div>DeepSeek-R1 answered 84.0% of questions correctly, requiring 59 seconds per question. DeepSeek-R1 demonstrated a significant difference in accuracy by question categories (<em>P</em> = .012) and was least accurate for questions about landmark studies (74.2% accuracy). ChatGPT o1 answered 89.0% of questions correctly, requiring 10 seconds per question. ChatGPT o1’s accuracy did not significantly differ across question categories (93.5% accurate on questions about landmark studies). DeepSeek-R1 used 7.2% more tokens than ChatGPT o1. At February 2025 prices, DeepSeek-R1 costs up to $1.56, compared with ChatGPT’s $37.96.</div></div><div><h3>Conclusion</h3><div>DeepSeek-R1 is less accurate and answers more slowly compared with ChatGPT o1, but is less costly at the time of this manuscript preparation. Careful analysis and consideration of the current landscape and performance of each model is needed before implementation of DeepSeek-R1 or ChatGPT o1 to determine if the added financial costs of ChatGPT o1 are within the intended goals of improved accuracy and efficiency.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101929"},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Experience Comparing Reduced Planning Target Volume Margins Using Cone Beam Computed Tomography Scan Guided Online Adaptive Radiation Therapy to Nonadaptive, Traditional Margin Plans for Muscle-Invasive Bladder Cancer","authors":"Samuel B. Hayworth MD ,&nbsp;Whitney S. Hotsinpiller MD ,&nbsp;Joel Pogue PhD ,&nbsp;Melissa Tyler CMD ,&nbsp;Joseph Harms PhD ,&nbsp;Carlos Cardenas PhD ,&nbsp;Dennis Stanley PhD ,&nbsp;Andrew McDonald MD, MS","doi":"10.1016/j.adro.2025.101934","DOIUrl":"10.1016/j.adro.2025.101934","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) for muscle-invasive bladder cancer (MIBC) requires substantial planning target volume (PTV) margins to accommodate bladder-filling variability. We hypothesized that cone beam computed tomography (CBCT) scan guided online adaptive (AD) RT (oART) improves target coverage while reducing normal tissue exposure compared with non-AD RT.</div></div><div><h3>Methods and Materials</h3><div>Over the course of a year, 8 patients with MIBC received oART. Five patients received 55 Gy in 20 fractions to a clinical target volume (CTV) that was expanded from the transurethral resection of a bladder tumor bed and 46 Gy to the remaining bladder; in contrast, 3 patients had the entire bladder designated as the high-dose CTV. PTVs were 7 mm isometric expansions of CTVs for AD treatment and non-AD (scheduled [SC]) treatment plans versus 15 mm for conventional large margin (LM) treatment plans. Target coverage and organ-at-risk (OAR) dosimetry for AD treatment plans were compared with SC and LM treatment plans per fraction using the Wilcoxon paired test. Total treatment time and acute toxicities were assessed.</div></div><div><h3>Results</h3><div>The AD treatment plan was selected for the delivery of all fractions. Daily bladder volumes differed from simulation by a mean of 60 (SD, ± 66) cc. The CTV D98% &gt; 98% was met for 160 (100%) of fractions with AD treatment plans versus 140 (87.5%) for LM and 67 (41.9%) with SC treatment plans. The CTV_high V90% = 100% for all AD treatment plans. Besides rectum_V30, AD treatment plans reduced OAR exposure for all metrics. Target and OAR objectives were met for 62.3%, 55.4%, and 91.2% of SC, LM, and AD treatment plans, respectively. Median fraction time was 24.7 minutes. Acute toxicity included only 3 grade 1 toxicity events and 2 grade 2 genitourinary or gastrointestinal toxicity events, with no occurrences of grade 3 or higher.</div></div><div><h3>Conclusions</h3><div>oART achieved acceptable dosimetry for target volumes with a reduced PTV margin of 7 mm, despite considerable daily bladder volume variation. AD treatment plans improved target coverage and OAR dosimetry. Future patient-centered studies should explore the long-term clinical impact of reduced margin of oART for MIBC.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101934"},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}