Advances in Radiation Oncology最新文献_第2页

Endoscopic Spacer-Assisted Stereotactic Body Radiation Therapy for Abdominal Oligometastases: A Novel Technique to Reduce Gastrointestinal Toxicity 内镜间隔辅助立体定向放射治疗腹部少转移：一种减少胃肠道毒性的新技术

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-06 DOI: 10.1016/j.adro.2025.101975

Sasha Ebrahimi MD, PhD, Jonathan Pham PhD, Albert J. Chang MD, PhD

引用次数: 0

Comparison of Local Medicare Guidance and Medicare Advantage Plans for Stereotactic Radiosurgery for Brain Metastases 脑转移瘤立体定向放射治疗的地方医疗保险指导和医疗保险优势计划的比较

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-05 DOI: 10.1016/j.adro.2025.101974

Dominic LaBella MD, Eileen Battershall, Zachary J. Reitman MD, PhD, Scott R. Floyd MD, PhD, Eugene J. Vaios MD, John P. Kirkpatrick MD, PhD, Paul Sperduto MD, Trey C. Mullikin MD

Purpose

Medicare Advantage operates under a capitated payment model, where Medicare Advantage Organizations (MAOs) must provide services that meet or exceed Medicare Parts A and B standards, ensuring actuarial equivalence. MAOs are mandated to base their coverage determinations on medical necessity, aligning with Medicare's national and local coverage determinations (LCD) policies.

Methods and Materials

This study evaluates coverage policies for stereotactic radiosurgery (SRS) for brain metastases (BM) across our institution's local LCD and various MAOs, including Cigna, Aetna, UnitedHealthcare, Humana, and Anthem. The CMS LCD L39553 (CMS) serves as the benchmark, deeming SRS medically necessary for new BM and repeat BM therapy if the patient has each of the following: good performance status (Karnofsky Performance Status ≥70 or Eastern Cooperative Oncology Group Performance Status 0-2), absence of leptomeningeal metastases, and no primary diagnosis of lymphoma, germ cell tumor, or small cell carcinoma. For repeat BM, CMS also requires stable extracranial disease and a life expectancy over 6 months. Additionally, SRS may be indicated for relapses in previously irradiated cranial fields to minimize normal tissue injury. Five MAO policies were reviewed, revealing alignment with LCD criteria in several areas but also presenting additional, sometimes more restrictive, requirements.

Results

For new BM, all MAOs required good performance status, with most also considering histology and absence of leptomeningeal metastases. Some MAOs introduced criteria like systemic therapy options, lesion number/volume, and BM size. For repeat BM, most MAOs required stable extracranial disease and occasionally considered life expectancy. Additional criteria included the number of BM over a year and postoperative SRS guidelines for lesion size and number.

Conclusions

Despite general concordance, the added criteria by MAOs could impose more stringent requirements than CMS, potentially resulting in coverage denials. It is important that MAO policies remain consistent with evidence-based guidelines to avoid disparities that could impact patient treatments.

医疗保险优势在资本化支付模式下运作，医疗保险优势组织（MAOs）必须提供符合或超过医疗保险a部分和B部分标准的服务，确保精算等效。要求mao根据医疗需要确定其覆盖范围，与Medicare的国家和地方覆盖范围确定（LCD）政策保持一致。方法和材料本研究评估了我院本地LCD和各种MAOs（包括Cigna， Aetna, UnitedHealthcare， Humana和Anthem）脑转移瘤（BM）立体定向放射手术（SRS）的覆盖政策。CMS LCD L39553 （CMS）作为基准，认为SRS在医学上对于新BM和重复BM治疗是必要的，如果患者具有以下每一项：良好的性能状态（Karnofsky性能状态≥70或Eastern Cooperative Oncology Group性能状态0-2），没有脑膜轻转移，没有淋巴瘤、生殖细胞肿瘤或小细胞癌的初步诊断。对于重复BM， CMS还要求稳定的颅外疾病和6个月以上的预期寿命。此外，SRS可用于先前照射过的颅野复发，以尽量减少正常组织损伤。审查了五项MAO政策，揭示了在几个领域与LCD标准的一致性，但也提出了额外的，有时更具限制性的要求。结果对于新发BM，所有MAOs都需要良好的性能状态，大多数还考虑组织学和无脑膜转移。一些MAOs引入了诸如全身治疗选择、病变数量/体积和脑基大小等标准。对于重复BM，大多数MAOs需要稳定的颅外疾病，偶尔考虑预期寿命。其他标准包括一年内BM的数量和术后SRS指南的病变大小和数量。结论尽管大体一致，MAOs增加的标准可能比CMS要求更严格，可能导致拒绝覆盖。重要的是，MAO政策应与循证指南保持一致，以避免可能影响患者治疗的差异。

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引用次数: 0

Impact of Quality Improvement Interventions on the Efficiency of Treatment Planning Timelines in a Modern Proton Therapy Clinic 质量改善干预对现代质子治疗诊所治疗计划时间表效率的影响

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-29 DOI: 10.1016/j.adro.2025.101895

Kristen A. McConnell PhD, MBA , Maria Valladares BS , Alonso N. Gutierrez PhD, MBA , Nicole Luther BS , Zachary Fellows BS , Lorrie LeGrand MHSc , Michael Chuong MD , Minesh P. Mehta MD , Andrew Wroe PhD

Purpose

Following the guidance of The American Association of Physicists in Medicine (AAPM) Medical Physics Practice Guideline (MPPG) 4a/4b, AAPM Task Groups 100/275, and American Society for Radiation Oncology’s Safety is No Accident, our institution focused on quality improvement to streamline clinical workflows, enable complex treatments, standardize procedures, and positively evolve our practice in proton radiation therapy. A retrospective institutional analysis was completed to map interventions identified prior to data analysis that were likely to affect the evolution of the treatment planning timelines.

Methods and Materials

Care Paths within our Oncology Information System were used to sequence and track clinical workflows since 2017. Data were mined between 2017 to 2023 to obtain the task’s completion and expected completion dates. The task completion offset was calculated to measure the number of days late or early the task was completed. Five quality management interventions were mapped onto control charts for each task to identify the evolution of the practice with each intervention. Average time, SDs, and statistical significance before and after each intervention were also computed. Additionally, total treatment planning times were computed for each patient and histograms, average time, median time, and standard error of the mean were computed and compared by year.

Results

Task completion offsets improved from being, on average, 1.59 to 2.63 days late to 0.06 to 2.25 days early, with control charts visually showing the reduction in mean value, reduction in SD, and ultimately, the processes falling more into control. Interventions 1, 2, and 3 showed the strongest overall statistical impact on task completion offsets. Overall, planning timelines improved from a median of 19 days to 11 days. More importantly, the distributions of overall planning time and spread of these times became Gaussian, demonstrating the characteristics of normalized activity patterns, with a reduction in variability.

Conclusions

The interventions identified before data collection were well associated with the evolution of the treatment planning timeline data. When quantifying with control charts, there were noted decreased task completion offset variabilities across many examined tasks. Additionally, the data showed shortened overall planning timelines during the time that the complexity of protons plans was increased, newer delivery approaches were made available, and more complex clinical scenarios were incorporated.

目的根据美国医学物理学家协会（AAPM）医学物理实践指南（MPPG） 4a/4b、AAPM任务组100/275和美国放射肿瘤学会的安全无事故指南的指导，我们的机构专注于质量改进，以简化临床工作流程，实现复杂治疗，标准化程序，并积极发展我们在质子放射治疗方面的实践。完成了一项回顾性机构分析，以绘制在数据分析之前确定的可能影响治疗计划时间表演变的干预措施。自2017年以来，我们的肿瘤信息系统中的方法和材料路径用于对临床工作流程进行排序和跟踪。数据在2017年至2023年之间进行挖掘，以获得任务的完成和预期完成日期。计算任务完成偏移量来衡量任务晚或早完成的天数。五个质量管理干预措施被映射到每个任务的控制图上，以确定每个干预措施的实践演变。计算每次干预前后的平均时间、标准差和统计学显著性。此外，计算每位患者的总治疗计划时间，并计算直方图、平均时间、中位时间和平均值的标准误差，并按年进行比较。结果任务完成偏移量从平均延迟1.59 - 2.63天提高到提前0.06 - 2.25天，控制图直观地显示了平均值的降低，SD的降低，最终过程更加可控。干预措施1、2和3对任务完成抵消的总体统计影响最强。总体而言，计划时间从19天的中位数提高到11天。更重要的是，总体规划时间的分布和这些时间的分布变成了高斯分布，显示了标准化活动模式的特征，变异性减少了。结论在数据收集之前确定的干预措施与治疗计划时间表数据的演变密切相关。当用控制图进行量化时，在许多被检查的任务中，任务完成度的减少抵消了变量。此外，数据显示，随着质子计划的复杂性增加，更新的交付方法可用，以及更复杂的临床场景被纳入，整体计划时间表缩短。

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引用次数: 0

Dosimetric Feasibility of Dose-Painting Radiation Therapy for Targeting Hypoxia in Prostate Cancer on a Novel Ring Gantry Radiation Therapy System 新型环形龙门放射治疗系统中针对前列腺癌缺氧的剂量涂片放射治疗的剂量学可行性

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-29 DOI: 10.1016/j.adro.2025.101940

Tanguy Perennec MD, MSc , Karine A. Al Feghali MD , Dorine de Jong PhD , Oluwaseyi M. Oderinde PhD , Grant Gibbard PhD , Mélanie Dore MD, MSc , Gregory Delpon PhD , Moignier Alexandra PhD , Yves Seroux , Ludovic Ferrer PhD , Matthieu Hatt PhD , Caroline Rousseau MD, PhD , Stéphane Supiot MD, PhD

Purpose

Hypoxia is a well-known major factor contributing to the radioresistance of prostate cancer, which could be counteracted by increasing the dose. This study aimed to demonstrate the dosimetric feasibility of a dose-painting radiation therapy plan for prostate cancer, using a novel ring gantry system, based on the localization of tumoral and hypoxic areas.

Methods and Materials

Seven patients from the Programme d’Action Intégré de Recherche-prostate study, who underwent external-beam radiation therapy for intermediate-risk prostate cancer and exhibited pretherapeutic fluromisonodazole positron emission tomography (PET) uptake in the tumor, were selected. The gross tumor volume (GTV) was delineated on the magnetic resonance imaging, and the hypoxic region within the planning target volume was delineated based on fluromisonodazole PET uptake. Intensity modulated radiation therapy planning was performed based on 3 different prescriptions: standard fractionation (77 Gy in 35 fractions to the planning target volume), with an integrated boost of 95 Gy and 118 Gy in 35 fractions to the GTV and the hypoxic region, moderate hypofractionation (60 Gy in 20 fractions) with a boost of 67 Gy and 91 Gy to the GTV and the hypoxic region, and high hypofractionation (40 Gy in 5 fractions) with a boost of 50 Gy to the GTV and as high as possible to the hypoxic region. Planning was performed on the research version of the RefleXion treatment planning system.

Results

We achieved the prescribed dose in all 7 patients while respecting the usual dose limits for organs at risk.

Conclusions

This study demonstrated the dosimetric feasibility of dose escalation in both the tumor and hypoxic regions in patients with prostate cancer using the RefleXion treatment planning system, without compromising the dose limits for organs at risks.

目的缺氧是引起前列腺癌放射耐药的主要因素，可通过增加剂量加以抵消。本研究旨在证明基于肿瘤和缺氧区域定位，使用新型环形龙门系统的前列腺癌剂量涂绘放射治疗计划的剂量学可行性。方法和材料选择7例来自于“国际前列腺研究计划”的患者，他们接受了中等风险前列腺癌的外束放射治疗，并在治疗前肿瘤中出现氟米索诺唑正电子发射断层扫描（PET）摄取。通过磁共振成像划定肿瘤总体积（GTV），并根据氟米索诺唑PET摄取划定规划靶体积内的缺氧区。根据3种不同的处方进行调强放疗计划：标准分馏(77 Gy 35计划靶体积分数),综合提高95 Gy 35和118 Gy分数制造中心和缺氧地区,温和的辐射(60 Gy 20分数)提高67 Gy和91 Gy制造中心和缺氧地区,和高辐射(40 Gy 5分数)的提高50 Gy制造中心和尽可能高的缺氧区域。对RefleXion治疗计划系统的研究版进行规划。结果7例患者均达到处方剂量，且符合危及器官的常用剂量限制。结论：本研究证明了在前列腺癌患者的肿瘤和缺氧区使用反射治疗计划系统进行剂量递增的剂量学可行性，且不影响危及器官的剂量限制。

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引用次数: 0

Radiation Pneumonitis in Breast Cancer Patients With Pre-existing Subpleural Curvilinear Lines Following Postoperative Radiation Therapy: 2 Cases 乳腺癌术后胸膜下曲线患者放射性肺炎2例分析

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-24 DOI: 10.1016/j.adro.2025.101964

Kohei Wakabayashi MD , Kenta Konishi MD , Shuhei Aramaki MD, PhD , Tsutomu Ikenohira MD , Tomoharu Akai MD , Kengo Yoshimitsu MD, PhD , Katsumasa Nakamura MD, PhD

引用次数: 0

Hydrogel Spacer Insertion Prior to Stereotactic Body Radiation Therapy to the Prostate: A Comparative Study 立体定向前列腺放射治疗前的水凝胶间隔置入：一项比较研究

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-22 DOI: 10.1016/j.adro.2025.101966

Myroslav Lutsyk MD , Yosef Landman MD , Eyal Fenig MD

Purpose

The insertion of a hydrogel spacer between the rectum and prostate before stereotactic body radiation therapy (SBRT) for prostate cancer significantly reduces the radiation dose to the rectum. Despite the widespread use of this technique, clinical data remain sparse. The objective of this study was to investigate the clinical benefit of a hydrogel spacer in SBRT.

Methods and Materials

The database of a tertiary medical center was retrospectively searched for all patients with prostate cancer who underwent SBRT, with or without the insertion of a hydrogel spacer, between June 2013 and December 2018. The groups were compared for rectal and urinary toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events v4) using the χ² test and t test. In addition, a subgroup analysis limited to patients receiving 37.5 or 40 Gy in 5 fractions was performed to account for the possible confounding effect of dose variability between the groups. Complications related to the procedure were also evaluated.

Results

The cohort included 308 patients who underwent SBRT with (n = 227) or without (n = 75) the insertion of a hydrogel spacer. Rates of grade 2 or higher rectal toxicity were 31 of 223 patients (13.9%) in the spacer group and 9 of 75 patients (12%) in the nonspacer group. Corresponding rates of urinary grade 2 toxicity were 58 of 223 patients (26%) and 14 of 75 patients (18.6%), respectively. Neither difference was statistically significant. Similar findings were observed in the subgroup analysis. Severe complications related to the procedure occurred in 5 of 227 cases (2.2%).

Conclusions

This study did not demonstrate a significant effect of hydrogel spacer insertion on reducing rectal or urinary toxicity in patients with prostate cancer undergoing SBRT. Given the dual consideration of questionable clinical benefit and the risk of debilitating complications, additional studies should be performed on the selective use of this procedure.

目的在前列腺癌立体定向全身放射治疗（SBRT）前，在直肠和前列腺之间插入水凝胶间隔物可显著降低直肠的放射剂量。尽管这种技术被广泛使用，但临床数据仍然很少。本研究的目的是探讨水凝胶间隔剂在SBRT中的临床疗效。方法和材料回顾性检索某三级医疗中心的数据库，检索2013年6月至2018年12月期间接受SBRT治疗的所有前列腺癌患者，无论是否插入水凝胶垫片。采用χ2检验和t检验比较两组的直肠和泌尿毒性（美国国家癌症研究所不良事件通用术语标准v4）。此外，对接受37.5 Gy或40 Gy 5次剂量的患者进行亚组分析，以解释组间剂量变异性可能产生的混淆效应。与手术相关的并发症也被评估。结果该队列包括308例接受SBRT的患者（n = 227）或未（n = 75）插入水凝胶间隔器。223例患者中间隔剂组有31例（13.9%）发生2级或以上直肠毒性，75例患者中无间隔剂组有9例（12%）发生直肠毒性。223例患者中相应的2级尿毒性发生率为58例（26%），75例患者中相应的14例（18.6%）。两种差异均无统计学意义。在亚组分析中也观察到类似的结果。227例患者中有5例（2.2%）发生严重并发症。结论：本研究未证明水凝胶间隔剂在减少前列腺癌患者接受SBRT的直肠或泌尿毒性方面有显著作用。考虑到可疑的临床益处和衰弱并发症的风险，应该对该手术的选择性使用进行额外的研究。

{"title":"Hydrogel Spacer Insertion Prior to Stereotactic Body Radiation Therapy to the Prostate: A Comparative Study","authors":"Myroslav Lutsyk MD , Yosef Landman MD , Eyal Fenig MD","doi":"10.1016/j.adro.2025.101966","DOIUrl":"10.1016/j.adro.2025.101966","url":null,"abstract":"<div><h3>Purpose</h3><div>The insertion of a hydrogel spacer between the rectum and prostate before stereotactic body radiation therapy (SBRT) for prostate cancer significantly reduces the radiation dose to the rectum. Despite the widespread use of this technique, clinical data remain sparse. The objective of this study was to investigate the clinical benefit of a hydrogel spacer in SBRT.</div></div><div><h3>Methods and Materials</h3><div>The database of a tertiary medical center was retrospectively searched for all patients with prostate cancer who underwent SBRT, with or without the insertion of a hydrogel spacer, between June 2013 and December 2018. The groups were compared for rectal and urinary toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events v4) using the χ<sup>2</sup> test and <em>t</em> test. In addition, a subgroup analysis limited to patients receiving 37.5 or 40 Gy in 5 fractions was performed to account for the possible confounding effect of dose variability between the groups. Complications related to the procedure were also evaluated.</div></div><div><h3>Results</h3><div>The cohort included 308 patients who underwent SBRT with (n = 227) or without (n = 75) the insertion of a hydrogel spacer. Rates of grade 2 or higher rectal toxicity were 31 of 223 patients (13.9%) in the spacer group and 9 of 75 patients (12%) in the nonspacer group. Corresponding rates of urinary grade 2 toxicity were 58 of 223 patients (26%) and 14 of 75 patients (18.6%), respectively. Neither difference was statistically significant. Similar findings were observed in the subgroup analysis. Severe complications related to the procedure occurred in 5 of 227 cases (2.2%).</div></div><div><h3>Conclusions</h3><div>This study did not demonstrate a significant effect of hydrogel spacer insertion on reducing rectal or urinary toxicity in patients with prostate cancer undergoing SBRT. Given the dual consideration of questionable clinical benefit and the risk of debilitating complications, additional studies should be performed on the selective use of this procedure.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101966"},"PeriodicalIF":2.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788010","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}

引用次数: 0

Relationship Between Intestinal Flora and Acute Radiation Enteritis in Patients With Advanced Cervical Cancer Undergoing Concurrent Chemoradiotherapy 晚期宫颈癌同步放化疗患者肠道菌群与急性放射性肠炎的关系

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-22 DOI: 10.1016/j.adro.2025.101968

Ziye Zheng MD , Siqi Sun ME , Jiawei Zhu MD , Qingwei Jiang MD , Jing Shen MD , Hongnan Zhen MD , Hui Guan MD , Wenhui Wang MD , Xiaomin Hu PhD , Fuquan Zhang MD , Junfang Yan MD

Purpose

Acute radiation enteritis (RE), particularly diarrhea, remains a major dose-limiting complication in patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT). The study investigated the relationship between dynamic intestinal flora alterations and RE-related diarrhea in patients with LACC undergoing CCRT.

Methods and Materials

This prospective observational cohort study enrolled 83 patients with LACC receiving CCRT in a hospital setting. The patients were categorized into a Mild group (mild diarrhea, adverse events grade < 2, n = 47) and a Severe group (severe diarrhea, grade ≥ 2, n = 36). Fecal samples were collected at baseline (T0), week 4 (T4), and week 8 (T8) after radiation therapy initiation. 16S rRNA sequencing was performed to analyze the microbial composition. Alpha/beta diversity, taxonomic differences, functional pathways, and correlations with clinical indicators were also evaluated.

Results

During CCRT, diarrhea severity peaked at 4 to 5 weeks and gradually decreased in weeks 5 to 8. Significantly decreased alpha diversity at T4 in the Severe group (nadir: 51.10% Firmicutes and 39.10% Bacteroidetes) was partially restored at T8. Beta diversity revealed clustering between the groups at T4. The relative abundances of f__Bacteroidaceae, g__Bacteroides, g__Lachnoclostridium, and s__Bacteroides_vulgatus were higher in the Severe group than in the Mild group at T4, whereas the f__Ruminococcaceae abundance was lower in the Severe group than in the Mild group. g__Bacteroides and g__Lachnoclostridium abundances were significantly and positively correlated with the duration of grade 2 diarrhea. The Severe group demonstrated upregulated amino/nucleotide sugar metabolism and downregulated unsaturated fatty acid biosynthesis. Phenotypic prediction indicated higher pathogenic Bacteroidetes and reduced stress-tolerant Proteobacteria in the Severe group.

Conclusions

Acute RE-related diarrhea severity in patients with cervical cancer undergoing CCRT is associated with intestinal dysbiosis. Severe diarrhea was correlated with reduced alpha diversity, lower Firmicutes/Bacteroidetes ratio, and enriched proinflammatory taxa.

目的急性放射性肠炎（RE），特别是腹泻，仍然是局部晚期宫颈癌（LACC）同步放化疗（CCRT）患者的主要剂量限制并发症。本研究探讨了行CCRT的LACC患者动态肠道菌群改变与re相关性腹泻的关系。方法和材料本前瞻性观察队列研究纳入83例在医院接受CCRT治疗的LACC患者。将患者分为轻度腹泻组（轻度腹泻，不良事件等级为<； 2, n = 47）和重度腹泻组（严重腹泻，等级≥2，n = 36）。在放射治疗开始后的基线（T0）、第4周（T4）和第8周（T8）收集粪便样本。采用16S rRNA测序分析微生物组成。α / β多样性、分类学差异、功能通路以及与临床指标的相关性也进行了评估。结果CCRT期间腹泻严重程度在4 ~ 5周达到高峰，在5 ~ 8周逐渐减轻。严重组在T4时α多样性显著降低（最低点：51.10%厚壁菌门和39.10%拟杆菌门），在T8时部分恢复。β多样性在T4组间呈现聚集性。在T4时，重度组的f__Bacteroidaceae、__bacteroides、__lachnoclostridium和__bacteroides_vulgatus的相对丰度高于轻度组，而重度组的f__Ruminococcaceae的相对丰度低于轻度组。拟杆菌和lachnoclostridium丰度与2级腹泻持续时间呈显著正相关。重度组表现出氨基酸/核苷酸糖代谢上调和不饱和脂肪酸生物合成下调。表型预测表明，重度组致病性拟杆菌门较高，耐应力变形杆菌门较少。结论宫颈癌CCRT患者急性re相关性腹泻严重程度与肠道生态失调有关。严重腹泻与α多样性降低、厚壁菌门/拟杆菌门比值降低和促炎类群丰富相关。

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引用次数: 0

Successful Stereotactic Body Radiation Therapy for Prostate Cancer in a Patient With Prior Total Colectomy and Ileal Pouch-Anal Anastomosis: A Case Report and Technical Considerations 立体定向放射治疗前列腺癌患者既往全结肠切除术和回肠袋-肛门吻合术：1例报告和技术考虑

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-22 DOI: 10.1016/j.adro.2025.101965

Takero Hirata MD, PhD , Shinichiro Fukuhara MD, PhD , Kentaro Takezawa MD, PhD , Naoki Kai MS , Masataka Nakai MD , Yasutoshi Fumimoto MD , Nobuyuki Tamaki MD , Shotaro Tatekawa MD, PhD , Kazuhiko Hayashi MD, PhD , Keisuke Tamari MD, PhD , Taigo Kato MD, PhD , Koji Hatano MD, PhD , Atsunari Kawashima MD, PhD , Shinichi Shimizu MD, PhD , Norio Nonomura MD, PhD , Kazuhiko Ogawa MD, PhD

引用次数: 0

A Comparative, Multiobserver Analysis of Nodal Contouring Methods in Pelvic Online Cone Beam-Based Adaptive Radiation Therapy 盆腔在线锥束自适应放射治疗中淋巴结轮廓化方法的多观察者对比分析

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-20 DOI: 10.1016/j.adro.2025.101959

Ethan Wang BSA , Michael Dohopolski MD , Allen Yen MD, Julia Jiazhen Shi BS, Brian Hrycushko PhD, David Parsons PhD, Yulun Liu PhD, Zohaib Iqbal PhD, Kevin Albuquerque MD

Purpose

In online cone beam computed tomography (CBCT)-based adaptive radiation therapy (ART), nodal recontouring ensures sufficient nodal coverage by accounting for anatomic change but is uniquely challenging due to small target size and time pressure. This study evaluates the accuracy of rigid propagation versus artificial intelligence-guided deformation (AID) for nodal autosegmentation via comparison to nodal recontours delineated with unlimited time (ie, benchmark contours).

Methods and Materials

We analyzed 25 nodal structures from 16 patients receiving pelvic online CBCT-based ART with nodal boost. Nodal structure sampling was informed by an initial power analysis. For each structure, we obtained rigidly propagated and AID-generated contours in addition to 2 benchmark contours and the clinical contour used in adapted plan generation. We calculated dice similarity coefficient (DSC), false-positive dice, false-negative dice, and 95% Hausdorff distance (HD95) between clinical, propagated, and AID contours against benchmark pairs and DSC and HD95 between benchmark pairs. The failure rate of nonbenchmark contours relative to benchmark pairs was calculated as the proportion of contours with an HD95 > 5 mm. We calculated the normalized D100, normalized D95, V100, and V95 of the adapted plan dose over all contours. Clinical tumor volume contours were used for all comparisons.

Results

Median DSC versus benchmark contours were 0.68 for rigidly propagated and 0.58 for AID contours. A significant difference in false-negative dice (P = .01, Cohen’s d 0.806) was identified in benchmark-to-propagated versus benchmark-to-AID comparison. The failure rate of rigidly propagated, AID, and clinical contours was 20%, 48%, and 28% respectively. The median DSC between benchmark contours was 0.75. No significant differences across dose metrics were identified between contour types.

Conclusions

Rigid propagation is superior to AID for initial contour generation in pelvic CBCT-based ART. Increased contouring time and image quality may improve contour quality and reduce interobserver variability but may be limited by the influence of individual contouring preferences.

目的：在基于在线锥束计算机断层扫描（CBCT）的适应性放射治疗（ART）中，通过考虑解剖变化，节点重新轮廓确保足够的节点覆盖，但由于目标尺寸小和时间压力，这是独特的挑战。本研究通过与无限时间描绘的节点重轮廓（即基准轮廓）进行比较，评估了刚性传播与人工智能引导变形（AID）在节点自动分割中的准确性。方法和材料我们分析了16例接受盆腔cbct在线ART并进行淋巴结增强的患者的25个淋巴结结构。节点结构采样是通过初始功率分析得到的。对于每个结构，除了2个基准轮廓和用于自适应平面生成的临床轮廓外，我们还获得了刚性传播和aids生成的轮廓。我们计算了骰子相似系数（DSC）、假阳性骰子、假阴性骰子、临床、传播和AID轮廓对基准对之间的95% Hausdorff距离（HD95）以及基准对之间的DSC和HD95。非基准轮廓相对于基准对的故障率计算为HD95 >； 5 mm轮廓的比例。我们计算了所有轮廓线上适应计划剂量的归一化D100、归一化D95、V100和V95。所有比较均采用临床肿瘤体积轮廓。结果刚性传播轮廓与基准轮廓的DSC中位数为0.68，AID轮廓为0.58。在基准-传播与基准- aid比较中，假阴性骰子的显着差异（P = 0.01, Cohen 's d 0.806）被确定。刚性传播、AID和临床轮廓的失败率分别为20%、48%和28%。基准轮廓之间的DSC中位数为0.75。轮廓线类型之间的剂量计量没有显著差异。结论在基于ct的盆腔ART中，刚性传播术比AID术更有利于初始轮廓的生成。增加轮廓时间和图像质量可以改善轮廓质量并减少观察者之间的可变性，但可能受到个人轮廓偏好的影响。

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引用次数: 0

Accuracy of Photon Dose Calculation on Photon-Counting Computed Tomography—A Comparison Study Based on Virtual Monoenergetic and Electron Density (Rho) Images for Pancreatic Cases 光子计数计算机层析成像中光子剂量计算的准确性——基于胰腺病例虚拟单能和电子密度（Rho）图像的比较研究

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-19 DOI: 10.1016/j.adro.2025.101957

Xin Wu MS , Patrick Wohlfahrt PhD , Jainil Shah PhD , Ludovica Lofino MD , Manisha Palta MD , Qiuwen Wu PhD , Q. Jackie Wu PhD , Yang Sheng PhD

<div><h3>Purpose</h3><div>Photon-counting computed tomography (PCCT) offers versatile anatomic information because of better energy discrimination and higher spatial resolution than conventional energy-integrating computed tomography (CT). With its rapid applications in diagnostic imaging, its potential within radiation oncology remains largely unexplored. Successful radiation therapy (RT) relies on both high-quality images to delineate tumor volume and accurate physical information of the anatomy for dose calculation. Specific to RT, dose calculation stands as a pivotal component in the process of treatment planning. This proof-of-concept study aimed to assess the accuracy of dose calculation and build the benchmark using PCCT images from a clinically operating NAEOTOM Alpha PCCT scanner from Siemens Healthineers.</div></div><div><h3>Methods and Materials</h3><div>A total of 29 patients receiving abdominal contrast-enhanced PCCT scans were included in this study with institutional review board approval. The following 2 sets of reconstructed images were selected for this study: (1) virtual monoenergetic images (VMIs) of 70 keV, which resembles the conventional CT image at 120 kVp, and (2) electron density (Rho) images derived from PCCT, which provides direct physical information for photon dose calculation. In addition to the default Hounsfield look-up table (HLUT) implemented in a treatment planning system, which is suitable for conventional CT images, a specific HLUT converting 70 keV VMI CT numbers to relative electron density was established following the consensus guidelines. Patient’s organs were contoured using a deep-learning-based autosegmentation model in syngo.via RT Image Suite from Siemens Healthineers. An elective and a gross tumor volume were simulated in the pancreatic region for treatment planning within this study. All patients were planned with a 9-field intensity modulated RT with simultaneous integral boost regimen 25/33 Gy using an in-house deep-learning-based autoplanning model. Planning guidelines followed the institutional pancreas stereotactic body RT protocol. Eleven dose-volume histogram (DVH) metrics were included for comparison of 3-dose calculation approaches (conventional, 70 keV VMI and Rho).</div></div><div><h3>Results</h3><div>The results revealed minimal dosimetry differences between 70 keV VMI and Rho images, with DVH metric percentage differences predominantly within 1% range (max: -1.60%) and 3-dimensional gamma analysis (1 mm/1%) pass rate >98% for most cases. The patient with the largest differences showed an average DVH metric difference of -1.32% and 3-dimensional gamma pass rate of 94.82%. Overall isodose distribution remained similar between 2 images for each patient. Dose calculation using the default HLUT in Eclipse showed DVH differences within a 1.5% range.</div></div><div><h3>Conclusions</h3><div>The results demonstrated good agreement in dose calculation between 70 keV VMI and Rho images. For

目的光子计数计算机断层扫描（PCCT）由于比传统的能量积分计算机断层扫描（CT）具有更好的能量识别和更高的空间分辨率，提供了多种解剖信息。随着其在诊断成像中的快速应用，其在放射肿瘤学中的潜力仍未得到充分开发。成功的放射治疗（RT）依赖于高质量的图像来描绘肿瘤体积和准确的解剖物理信息来计算剂量。具体到放疗，剂量计算是治疗计划过程中的关键组成部分。这项概念验证研究旨在评估剂量计算的准确性，并使用西门子Healthineers公司临床运行的NAEOTOM Alpha PCCT扫描仪的PCCT图像建立基准。方法和材料本研究经机构审查委员会批准，共纳入29例接受腹部对比增强PCCT扫描的患者。本研究选择了2组重建图像：(1)70 keV的虚拟单能图像（VMIs），与传统CT图像在120 kVp下的图像相似；(2)来自PCCT的电子密度（Rho）图像，为光子剂量计算提供了直接的物理信息。除了在治疗计划系统中实现的默认Hounsfield查找表（HLUT）之外，该表适用于常规CT图像，根据共识指南建立了将70 keV VMI CT数转换为相对电子密度的特定HLUT。使用syngo中基于深度学习的自动分割模型对患者的器官进行轮廓化。通过西门子Healthineers的RT图像套件。在本研究中，模拟胰腺区域的选择性和总肿瘤体积，以制定治疗计划。所有患者计划使用基于内部深度学习的自动计划模型进行9场强度调制RT，同时进行25/33 Gy的积分增强方案。计划指南遵循机构胰腺立体定向体RT协议。采用11个剂量-体积直方图（DVH）指标比较3种剂量计算方法（常规、70 keV VMI和Rho）。结果显示70 keV VMI和Rho图像之间的剂量学差异很小，DVH度量百分比差异主要在1%范围内（最大：-1.60%），大多数病例的三维伽马分析（1 mm/1%）通过率为98%。差异最大的患者DVH指标平均差异为-1.32%，三维伽马通过率为94.82%。总体等剂量分布在每个患者的2张图像之间保持相似。使用Eclipse中的默认HLUT进行剂量计算，显示DVH差异在1.5%范围内。结论70 keV VMI图像与Rho图像在剂量计算上有较好的一致性。对于具有碘对比度的区域，PCCT提供的Rho图像可以抑制对比度增强，从而减轻不必要的不确定性。这一基准性能表明，PCCT可以安全地用于剂量计算，并具有一定的优势，使其成为RT治疗计划的有价值的替代方案。

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