Advances in Radiation Oncology最新文献

{"title":"Rotationally Intensified Proton Lattice: A Novel Lattice Technique Using Spot-Scanning Proton Arc Therapy","authors":"Joseph S. Lee MD, PhD ,&nbsp;Derek A. Mumaw MD ,&nbsp;Peilin Liu MS ,&nbsp;Bailey A. Loving MD ,&nbsp;Ebin Sebastian MBBS ,&nbsp;Xiaoda Cong MS ,&nbsp;Mark S. Stefani PhD ,&nbsp;Brian F. Loughery PhD ,&nbsp;Xiaoqiang Li PhD ,&nbsp;Rohan Deraniyagala MD ,&nbsp;Muayad F. Almahariq MD, PhD ,&nbsp;Xuanfeng Ding PhD ,&nbsp;Thomas J. Quinn MD","doi":"10.1016/j.adro.2024.101632","DOIUrl":"10.1016/j.adro.2024.101632","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to explore the feasibility and dosimetric advantage of using spot-scanning proton arc (SPArc) for lattice radiation therapy in comparison with volumetric-modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) lattice techniques.</div></div><div><h3>Methods</h3><div>Lattice plans were retrospectively generated for 14 large tumors across the abdomen, pelvis, lung, and head-and-neck sites using VMAT, IMPT, and SPArc techniques. Lattice geometries comprised vertices 1.5 cm in diameter that were arrayed in a body-centered cubic lattice with a 6-cm lattice constant. The prescription dose was 20 Gy (relative biological effectiveness [RBE]) in 5 fractions to the periphery of the tumor, with a simultaneous integrated boost of 66.7 Gy (RBE) as a minimum dose to the vertices. Organ-at-risk constraints per American Association of Physicists in Medicine Task Group 101were prioritized. Dose-volume histograms were extracted and used to identify maximum, minimum, and mean doses; equivalent uniform dose; D95%, D50%, D10%, D5%; V19Gy; peak-to-valley dose ratio (PVDR); and gradient index (GI). The treatment delivery time of IMPT and SPArc were simulated based on the published proton delivery sequence model.</div></div><div><h3>Results</h3><div>Median tumor volume was 577 cc with a median of 4.5 high-dose vertices per plan. Low-dose coverage was maintained in all plans (median V19Gy: SPArc 96%, IMPT 96%, VMAT 92%). SPArc generated significantly greater dose gradients as measured by PVDR (SPArc 4.0, IMPT 3.6, VMAT 3.2; SPArc-IMPT <em>P</em> = .0001, SPArc-VMAT <em>P</em> &lt; .001) and high-dose GI (SPArc 5.9, IMPT 11.7, VMAT 17.1; SPArc-IMPT <em>P</em> = .001, SPArc-VMAT <em>P</em> &lt; .01). Organ-at-risk constraints were met in all plans. Simulated delivery time was significantly improved with SPArc compared with IMPT (510 seconds vs 637 seconds, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>SPArc therapy was able to achieve high-quality lattice plans for various sites with superior gradient metrics (PVDR and GI) when compared with VMAT and IMPT. Clinical implementation is warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101632"},"PeriodicalIF":2.2,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427409","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 Outcomes and Prognostic Factors of Chemotherapy Combined With Radiation Therapy for Patients With Early-Stage Extranodal Natural Killer/T-Cell Lymphoma","authors":"Shu-Bei Wang MD ,&nbsp;Jia-Yi Chen MD ,&nbsp;Wei-Li Zhao MD ,&nbsp;Cheng Xu MD ,&nbsp;Wei-Guo Cao MD ,&nbsp;Yi-Min Han MD ,&nbsp;Shu Cheng MD ,&nbsp;Peng-Peng Xu MD ,&nbsp;Hui-Juan Zhong MD ,&nbsp;Gang Cai MD","doi":"10.1016/j.adro.2024.101647","DOIUrl":"10.1016/j.adro.2024.101647","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to assess the treatment outcomes, toxicity, and potential prognostic factors in patients with early-stage extranodal natural killer/T-cell lymphoma treated with radiation therapy combined with chemotherapy.</div></div><div><h3>Methods and Materials</h3><div>One hundred eighteen patients with stage I/II extranodal natural killer/T-cell lymphoma who were treated with radiation therapy combined with chemotherapy were retrospectively analyzed between July 2003 and January 2019. The median dose was 50 Gy (Range, 45-61.2 Gy). The Kaplan-Meier method was used to calculate progression-free survival and overall survival. The patients were scored according to their prognostic indices.</div></div><div><h3>Results</h3><div>The overall and complete response rates were 93.2% and 82.2%, respectively. At a median follow-up of 43 months, the 5-year overall survival and progression-free survival rates were 73.9% and 68.4%, respectively. Adverse events of grade 3 or higher were observed in 20 patients (16.9%). Patients with primary disease in the Waldeyer's ring had poorer survival (<em>P</em> = .015). Compared with anthracycline-based regimens, non–anthracycline-based regimens significantly improved the 5-year overall survival (76.6% vs 54.8%, <em>P</em> = .027) and progression-free survival (72.4% vs 53.1%, <em>P</em> = .013). After treatment, the 5-year overall survival rate was 78.6% in complete response patients versus 44.9% in noncomplete response patients (<em>P</em> = .003). For patients with low- and intermediate-low-risk according to the nomogram-revised risk index model, the complete response rate was 100%. When primary lesion data were added to the nomogram-revised risk index as the basis for another prognostic index (modified nomogram-revised risk index), the low-risk (0 to 2 risk factors) and high-risk (3 or more risk factors) categories were noted (84.2% vs 62.2%, <em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>Patients with early-stage extranodal natural killer/T-cell lymphoma had high response rates and favorable survival rates with radiation therapy and non–anthracycline-based chemotherapy regimens. Patients who achieved complete response had better survival than those who did not. The extranodal natural killer/T-cell lymphoma-specific prognostic models may require further optimization.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101647"},"PeriodicalIF":2.2,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527863","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":"Dosimetric Evaluation of Hippocampus Sparing Intensity Modulated Radiation Therapy in Patients With Stage T1-T2 and Stage T3-T4 Nasopharyngeal Carcinoma","authors":"Xiaofeng Zhou MD ,&nbsp;Kui Wu MPhys ,&nbsp;Niharika Prasad BDS ,&nbsp;Sanjay Jaiswal PhD ,&nbsp;Biao Jiang ,&nbsp;Xia Li MPhys ,&nbsp;Wenzheng Sun PhD ,&nbsp;Lingli Mao PhD ,&nbsp;Kanghua Huang PhD ,&nbsp;Minghan Shi PhD ,&nbsp;Shen Li ,&nbsp;Qichun Wei MD, PhD","doi":"10.1016/j.adro.2024.101646","DOIUrl":"10.1016/j.adro.2024.101646","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the hippocampus (HPC) dose reduced by HPC-sparing intensity modulated radiation therapy (IMRT) plans between nasopharyngeal carcinoma (NPC) patients of stages T1-T2 and T3-T4, and to investigate the correlation between the dose of the HPC and the volume of PTV_nx70 (the planning target volume of the primary tumor in the nasopharynx that received 70 Gy).</div></div><div><h3>Methods and Materials</h3><div>Fifty-eight NPC patients were retrospectively evaluated. HPC-nonsparing IMRT or sparing IMRT for each patient was designed according to the protocol for NPC. Dose-volume histogram was used to evaluate the IMRT plans for each patient. The difference in values of HPC parameters (eg, D_min[NS] – D_min[S]) between HPC-sparing and nonsparing plans in the stage T1-T2 group and stage T3-T4 group were compared. The correlations between the dose of the HPC and the volume of PTV_nx70 were analyzed.</div></div><div><h3>Results</h3><div>There was no significance between HPC-sparing and nonsparing IMRT plans. Compared with the HPC-nonsparing plans, the HPC-sparing plans significantly decreased both dosimetric and volumetric parameters for the HPC (<em>P</em> &lt; .05), except for D_min, D_98%, and V₅. The medians of D_median[NS] – D_median[S], D_mean[NS] – D_mean[S], D_40%[NS] – D_40%[S], V₃₀[NS] – V₃₀[S], V₄₀[NS] – V₄₀[S] and V₅₀[NS] – V₅₀[S] in the T1-T2 group were significantly lower than in the T3-T4 group (<em>P</em> &lt; .05), respectively. Both dosimetric and volumetric parameters for the HPC were positively correlated with the volume of PTV_nx70 in HPC-sparing and HPC-nonsparing plans (<em>P</em> &lt; .05). The volume of PTV_nx70 was positively correlated with D_median[NS] – D_median[S], D_mean[NS] – D_mean[S], D_40%[NS] – D_40%[S], V₄₀[NS] – V₄₀[S] and V₅₀[NS] – V₅₀[S] (<em>P</em> &lt; .05).</div></div><div><h3>Conclusions</h3><div>HPC-sparing IMRT plans may play a more significant role in decreasing D_median, D_mean, D_40%, and V₃₀-V₅₀ of HPC in NPC patients with stages T3-T4 than those in stages T1-T2. PTV_nx70 volume of NPC patients is positively correlated with all dosimetric and volumetric parameters of HPC and the reduction of specific dosage parameters by HPC-sparing IMRT plans.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101646"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427446","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":"Ultra–Low-Dose Radiation for Extranodal Marginal Zone Lymphoma of the Lung","authors":"Susan Y. Wu MD ,&nbsp;Penny Q. Fang MD, MBA ,&nbsp;Ahmed Fetooh MBBS ,&nbsp;Gohar S. Manzar MD, PhD ,&nbsp;Kelsey L. Corrigan MD, MPH ,&nbsp;Benjamin R. Schrank MD, PhD ,&nbsp;Lewis Nasr MD, MS ,&nbsp;Dai Chihara MD, PhD ,&nbsp;Luis E. Malpica Castillo MD ,&nbsp;Ranjit Nair MD ,&nbsp;Raphael E. Steiner MD ,&nbsp;Preetesh Jain MBBS, MD, DM, PhD ,&nbsp;Sattva S. Neelapu MD ,&nbsp;Paolo Strati MD ,&nbsp;Loretta J. Nastoupil MD ,&nbsp;Bouthaina S. Dabaja MD ,&nbsp;Chelsea C. Pinnix MD, PhD ,&nbsp;Jillian R. Gunther MD, PhD","doi":"10.1016/j.adro.2024.101648","DOIUrl":"10.1016/j.adro.2024.101648","url":null,"abstract":"<div><h3>Purpose</h3><div>Definitive intent radiation therapy (RT) for early-stage mucosa-associated lymphoid tissue (MALT) lymphoma typically includes a dose of 24 to 30 Gy. While modest, these doses may have associated toxicity. For patients with indolent B-cell lymphoma, there is increasing support for the use of ultra–low-dose RT (ULDRT) using 4 Gy in 2 fractions as part of a response-adapted approach, as high rates of complete response have been documented. This paradigm has been prospectively evaluated in the management of orbital and gastric indolent B-cell lymphomas; however, there is limited data guiding the use of ULDRT for lung MALT.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 20 patients at our institution with lung MALT treated with ULDRT as part of a response-adapted approach. Clinical variables including prior systemic therapy and symptoms were abstracted from the electronic health record. Responses were assessed using the revised Lugano criteria.</div></div><div><h3>Results</h3><div>At a median follow up of 17 months following 4 Gy (IQR, 8-37 months), we observed 100% local control. Nineteen patients (95%) experienced a complete response. No patients with stage IE disease at RT (17/20; 85%) experienced distant progression. Nine patients (45%) were symptomatic prior to RT, with improvement or resolution of symptoms in 7 (7/9; 78%). One patient developed grade 2 pleuritic pain following RT, which resolved with a brief course of steroids. No other toxicities were noted.</div></div><div><h3>Conclusions</h3><div>ULDRT, given in a response-adapted approach, is effective and well tolerated by patients with lung MALT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101648"},"PeriodicalIF":2.2,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527777","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":"Fifteen-Year Experience of a Single Institution: Outcomes for Early-Stage Hodgkins Lymphoma Comparing Chemotherapy Alone Versus Combined Modality Therapy","authors":"Joshua Y. Qian MD ,&nbsp;Radhesh Amin BS ,&nbsp;Humzah Ali BS ,&nbsp;Yichun Cao MPH ,&nbsp;Jeffrey M. Switchenko PhD ,&nbsp;Arif S. Rashid MD ,&nbsp;Pamela B. Allen MD ,&nbsp;Sheela Hanasoge MBBS, PhD ,&nbsp;Mohammad K. Khan MD, PhD","doi":"10.1016/j.adro.2024.101636","DOIUrl":"10.1016/j.adro.2024.101636","url":null,"abstract":"<div><h3>Purpose</h3><div>Doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy is the current standard treatment for early-stage Hodgkins lymphoma (HL). The use of consolidative radiation therapy (RT) in addition to chemotherapy may lead to better survival rates but is controversial because of concerns about long-term toxicity. The aim of this study is to compare outcomes of patients receiving ABVD chemotherapy alone (CTX alone) versus ABVD with consolidative RT (CMT).</div></div><div><h3>Methods and Materials</h3><div>A single-institution, retrospective review of patients with HL diagnosed from 2000 to 2014 was conducted. Patients were identified from the National Cancer Database. Inclusion criteria included patients aged ≥18 years, with stage I or II HL, who received ABVD with a complete response with/without CMT. Consolidative RT must have been started within 90 days of completing chemotherapy. Institutional review board approval was obtained. Follow-up details and treatment responses were collected from medical record reviews. Standard statistical analysis and Kaplan-Meier curves were used to estimate relapse-free survival (RFS).</div></div><div><h3>Results</h3><div>One hundred and 8 patients with early-stage HL were identified. The median age at diagnosis was 31 years (range, 19-72). Most patients were female (63%) and Caucasian (65%). stage II HL was present in 89%of patients, 89% had an Eastern Cooperative Oncology Group score of 0 or 1, 35% had B symptoms, and 9% had extranodal involvement. A total of 52.8% received CMT (<em>n</em> = 57) and 47.2% received CTX alone (<em>n</em> = 51). The CMT group had fewer cycles of chemotherapy compared to the CTX-alone group (mean cycles, 5.2 vs 5.7, <em>P</em> = 0.045). Twenty-four relapse events occurred in the CTX-alone group, while no relapse events occurred in the CMT group. RFS at 10 years was significantly improved in the CMT group (100%) compared to CTX alone (47.4%, <em>P</em> &lt; .0001; HR = .03, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>ABVD with consolidative RT was associated with improved RFS. Further studies of toxicity comparisons, advanced stages, and nonfavorable HL are warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101636"},"PeriodicalIF":2.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142537582","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":"Use of Virtual CT and On-Treatment MRI to Reduce Radiation Dose and Anesthesia Exposure Associated With the Adaptive Workflow in Pediatric Patients Treated With Intensity Modulated Proton Therapy","authors":"Khadija Sheikh PhD ,&nbsp;Ryan Oglesby PhD ,&nbsp;William T. Hrinivich PhD ,&nbsp;Heng Li PhD ,&nbsp;Matthew M. Ladra MD ,&nbsp;Sahaja Acharya MD","doi":"10.1016/j.adro.2024.101634","DOIUrl":"10.1016/j.adro.2024.101634","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to determine whether virtual computed tomography (vCT) derived from daily cone beam computed tomography (CBCT), or on-treatment magnetic resonance imaging (MRI_tx) can replace quality assurance computed tomography (qCT) in our clinical workflow to minimize imaging dose and potentially anesthesia exposure in patients requiring plan adaptation.</div></div><div><h3>Methods and Materials</h3><div>Pediatric patients (age &lt;24 years) treated from 2020 to 2023 with intensity modulated proton therapy with at least 1 qCT during proton therapy were eligible. For cases that required plan adaptation, the dose was recalculated on vCT and compared with same-day qCT as well as the original planning computed tomography (pCT). Anatomic changes triggering plan adaptation were grouped into categories. Two pediatric radiation oncologists verified whether these changes could be detected using CBCT, qCT, and/or MRI_tx. A new adaptive imaging workflow was proposed to limit imaging dose and anesthesia exposure.</div></div><div><h3>Results</h3><div>One hundred sixty-eight pediatric patients were treated from 2020 to 2023. Across all patients, there were 517 qCT scans and 61 MRI_tx acquired. The median number of qCT scans per patient was 3 (range, 1-5). The treatment plans for 20 patients (12%) were adapted. In all patients requiring plan adaptation, there was a correlation between dose differences in target coverage and maximum body dose when comparing vCT with pCT and qCT with pCT (n = 20, r² = 0.79, <em>P</em> &lt; .01, and r² = 0.32 <em>P</em> = .01, respectively). The most common reason for adaptation was tissue change (eg, inflammation, changes in abdominal gas, or diaphragmatic variability) in the beam path (10/20) and changes in tumor volume (6/20). All cases of weight change, tissue change in beam path, and unreproducible setup could be detected on CBCT. All cases of change in tumor volume within the brain were detected on MRI_tx. Replacing the qCT with the vCT was associated with an estimated median reduction of imaging dose by 50% and anesthesia exposure by 1.5 hours.</div></div><div><h3>Conclusions</h3><div>vCT derived from daily CBCT only or MRI_tx can safely replace qCT for monitoring dosimetric changes to trigger a new pCT in our clinical workflow. This change would potentially reduce imaging dose and anesthesia exposure.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101634"},"PeriodicalIF":2.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427408","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":"Five-Year Prostate-Specific Membrane Antigen Positron Emission Tomography-Based Outcomes of Spot-Scanning Proton Radiation Therapy for Localized Prostate Cancer: A Single Institution Experience","authors":"Will Sperduto MD ,&nbsp;Molly M. Voss BS ,&nbsp;Brady Laughlin MD ,&nbsp;Diego A.S. Toesca MD ,&nbsp;William W. Wong MD ,&nbsp;Sameer R. Keole MD, FASTRO ,&nbsp;Jean-Claude M. Rwigema MD ,&nbsp;Nathan Y. Yu MD ,&nbsp;Steven E. Schild MD ,&nbsp;Sarah E. James MD, PhD ,&nbsp;Thomas B. Daniels MD ,&nbsp;Todd A. DeWees PhD ,&nbsp;Carlos E. Vargas MD","doi":"10.1016/j.adro.2024.101639","DOIUrl":"10.1016/j.adro.2024.101639","url":null,"abstract":"<div><h3>Purpose</h3><div>We report 5-year oncologic outcomes of a prospective series of patients with prostate cancer treated with spot-scanning proton therapy (SSPT).</div></div><div><h3>Methods and Materials</h3><div>A prospective registry identified patients with prostate cancer treated with SSPT between January 2016 and December 2018. Five-year overall survival, local control, biochemical failure, regional and distant failures, and adverse events (AEs) were assessed. Biochemical failure was defined as rise in prostate-specific antigen ≥ 2.0 ng/mL above nadir prostate-specific antigen. Baseline-adjusted toxicities were assigned using the Common Terminology Criteria for Adverse Events version 5.0.</div></div><div><h3>Results</h3><div>With a median follow-up of 4.4 years, 284 patients with prostate cancer were treated with SSPT. Median total radiation dose was 79.2 Gy over 44 fractions, 70 Gy over 28 fractions, and 38 Gy over 5 fractions for conventional fractionation (CF), hypofractionation (HF), and stereotactic body radiation therapy (SBRT), respectively. Biochemical failure rate for all patients was 6.7%. Five-year local control rates for CF, HF, and SBRT were 100%, 100%, and 97.3%, respectively (<em>P</em> = .07). Regional recurrences occurred in 12 (4.2%) patients: 8 treated with CF, 2 with HF, and 2 with SBRT (<em>P</em> = .62). Distant failures occurred in 12 patients (4.2%): 5 treated with CF, 7 with HF, and none with SBRT (<em>P</em> = .05). Five-year overall survival for patients treated with CF, HF, and SBRT SSPT were 88.1%, 86.1%, and 97.2%, respectively (<em>P</em> = .1). Acute and chronic grade 2+ gastrointestinal AEs occurred in 8 (2.8%) and 51 (18.0%) patients, respectively. Acute and chronic grade 3+ gastrointestinal AEs occurred in 3 (1.1%) and 4 (1.4%) patients, respectively. Acute and chronic grade 2+ genitourinary-related AEs were observed in 71 (25%) and 63 (22.2%) patients, respectively. Acute and chronic grade 3+ genitourinary toxicity were observed in 3 (1.1%) and 6 (2.1%) patients, respectively.</div></div><div><h3>Conclusions</h3><div>SSPT provides high local control rates and excellent oncologic outcomes across different fractionation schedules with low long-term AE rates.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101639"},"PeriodicalIF":2.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427444","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":"Long-Term Imaging Follow-up of Radiation Necrosis After Stereotactic Radiosurgery: A Case Report and Lessons Learned","authors":"Mashal Ahmed MSc ,&nbsp;Timothy K. Nguyen MD ,&nbsp;Stephanie Gulstene MD","doi":"10.1016/j.adro.2024.101633","DOIUrl":"10.1016/j.adro.2024.101633","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101633"},"PeriodicalIF":2.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427443","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 Fletcher-Cox Pathway: A Unique View on Clinical Trial Education","authors":"Shalini Moningi MD ,&nbsp;Shane Stecklein MD, PhD ,&nbsp;Sonal Noticewala MD, MAS ,&nbsp;Olsi Gjyshi MD ,&nbsp;Todd Pezzi MD ,&nbsp;David Boyce-Fappiano MD ,&nbsp;Prajnan Das MD, MS, MPH ,&nbsp;Bruce Minsky MD ,&nbsp;Emma B. Holliday MD ,&nbsp;Andrew J. Bishop MD ,&nbsp;Albert C. Koong MD, PhD ,&nbsp;Chelsea C. Pinnix MD, PhD","doi":"10.1016/j.adro.2024.101637","DOIUrl":"10.1016/j.adro.2024.101637","url":null,"abstract":"<div><h3>Purpose</h3><div>There currently are no established formal mentorship and training programs for radiation oncology (RO) trainees to learn trial design, creation, writing, or implementation. There only exists informal training on analyzing clinical trials in RO residency programs. The integration of a longitudinal formal training and mentorship program for clinical trialists—consisting of clinical trial education, design, mentorship, and implementation during the RO residency education—will give residents not only formal teaching in the subject but also strong tools and requisite mentorship in hopes to help them succeed as future academic physicians and leaders in the field of RO.</div></div><div><h3>Methods and Materials</h3><div>We developed a clinical trial training pathway in 2018 at MD Anderson Cancer Center, proposing it as a pilot program. The “Fletcher-Cox Pathway” was accepted with a highly positive response by trainees and is now offered as a standard option to RO trainees at our institution.</div></div><div><h3>Results</h3><div>With the guidance of their principal investigator, residents participating in this pathway design and submit a clinical trial for institutional review board review. In 2019, after implementation of the pilot program, 4 of the incoming 7 residents joined the pathway. The program continues, and the current cohort of trainees have received training in clinical trial design and worked with dedicated mentor(s) regarding clinical trial ideas; their studies are currently accruing patients.</div></div><div><h3>Conclusions</h3><div>This pilot program has been viewed by trainees and mentors as successful; it highlights how a structured approach meets a clear need within RO training. We envision the creation of a national platform to increase access, whereby programs adopt this clinical trialist educational pathway, which ultimately leads to the development of a robust clinical trial community with communal resources. We hope that this not only improves and provides educational initiatives to all trainees but also initiates further collaboration.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101637"},"PeriodicalIF":2.2,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527861","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":"Stereotactic Body Radiation Therapy for Palliative Reirradiation of Acrometastasis in the Hand From Breast Cancer","authors":"Thomas R. Mazur PhD ,&nbsp;H Michael Gach PhD ,&nbsp;Joshua P. Schiff MD ,&nbsp;Laura L. Ochoa PhD ,&nbsp;Michael J. Naughton MD ,&nbsp;Imran Zoberi MD","doi":"10.1016/j.adro.2024.101630","DOIUrl":"10.1016/j.adro.2024.101630","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101630"},"PeriodicalIF":2.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653612","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}