Advances in Radiation Oncology最新文献_第3页

Patterns of Care in Adjuvant Radiation Therapy for Stage II Endometrioid Endometrial Adenocarcinoma: A National Cancer Database Analysis 辅助放射治疗II期子宫内膜样子宫内膜腺癌的护理模式：国家癌症数据库分析。

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101698

Jessica Cruttenden MD , Christopher Weil MD , Danae Byer BS , Lindsay Burt MD , Gita Suneja MD , David Gaffney MD, PhD , Cristina DeCesaris MD

Purpose

Treating stage II endometrial cancer involves total hysterectomy, bilateral salpingo-oophorectomy, and risk-adapted adjuvant therapy. Professional guidelines support various adjuvant treatments, but high-level data supporting specific options are conflicting. We sought to evaluate adjuvant radiation therapy (RT) trends for these patients, hypothesizing increased utilization of pelvic external beam RT (EBRT) over time.

Methods and Materials

Patients diagnosed in 2004-2019 with stage II endometrioid endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and surgical staging were identified in the National Cancer Database. Patient characteristics per adjuvant RT received were compared using Wilcoxon rank sum and analysis of variance testing. Multivariable regression analysis (MVA) identified variables associated with EBRT, vaginal brachytherapy (VBT), or RT omission. A P value < .05 was significant, except in MVA, where Bonferroni correction was employed (p value < .017).

Results

Patients meeting criteria totaled 18,798; 19% received adjuvant EBRT alone, 25% VBT alone, 24% EBRT + VBT, and 32% no RT. Adjuvant RT use increased from 2004 to 2019, particularly EBRT + VBT (p < .05). In MVA, community hospital treatment (odds ratio [OR], 1.8; p < .001), Midwest location (OR, 1.2; p = .02), single-agent chemotherapy receipt (OR, 6.9; p < .001), lymphovascular space invasion (OR, 1.4; p < .001), and positive surgical margins (OR, 1.8; p < .001) were positively associated with EBRT. No variables were positively associated with VBT. Black race (OR, 1.2; p = .03), community hospital treatment (OR, 1.4; p = .04), South (OR, 2.2; p < .001) or West (OR, 2.1; p < .001) location, distance >50 miles from the treatment center (OR, 1.5; p < .001), and grade 2 (OR, 1.2; p < .001) or 3 (OR, 1.3; p = .01) disease were associated with RT omission.

Conclusions

Adjuvant RT for stage II endometrial cancer increased over time, particularly EBRT + VBT. Patient-related factors such as race, region, and distance from the treatment center were associated with RT omission, suggesting sociodemographic barriers to care. Tumor-related factors such as positive surgical margins and lymphovascular space invasion were associated with EBRT receipt, suggesting consideration of high-risk factors for locoregional recurrence in adjuvant RT approaches.

目的：II期子宫内膜癌的治疗包括全子宫切除术、双侧输卵管-卵巢切除术和风险适应辅助治疗。专业指南支持各种辅助治疗，但支持具体选择的高级数据相互矛盾。我们试图评估这些患者的辅助放射治疗（RT）趋势，假设盆腔外束放射治疗（EBRT）的使用随着时间的推移而增加。方法和材料：在国家癌症数据库中确定2004-2019年诊断为II期子宫内膜样子宫内膜癌并接受全子宫切除术、双侧输卵管-卵巢切除术和手术分期的患者。采用Wilcoxon秩和和方差分析对接受辅助放疗的患者特征进行比较。多变量回归分析（MVA）确定了与EBRT、阴道近距离治疗（VBT）或RT遗漏相关的变量。除MVA采用Bonferroni校正外，P值< 0.05显著（P值< 0.017）。结果：符合标准的患者共18798例；19%的人单独接受了EBRT辅助治疗，25%的人单独接受了VBT辅助治疗，24%的人接受了EBRT + VBT辅助治疗，32%的人没有接受RT辅助治疗。从2004年到2019年，辅助RT的使用增加了，特别是EBRT + VBT （p < 0.05）。在MVA中，社区医院治疗(优势比[OR]， 1.8；p < .001)，中西部地区(OR, 1.2；p = .02)，单药化疗剂量(OR, 6.9；p < 0.001)，淋巴血管间隙侵犯(OR, 1.4；p < 0.001)，手术切缘阳性(OR, 1.8；p < 0.001)与EBRT呈正相关。没有变量与VBT呈正相关。黑人种族(OR, 1.2；p = .03)，社区医院治疗(OR, 1.4；p = .04)，南方(OR, 2.2；p < 0.001)或West (or, 2.1；p < .001)位置，距离治疗中心50英里(OR, 1.5；p < .001)， 2级(OR, 1.2；p < .001)或3 (or, 1.3；p = 0.01)疾病与RT遗漏相关。结论：II期子宫内膜癌的辅助放疗随着时间的推移而增加，尤其是EBRT + VBT。患者相关因素，如种族、地区和距离治疗中心的距离与RT遗漏有关，提示护理的社会人口学障碍。肿瘤相关因素，如手术切缘阳性和淋巴血管间隙浸润与EBRT接受相关，提示在辅助RT入路中考虑局部复发的高危因素。

{"title":"Patterns of Care in Adjuvant Radiation Therapy for Stage II Endometrioid Endometrial Adenocarcinoma: A National Cancer Database Analysis","authors":"Jessica Cruttenden MD , Christopher Weil MD , Danae Byer BS , Lindsay Burt MD , Gita Suneja MD , David Gaffney MD, PhD , Cristina DeCesaris MD","doi":"10.1016/j.adro.2024.101698","DOIUrl":"10.1016/j.adro.2024.101698","url":null,"abstract":"<div><h3>Purpose</h3><div>Treating stage II endometrial cancer involves total hysterectomy, bilateral salpingo-oophorectomy, and risk-adapted adjuvant therapy. Professional guidelines support various adjuvant treatments, but high-level data supporting specific options are conflicting. We sought to evaluate adjuvant radiation therapy (RT) trends for these patients, hypothesizing increased utilization of pelvic external beam RT (EBRT) over time.</div></div><div><h3>Methods and Materials</h3><div>Patients diagnosed in 2004-2019 with stage II endometrioid endometrial cancer who underwent total hysterectomy, bilateral salpingo-oophorectomy, and surgical staging were identified in the National Cancer Database. Patient characteristics per adjuvant RT received were compared using Wilcoxon rank sum and analysis of variance testing. Multivariable regression analysis (MVA) identified variables associated with EBRT, vaginal brachytherapy (VBT), or RT omission. A <em>P</em> value < .05 was significant, except in MVA, where Bonferroni correction was employed (<em>p</em> value < .017).</div></div><div><h3>Results</h3><div>Patients meeting criteria totaled 18,798; 19% received adjuvant EBRT alone, 25% VBT alone, 24% EBRT + VBT, and 32% no RT. Adjuvant RT use increased from 2004 to 2019, particularly EBRT + VBT (<em>p</em> < .05). In MVA, community hospital treatment (odds ratio [OR], 1.8; <em>p</em> < .001), Midwest location (OR, 1.2; <em>p</em> = .02), single-agent chemotherapy receipt (OR, 6.9; <em>p</em> < .001), lymphovascular space invasion (OR, 1.4; <em>p</em> < .001), and positive surgical margins (OR, 1.8; <em>p</em> < .001) were positively associated with EBRT. No variables were positively associated with VBT. Black race (OR, 1.2; <em>p</em> = .03), community hospital treatment (OR, 1.4; <em>p</em> = .04), South (OR, 2.2; <em>p</em> < .001) or West (OR, 2.1; <em>p</em> < .001) location, distance >50 miles from the treatment center (OR, 1.5; <em>p</em> < .001), and grade 2 (OR, 1.2; <em>p</em> < .001) or 3 (OR, 1.3; <em>p</em> = .01) disease were associated with RT omission.</div></div><div><h3>Conclusions</h3><div>Adjuvant RT for stage II endometrial cancer increased over time, particularly EBRT + VBT. Patient-related factors such as race, region, and distance from the treatment center were associated with RT omission, suggesting sociodemographic barriers to care. Tumor-related factors such as positive surgical margins and lymphovascular space invasion were associated with EBRT receipt, suggesting consideration of high-risk factors for locoregional recurrence in adjuvant RT approaches.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101698"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982436","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}

引用次数: 0

Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series 不可切除腹膜后肉瘤中央增强放疗的疗效：一个病例系列。

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101689

Danielle N. Burner BS , Peter G. Hendrickson MD, PhD , Diana M. Cardona MD , Dan G. Blazer III MD , James B. Mullins CMD , David G. Kirsch MD, PhD

Purpose

Optimal treatment of retroperitoneal sarcoma (RPS) remains undefined. Here, we report the feasibility of using high-dose boost radiation (3-4 Gy) to the central part of the tumor in patients with unresectable RPS.

Methods and Materials

Five patients with unresectable RPS were treated with radiation therapy using a central boost technique with intensity modulated radiation therapy. On average, doses of 25 Gy to 45 Gy were delivered to the outer part of the tumor (planning target volume 1), while the central part of the tumor (planning target volume 2) received a 56 Gy to 75 Gy physical dose, which translates to a 62.67 Gy to 87.5 Gy equivalent dose in 2 Gy fractions (EQD2). To minimize radiation toxicity to the adjacent bowel and other organs, we used sequential, interdigitated, or simultaneous integrated boost (SIB) techniques.

Results

In this case series of variable RPS histology, the median survival postradiation therapy was 30 months. Three of the 5 patients had clinically stable local disease on follow-up scans, and none of the patients experienced clinically significant toxicity.

Conclusions

In summary, in this small case series of 5 patients, treatment was tolerated well, and excellent local responses were observed regardless of the timing of the central boost. Given the high rates of metastatic disease that developed in responding patients, effective systemic therapy will likely be needed for unresectable RPS treated with aggressive radiation therapy to the central part of the tumor.

目的：腹膜后肉瘤（RPS）的最佳治疗方法尚不明确。在这里，我们报告了在不可切除的RPS患者中使用高剂量增强辐射（3-4 Gy）到肿瘤中心部分的可行性。方法和材料：对5例不可切除的RPS患者采用中央增强技术加调强放射治疗。平均而言，25 Gy至45 Gy的剂量被递送到肿瘤的外部部分（计划靶体积1），而肿瘤的中心部分（计划靶体积2）接受了56 Gy至75 Gy的物理剂量，这相当于62.67 Gy至87.5 Gy的等效剂量，分为2 Gy的分数（EQD2）。为了尽量减少对邻近肠道和其他器官的辐射毒性，我们使用了顺序、交叉指间或同时集成增强（SIB）技术。结果：在这个RPS组织学变化的病例系列中，放射治疗后的中位生存期为30个月。在随访扫描中，5例患者中有3例局部疾病临床稳定，没有一例患者出现临床明显的毒性。结论：总之，在这个5例患者的小病例系列中，治疗耐受性良好，并且无论中心增强的时间如何，都观察到良好的局部反应。考虑到在有反应的患者中发生的高转移率，对不可切除的RPS进行肿瘤中心部位的积极放射治疗可能需要有效的全身治疗。

{"title":"Response to Central Boost Radiation Therapy in Unresectable Retroperitoneal Sarcoma: A Case Series","authors":"Danielle N. Burner BS , Peter G. Hendrickson MD, PhD , Diana M. Cardona MD , Dan G. Blazer III MD , James B. Mullins CMD , David G. Kirsch MD, PhD","doi":"10.1016/j.adro.2024.101689","DOIUrl":"10.1016/j.adro.2024.101689","url":null,"abstract":"<div><h3>Purpose</h3><div>Optimal treatment of retroperitoneal sarcoma (RPS) remains undefined. Here, we report the feasibility of using high-dose boost radiation (3-4 Gy) to the central part of the tumor in patients with unresectable RPS.</div></div><div><h3>Methods and Materials</h3><div>Five patients with unresectable RPS were treated with radiation therapy using a central boost technique with intensity modulated radiation therapy. On average, doses of 25 Gy to 45 Gy were delivered to the outer part of the tumor (planning target volume 1), while the central part of the tumor (planning target volume 2) received a 56 Gy to 75 Gy physical dose, which translates to a 62.67 Gy to 87.5 Gy equivalent dose in 2 Gy fractions (EQD2). To minimize radiation toxicity to the adjacent bowel and other organs, we used sequential, interdigitated, or simultaneous integrated boost (SIB) techniques.</div></div><div><h3>Results</h3><div>In this case series of variable RPS histology, the median survival postradiation therapy was 30 months. Three of the 5 patients had clinically stable local disease on follow-up scans, and none of the patients experienced clinically significant toxicity.</div></div><div><h3>Conclusions</h3><div>In summary, in this small case series of 5 patients, treatment was tolerated well, and excellent local responses were observed regardless of the timing of the central boost. Given the high rates of metastatic disease that developed in responding patients, effective systemic therapy will likely be needed for unresectable RPS treated with aggressive radiation therapy to the central part of the tumor.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101689"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982444","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}

引用次数: 0

Dosimetric Predictors of Acute Radiation Pneumonitis and Esophagitis in Hypofractionated Thoracic Irradiation of Non-Small Cell Lung Cancer Patients With Poor Prognostic Factors

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101682

Saskia Kenndoff BSc, MD , Alexander Nieto MD , Julian Elias Guggenberger MD , Julian Taugner MD , Sina Mansoorian MD , Lukas Käsmann MD, MHBA , Nina-Sophie Schmidt-Hegemann MD , Farkhad Manapov MD , Claus Belka MD , Chukwuka Eze MD

Purpose

The proliferation rates of non-small cell lung cancer (NSCLC) and associated radiation resistance highlight the potential of hypofractionated radiation therapy (hypoRT). However, radiation pneumonitis and esophagitis remain dose-limiting adverse events. This study investigates dosimetric factors influencing the risk of pneumonitis and esophagitis in highly multimorbid patients undergoing moderately hypoRT.

Methods and Materials

Forty-seven NSCLC patients with poor performance status treated between January 2014 and July 2021 were included. Dosimetric parameters including mean lung dose (MLD), percentage of normal (ipsi-/contralateral) lung volume (Vx) receiving ≥x Gy (x = 20, 18, 10, and 5 Gy); mean heart dose (MHD), percentage of the heart volume (HVx) receiving ≥x Gy (x = 20, 10, and 5 Gy); and mean esophageal dose (MED), percentage of esophagus volume (EVx) receiving ≥x Gy (x = 40, 30, 20, 18, 10, and 5 Gy) were analyzed retrospectively. Acute radiation pneumonitis/esophagitis events were assessed within 6/3 months posttreatment. Statistical analyses included random forests, binary logistic regression, and linear regression.

Results

Among the 47 patients with compromised lung function and poor prognostic factors, 8 (17%) and 26 (55%) patients developed all-grade pneumonitis or esophagitis, while 4 (9%) and 10 (21%) patients developed CTCAE grade ≥2 pneumonitis and esophagitis, respectively. Exploratory analyses suggest that V10, V18, and MLD values are associated with an increased risk of pneumonitis. Linear regressions confirmed this for MLD values greater than 9.2 Gy (P = .050). Additionally, higher V5 and V10 values in the contralateral lung were associated with a greater risk of pneumonitis (P = .013/P = .032). Dmax proved to be a significant predictor of esophagitis (P = .020). Moreover, evidence suggests that EV5 and EV40 may portend esophagitis onset.

Conclusions

This study provides insights into dosimetric factors influencing pneumonitis/esophagitis development in NSCLC patients undergoing hypoRT. While MLD and Dmax emerged as significant predictors of pneumonitis and esophagitis, the small sample size limited the depth of conclusions. Further research with larger cohorts is warranted to validate these observations, potentially optimizing treatment planning and outcomes in this challenging patient population.

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引用次数: 0

Early Outcomes from Proton Craniospinal Irradiation for Leptomeningeal Metastasis From Solid Tumors

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101697

Keng Lam MD , Lewis F. Nasr MD , Clark R. Andersen MS , Kathryn E. Marqueen MD , Jing Li MD, PhD , Chenyang Wang MD , Thomas H. Beckham MD, PhD , Nazanin K. Majd MD, PhD , Ashley E. Aaroe MD , Monica Loghin MD , Barbara J. O'Brien MD , Susan L. McGovern MD, PhD

Purpose

Treatment options for leptomeningeal metastasis (LM) are limited. A recent phase 2 study found that proton craniospinal irradiation (pCSI) was well-tolerated and improved survival. We report our experience with pCSI for solid-tumor LM.

Methods and Materials

This is a retrospective review of patients treated with pCSI for solid-tumor LM from December 2020 to January 2024 at our center. Patient characteristics were summarized using descriptive statistics. Median overall survival and median central nervous system progression-free survival from the first day of pCSI were estimated using Kaplan-Meier survival curves.

Results

We identified 45 patients who completed pCSI. The median age was 54 years (range, 23-79); 73% were female, and 53% lived more than 100 miles from our center. Breast cancer (53%), lung cancer (20%), and melanoma (9%) were the most common primary cancers; 51% of patients had stable systemic disease at LM diagnosis. All had imaging evidence of LM, and 64% of cases were confirmed using cytologic examination of the cerebrospinal fluid. Eighty percent had symptomatic LM, and the median Karnofsky performance scale at LM diagnosis was 80. The median time from primary cancer diagnosis to LM detection was 23.1 months (range, 0-221.3). Fifty-three percent of patients had active brain metastasis at LM diagnosis; 33% of all patients had received prior intracranial radiation. The median time from simulation to pCSI start was 12 days. At the first visit following pCSI, the median Karnofsky performance scale score was 70. During or right after radiation, 76% of patients reported nausea, 51% headache, and 31% fatigue. Following pCSI, 4% received intrathecal chemotherapy, 67% systemic therapy, and 9% hospice care; 18% were observed and 2% lost to follow-up. Median overall survival was 13.7 months (95% confidence interval [CI], 11.2 to not reached), and median progression-free survival was 6.5 months (95% CI, 4.9-12.8).

Conclusions

The outcomes in our cohort are comparable to those recently reported in a phase 2 trial. Further study is indicated to determine the optimal candidates for pCSI and sequential therapies.

{"title":"Early Outcomes from Proton Craniospinal Irradiation for Leptomeningeal Metastasis From Solid Tumors","authors":"Keng Lam MD , Lewis F. Nasr MD , Clark R. Andersen MS , Kathryn E. Marqueen MD , Jing Li MD, PhD , Chenyang Wang MD , Thomas H. Beckham MD, PhD , Nazanin K. Majd MD, PhD , Ashley E. Aaroe MD , Monica Loghin MD , Barbara J. O'Brien MD , Susan L. McGovern MD, PhD","doi":"10.1016/j.adro.2024.101697","DOIUrl":"10.1016/j.adro.2024.101697","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment options for leptomeningeal metastasis (LM) are limited. A recent phase 2 study found that proton craniospinal irradiation (pCSI) was well-tolerated and improved survival. We report our experience with pCSI for solid-tumor LM.</div></div><div><h3>Methods and Materials</h3><div>This is a retrospective review of patients treated with pCSI for solid-tumor LM from December 2020 to January 2024 at our center. Patient characteristics were summarized using descriptive statistics. Median overall survival and median central nervous system progression-free survival from the first day of pCSI were estimated using Kaplan-Meier survival curves.</div></div><div><h3>Results</h3><div>We identified 45 patients who completed pCSI. The median age was 54 years (range, 23-79); 73% were female, and 53% lived more than 100 miles from our center. Breast cancer (53%), lung cancer (20%), and melanoma (9%) were the most common primary cancers; 51% of patients had stable systemic disease at LM diagnosis. All had imaging evidence of LM, and 64% of cases were confirmed using cytologic examination of the cerebrospinal fluid. Eighty percent had symptomatic LM, and the median Karnofsky performance scale at LM diagnosis was 80. The median time from primary cancer diagnosis to LM detection was 23.1 months (range, 0-221.3). Fifty-three percent of patients had active brain metastasis at LM diagnosis; 33% of all patients had received prior intracranial radiation. The median time from simulation to pCSI start was 12 days. At the first visit following pCSI, the median Karnofsky performance scale score was 70. During or right after radiation, 76% of patients reported nausea, 51% headache, and 31% fatigue. Following pCSI, 4% received intrathecal chemotherapy, 67% systemic therapy, and 9% hospice care; 18% were observed and 2% lost to follow-up. Median overall survival was 13.7 months (95% confidence interval [CI], 11.2 to not reached), and median progression-free survival was 6.5 months (95% CI, 4.9-12.8).</div></div><div><h3>Conclusions</h3><div>The outcomes in our cohort are comparable to those recently reported in a phase 2 trial. Further study is indicated to determine the optimal candidates for pCSI and sequential therapies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101697"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045457","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}

引用次数: 0

Comprehensive Image Quality Evaluation and Motion Phantom Studies of an Ultra-Fast (6-Second) Cone-Beam Computed Tomography Imaging System on a Ring Gantry Linear Accelerator 环形龙门直线加速器上超快（6秒）锥束计算机断层成像系统的综合图像质量评价和运动幻影研究。

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101681

Hui Zhao PhD , Geoff Nelson PhD , Vikren Sarkar PhD , Courtney Oare PhD , Martin Szegedi , Sara St. James PhD , Jeremy Kunz PhD , Ryan Price PhD , Y. Jessica Huang PhD

Purpose

To evaluate the image quality of an ultrafast cone-beam computed tomography (CBCT) system—Varian HyperSight.

Methods and Materials

In this evaluation, 5 studies were performed to assess the image quality of HyperSight CBCT. First, a HyperSight CBCT image quality evaluation was performed and compared with Siemens simulation-CT and Varian TrueBeam CBCT. Second, a visual comparison of image quality among simulation-CTs, HyperSight CBCT, and TrueBeam CBCT was performed for a patient with head and neck cancer and patients with metal dental fillings and prostheses. Third, the Hounsfield unit (HU) versus electron density curve of HyperSight CBCT was compared with GE and Siemens simulation CTs. Fourth, Siemens simulation-CT and HyperSight CBCT scans were acquired on the Catphan set-up at different locations inside the bore (±10 cm in all 3 principal directions from the center), and the HU variations for different materials were evaluated. Fifth, a 4-dimensional lung tumor phantom study was performed to assess moving tumor alignment during image registration.

Results

Significant improvement of image contrast, HU constancy, and noise level on HyperSight CBCT was observed compared with TrueBeam CBCT. Significant image quality improvement was observed on HyperSight CBCT for patients with dental fillings and prostheses compared with simulation-CT without metal artifact reduction. The linear fit trendline of HU versus electron density curves for GE simulation-CT, Siemens simulation-CT, and HyperSight CBCT showed a 0.6% difference for HU values below 2000. The maximum HU difference for HyperSight CBCT when Catphan was positioned within ±10 cm in all 3 principal directions was ≤ 98 on bone 50%, ≤ 29 other than bone, and was ≤ 31 on bone 50%, and ≤ 17 other than bone for Siemens simulation-CT. Both tumor shape and tumor alignment discrepancies on CBCT scans were observed in a 4-dimensional phantom study.

Conclusions

This evaluation shows significant image improvement of HyperSight CBCT over conventional CBCT on image contrast, HU constancy, and noise level with scatter correction and metal artifact reduction reconstruction methods. HyperSight CBCT has similar image quality to simulation-CTs and shows the potential application for treatment planning. The rapid acquisition of HyperSight CBCT showed both tumor shape and tumor alignment discrepancies of moving targets. Careful considerations of patient respiratory motion monitoring and target matching are highly recommended.

目的：评价超快锥束计算机断层扫描（CBCT）系统varian HyperSight的图像质量。方法和材料：在本评价中，进行了5项研究来评估HyperSight CBCT的图像质量。首先，进行HyperSight CBCT图像质量评估，并与Siemens simulation-CT和Varian TrueBeam CBCT进行比较。其次，对一名头颈癌患者和使用金属牙填充物和假体的患者进行模拟ct、HyperSight CBCT和TrueBeam CBCT的图像质量进行视觉比较。第三，将HyperSight CBCT的Hounsfield单位（HU）与电子密度曲线与GE和Siemens模拟ct进行比较。第四，在井眼内不同位置（距中心所有3个主要方向±10厘米）的Catphan装置上获取西门子模拟ct和HyperSight CBCT扫描，并评估不同材料的HU变化。第五，进行了一个四维肺肿瘤幻象研究，以评估图像配准过程中移动肿瘤的对齐。结果：与TrueBeam CBCT相比，HyperSight CBCT的图像对比度、HU稳定性和噪声水平均有显著改善。与未减少金属伪影的模拟ct相比，使用HyperSight CBCT对补牙和假体患者的图像质量有显著改善。GE模拟ct、Siemens模拟ct和HyperSight CBCT的HU与电子密度曲线的线性拟合趋势线显示，2000以下的HU值差异为0.6%。当Catphan在3个主要方向定位在±10 cm范围内时，HyperSight CBCT最大HU差值为50%骨≤98，非骨≤29,50%骨≤31，非骨≤17。在一个四维幻影研究中观察到CBCT扫描上的肿瘤形状和肿瘤排列差异。结论：通过散点校正和金属伪影减少重建方法，HyperSight CBCT在图像对比度、HU稳定性和噪声水平上比传统CBCT有显著改善。HyperSight CBCT具有与模拟ct相似的图像质量，并显示出治疗计划的潜在应用。HyperSight CBCT的快速采集显示了运动目标的肿瘤形状和肿瘤排列差异。强烈建议仔细考虑患者呼吸运动监测和目标匹配。

{"title":"Comprehensive Image Quality Evaluation and Motion Phantom Studies of an Ultra-Fast (6-Second) Cone-Beam Computed Tomography Imaging System on a Ring Gantry Linear Accelerator","authors":"Hui Zhao PhD , Geoff Nelson PhD , Vikren Sarkar PhD , Courtney Oare PhD , Martin Szegedi , Sara St. James PhD , Jeremy Kunz PhD , Ryan Price PhD , Y. Jessica Huang PhD","doi":"10.1016/j.adro.2024.101681","DOIUrl":"10.1016/j.adro.2024.101681","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the image quality of an ultrafast cone-beam computed tomography (CBCT) system—Varian HyperSight.</div></div><div><h3>Methods and Materials</h3><div>In this evaluation, 5 studies were performed to assess the image quality of HyperSight CBCT. First, a HyperSight CBCT image quality evaluation was performed and compared with Siemens simulation-CT and Varian TrueBeam CBCT. Second, a visual comparison of image quality among simulation-CTs, HyperSight CBCT, and TrueBeam CBCT was performed for a patient with head and neck cancer and patients with metal dental fillings and prostheses. Third, the Hounsfield unit (HU) versus electron density curve of HyperSight CBCT was compared with GE and Siemens simulation CTs. Fourth, Siemens simulation-CT and HyperSight CBCT scans were acquired on the Catphan set-up at different locations inside the bore (±10 cm in all 3 principal directions from the center), and the HU variations for different materials were evaluated. Fifth, a 4-dimensional lung tumor phantom study was performed to assess moving tumor alignment during image registration.</div></div><div><h3>Results</h3><div>Significant improvement of image contrast, HU constancy, and noise level on HyperSight CBCT was observed compared with TrueBeam CBCT. Significant image quality improvement was observed on HyperSight CBCT for patients with dental fillings and prostheses compared with simulation-CT without metal artifact reduction. The linear fit trendline of HU versus electron density curves for GE simulation-CT, Siemens simulation-CT, and HyperSight CBCT showed a 0.6% difference for HU values below 2000. The maximum HU difference for HyperSight CBCT when Catphan was positioned within ±10 cm in all 3 principal directions was ≤ 98 on bone 50%, ≤ 29 other than bone, and was ≤ 31 on bone 50%, and ≤ 17 other than bone for Siemens simulation-CT. Both tumor shape and tumor alignment discrepancies on CBCT scans were observed in a 4-dimensional phantom study.</div></div><div><h3>Conclusions</h3><div>This evaluation shows significant image improvement of HyperSight CBCT over conventional CBCT on image contrast, HU constancy, and noise level with scatter correction and metal artifact reduction reconstruction methods. HyperSight CBCT has similar image quality to simulation-CTs and shows the potential application for treatment planning. The rapid acquisition of HyperSight CBCT showed both tumor shape and tumor alignment discrepancies of moving targets. Careful considerations of patient respiratory motion monitoring and target matching are highly recommended.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 2","pages":"Article 101681"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881104","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}

引用次数: 0

Dosimetric and On-treatment Clinical Results of a Volumetric-based Skin-sparing Planning Technique for Patients Treated to the Breast and Chest Wall With Pencil-Beam Scanning Proton Therapy 以体积为基础的保皮计划技术对接受铅笔束扫描质子治疗的乳房和胸壁患者的剂量学和治疗中的临床结果。

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101653

Avani D. Rao MD , Alexander Goughenour CS, CMD , Betelehem Kebede BS , Caroline Bamberger BS , Grayden MacLennan MS, CMD , Jackeline Castro BS, CMD , Lisa Stephenson MS, CMD , Amanuel Negussie MS, CMD , Sydney Seracino CMD , Hongkun Wang PhD , Stella Hetelekidis MD , Sarah J. Gao MD , Lonika Majithia MS, MD , Ashish Chawla MD , Ashkan Parniani MBA, CMD , Peng Wang PhD, DABR , Jiajin Fan PhD, DABR

Purpose

This study evaluates the hypothesis that a volumetric skin-sparing planning technique (SSPT) will reduce acute dermatitis in patients treated to the breast or chest wall (CW) with proton pencil-beam scanning (PBS).

Methods and Materials

In January 2022, our center incorporated volumetric-based skin-sparing objectives in addition to skin hot spot evaluation as an SSPT. The SSPT incorporated an objective to limit the volume of a skin evaluation structure (skin-eval) receiving 95% of the prescription dose or more (V95%Rx) to ideally < 50%. We compared target coverage, robustness, skin-eval dosimetry, and acute on-treatment skin toxicity in patients treated with and without incorporation of this SSPT. Patients with skin/dermal lymphatic invasion or inflammatory breast cancer were excluded.

Results

A total of 84 patients who received breast/CW PBS were included (43 planned without and 41 with the SSPT). There was no difference in percentages of patients treated with intact breast/CW/immediate CW reconstruction between groups. Mean skin-evalV95%Rx was 72% vs 30%, P < .0001, for those treated without versus with an SSPT. Maximum %Rx to the skin-eval volume of 0.03, 0.3, and 1 cc was higher in patients treated without versus with an SSPT (103.1% vs 101.5%; 101.3% vs 100.4%; and 101.8% vs 99.7% [all P ≤ .0001]), respectively. There was a small difference in the mean clinical target volume V97.5%Rx in patients treated without versus with the SSPT (97.8% vs 96.5%, P = .0003). Patients planned using the SSPT demonstrated reduced rates of grade 1 breast pain at week 2 (12% vs 33%, P = .0424) and grades 2 and 3 dermatitis at weeks 4 and 5 (week 4 dermatitis ≥ grade 2, 18% vs 43%, P = .0224; week 5 dermatitis ≥ grade 2, 45% vs 69%, P = .0006). There were numerically more patients requiring a treatment break or not completing the full intended prescription (4 vs 1) in the pre-SSPT cohort.

Conclusions

The use of an SSPT may reduce acute skin toxicity in patients with breast cancer treated with PBS.

目的：本研究评估了体积皮肤保留计划技术（SSPT）可以减少质子铅笔束扫描（PBS）治疗乳房或胸壁（CW）患者的急性皮炎的假设。方法和材料：2022年1月，我们中心将基于体积的皮肤保留目标纳入皮肤热点评估作为SSPT。SSPT纳入了一个目标，将接受处方剂量95%或以上（V95%Rx）的皮肤评估结构（皮肤评估）的体积限制在理想的< 50%。我们比较了使用和不使用该SSPT治疗的患者的靶覆盖率、稳健性、皮肤评估剂量学和急性治疗时皮肤毒性。排除皮肤/真皮淋巴浸润或炎性乳腺癌患者。结果：共纳入84例接受乳腺/CW PBS的患者（43例计划不接受SSPT， 41例接受SSPT）。两组间接受完整乳房/连续乳房重建/立即连续乳房重建的患者百分比无差异。无SSPT组和接受SSPT组的平均皮肤评价（95% rx）分别为72%和30%，P < 0.0001。未接受SSPT治疗的患者皮肤评估体积的最大%Rx值为0.03、0.3和1cc，高于接受SSPT治疗的患者(103.1% vs 101.5%；101.3% vs 100.4%；101.8% vs 99.7%[均P≤0.0001])。未接受SSPT治疗的患者与接受SSPT治疗的患者的平均临床靶体积V97.5%Rx有微小差异（97.8% vs 96.5%, P = 0.0003）。计划使用SSPT的患者在第2周表现出1级乳房疼痛（12%对33%，P = 0.0424）和2级和3级皮炎(第4周皮炎≥2级，18%对43%，P = 0.0224；第5周皮炎≥2级（45% vs 69%, P = 0.0006）。在sspt前队列中，需要中断治疗或未完成全部预定处方的患者数量更多（4比1）。结论：使用SSPT可以降低接受PBS治疗的乳腺癌患者的急性皮肤毒性。

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引用次数: 0

First-in-Men Online Adaptive Robotic Stereotactic Body Radiation Therapy: Toward Ultrahypofractionation for High-Risk Prostate Cancer Patients

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-02-01 DOI: 10.1016/j.adro.2024.101701

Victor J. Brand MD, Maaike T.W. Milder PhD, Miranda E.M.C. Christianen MD, PhD, Kim C. de Vries MD, Mischa S. Hoogeman PhD, Luca Incrocci MD, PhD, Femke E. Froklage MD, PhD

Purpose

Ultrahypofractionation presents challenges for a subset of high-risk prostate cancer patients due to the large planning target volume (PTV) margin required for the seminal vesicles. Online adaptive radiation therapy could potentially reduce this margin. This paper focuses on the development, preclinical validation, and clinical testing of online adaptive robotic stereotactic body radiation therapy for this patient group.

Methods and Materials

An online adaptive workflow was developed for the CyberKnife with integrated in-room CT-on-rails. Preclinical validation involved comparing deep learning–based auto-contouring with deformable or rigid contour propagation in terms of subsequent editing time. A fast treatment planning method was implemented and compared with the conventional method in terms of optimization time and adherence to planning constraints. Clinical testing was conducted in the first study patients of the UPRATE trial, which investigates the feasibility of seminal vesicle PTV margin reduction in low-volume metastasized prostate cancer patients. Treatment time and patient experience were recorded.

Results

Rigid registration for prostate and deep-learning auto-contouring for seminal vesicles and organs at risk were selected based on editing time and robustness for anatomic changes. The fast treatment planning method reduced the optimization time from 10 to 3.5 minutes (P = .005). No significant differences in dose parameters were observed compared with the conventional plans. During clinical testing, 53 of 60 fast treatment plans adhered to the planning constraints, and all 60 were clinically accepted and delivered. The average total treatment time was 67.7 minutes, showing a downward trend. The treatment was well-experienced overall.

Conclusions

Online adaptive stereotactic body radiation therapy using CyberKnife with integrated CT-on-rails is clinically feasible for prostate cancer patients with seminal vesicles included in the target volume. The UPRATE trial outcome will reveal the extent to which online adaptation can reduce the PTV margin of the seminal vesicles.

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引用次数: 0

Exploring the Role of Radiosurgery for Atypical Meningiomas: Addressing Suboptimal Local Control in High-Risk Patients

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-01-30 DOI: 10.1016/j.adro.2024.101709

Sanjeev Sreenivasan MD, MCh , Salem Najjar BA , Daniel Ma MD , Sabrina L. Begley BS , Yen-Ruh Wuu MD , Zaker Rana MD , Emile Gogineni DO , Michael Schulder MD , Anuj Goenka MD

Purpose

Despite recent advancements in the treatment of atypical meningioma, control rates in high-risk patients continue to be suboptimal. Stereotactic radiosurgery (SRS) offers the ability to achieve improved local control (LC) with a low toxicity profile. However, available data are limited. We aimed to conduct a comprehensive review of a consecutive cohort of patients diagnosed with high-risk atypical meningioma who underwent SRS, either as a single-fraction SRS or in the hypofractionated SRS (hf-SRS), and evaluate the LC rates (LCR) with a specific emphasis on patterns of treatment failure.

Methods and Materials

We identified consecutive patients diagnosed with high-risk World Health Organization grade 2 meningioma treated with SRS at a single institution between 2014 and 2021. High-risk meningioma was defined as a residual disease or recurrence after initial gross total resection. Follow-up data were analyzed to evaluate LCRs and patterns of treatment failure. We defined local failure as tumor recurrence wthin the prescription isodose line, marginal failure as recurrence within 5 mm but outside the prescription isodose line, and distant/regional failure as recurrence beyond 5 mm of the prescription isodose line but within 2 cm of the surgical cavity.

Results

We identified 45 pathologically confirmed atypical meningiomas in 25 patients. Thirty-three tumors underwent single-fraction SRS, and 12 tumors received hf-SRS. The median follow-up was 36 months (range, 2-86 months). The 3-year LCR was 84.6%, and overall survival was 96.0%. Four patients with a total of 7 tumors experienced treatment failure. Failures were either local (3 patients and 3 lesions) or marginal (3 patients and 4 lesions). Patients treated with hf-SRS did not exhibit local, marginal, or distant failures.

Conclusions

Our institutional data on atypical patients with meningioma treated with radiosurgery compare favorably to existing literature using fractionated radiation therapy. SRS offers a promising strategy to improve LC in this patient population, and the occurrence of marginal failure plays a role in creating clinical target volume margins.

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引用次数: 0

Toxicities Associated with Adjuvant Radiation Therapy in Atypical Meningioma

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-01-25 DOI: 10.1016/j.adro.2025.101726

Grace Lee MD , Audrey Aitelli BS , Andrzej Niemierko PhD , Nayan Lamba MD , Daniel W. Kim MD, MBA , William T. Curry MD , Kevin S. Oh MD , Frederick G. Barker II MD , Helen A. Shih MD, MS, MPH

Purpose

While adjuvant radiation therapy (RT) may prolong progression-free survival in resected atypical meningiomas, whether such progression-free survival benefit outweighs potential treatment toxicities remains controversial. Here, we compare the acute and late toxicity outcomes of atypical meningiomas managed with upfront adjuvant RT versus surveillance.

Methods and Materials

In our prior single-institution retrospective study of 230 patients with resected atypical meningiomas between 2000 and 2015, adjuvant RT was associated with a significantly lower risk of progression/recurrence compared with surveillance (hazard ratio, 0.21; P < .01), with 36% of surveillance patients eventually requiring salvage RT. In this study, the acute (≤6 months) and late (>6 months) RT toxicities from the same patient cohort for those who received adjuvant (n = 51) versus salvage RT (n = 64) were compared. Additionally, treatment toxicity at the last follow-up was compared between the adjuvant RT (n = 51) and the surveillance (n = 179) groups. Toxicities were graded per the Common Terminology Criteria for Adverse Events v5.0.

Results

RT in the adjuvant compared with the salvage setting was generally associated with greater RT toxicities both in the acute (90% vs 69%, P < .01) and late (57% vs 33%, P = .01) setting. While there was no significant difference in grade 3 to 4 acute toxicities, late grade 3 to 4 toxicities were present in 14% of the adjuvant group versus 3% of the salvage RT group (P = .04). Radionecrosis was present in 18% of adjuvant RT versus 8% of salvage RT group (P = .11). Between the adjuvant RT and surveillance groups, any treatment-related toxicity at the last follow-up was greater in the adjuvant RT group (31% vs 15%, P < .01), with a trend toward greater grade 3 to 4 toxicities (8% vs 3%, P = .10). There was no difference in the rate of cerebrovascular accident (4% vs 4%, P = .99).

Conclusions

Adjuvant RT may be associated with greater acute and late treatment toxicities, which can significantly impact the quality of life of patients with atypical meningioma. Potential RT toxicity should be carefully weighed against tumor control benefits in deciding the optimal use and timing of RT.

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引用次数: 0

In Vitro α/β Ratio Variations in Cervical Cancer, with Consequent Effects on Equivalent Dose in 2 Gy Fraction in High-Dose-Rate Brachytherapy

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-01-23 DOI: 10.1016/j.adro.2025.101725

Cameron Thayer-Freeman MS , Brien Washington PhD , Denise Fabian MD , Dennis Cheek PhD , William St Clair MD , Mark Bernard MD , Wei Luo PhD

Purpose

To determine the distributions of published α/β values measured in vitro and the resulting uncertainties in the equivalent dose in 2 Gy fractions (EQD₂) when applied to high-dose-rate brachytherapy (HDR-BT) for cervical cancer.

Methods and Materials

An analysis of 98 published α/β values from 31 papers was conducted, spanning 23 cervical cancer cell lines. Values were further divided into squamous cell carcinoma and adenocarcinoma histologies. Probability distributions were fit to histograms using the bootstrapped Kolmogorov-Smirnov goodness-of-fit test. Both average and most probable α/β values for cervical cancer were determined. The probability distributions were then applied to three representative external beam therapy (EBT) plus HDR brachytherapy prescriptions to determine the potential impact they would have on the equivalent dose in 2 Gy fractions (EQD₂) for each prescription.

Results

Published results of α/β values ranged from 1.06 to 34.3 Gy. A right-skewed log-normal distribution was shown to be the best fit for overall α/β values as well as for squamous cell carcinoma and adenocarcinoma subtypes.. Average α/β values were determined to be 8.05, 8.47, and 6.60 Gy for the total, squamous cell carcinoma, and adenocarcinoma groups, respectively. The most probable values were 4.25, 4.34, and 4.22 Gy, respectively. The variations in α/β values led to uncertainties of −8.0 to 46.4 Gy in EQD₂. Average α/β values resulted in EQD₂ deviations of up to 4.3 Gy for the 83.9 Gy EQD₂ prescription, whereas most probable values resulted in disparities as significant as 10 Gy. We used our α/β value distributions to create uncertainty distributions for EQD₂ and discovered that the 83.9 Gy prescription in EQD₂ had average variations of up to 8% from the intended dose.

Conclusion

There was large variation in in vitro α/β values which presented as a right-skewed log-normal distribution with a most probable value of ∼4.3 Gy for cervical cancer. Adenocarcinoma showed somewhat lower average α/β values compared with squamous cell carcinoma, but the difference was not substantial enough to draw definitive conclusions. Lower α/β values resulted in higher EQD₂ for HDR-BT compared with α/β values at 10 Gy. This suggests that more accurate and potentially lower α/β values should be used for cervical cancer.

{"title":"In Vitro α/β Ratio Variations in Cervical Cancer, with Consequent Effects on Equivalent Dose in 2 Gy Fraction in High-Dose-Rate Brachytherapy","authors":"Cameron Thayer-Freeman MS , Brien Washington PhD , Denise Fabian MD , Dennis Cheek PhD , William St Clair MD , Mark Bernard MD , Wei Luo PhD","doi":"10.1016/j.adro.2025.101725","DOIUrl":"10.1016/j.adro.2025.101725","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the distributions of published α/β values measured in vitro and the resulting uncertainties in the equivalent dose in 2 Gy fractions (EQD<sub>2</sub>) when applied to high-dose-rate brachytherapy (HDR-BT) for cervical cancer.</div></div><div><h3>Methods and Materials</h3><div>An analysis of 98 published α/β values from 31 papers was conducted, spanning 23 cervical cancer cell lines. Values were further divided into squamous cell carcinoma and adenocarcinoma histologies. Probability distributions were fit to histograms using the bootstrapped Kolmogorov-Smirnov goodness-of-fit test. Both average and most probable α/β values for cervical cancer were determined. The probability distributions were then applied to three representative external beam therapy (EBT) plus HDR brachytherapy prescriptions to determine the potential impact they would have on the equivalent dose in 2 Gy fractions (EQD<sub>2</sub>) for each prescription.</div></div><div><h3>Results</h3><div>Published results of α/β values ranged from 1.06 to 34.3 Gy. A right-skewed log-normal distribution was shown to be the best fit for overall α/β values as well as for squamous cell carcinoma and adenocarcinoma subtypes.. Average α/β values were determined to be 8.05, 8.47, and 6.60 Gy for the total, squamous cell carcinoma, and adenocarcinoma groups, respectively. The most probable values were 4.25, 4.34, and 4.22 Gy, respectively. The variations in α/β values led to uncertainties of −8.0 to 46.4 Gy in EQD<sub>2</sub>. Average α/β values resulted in EQD<sub>2</sub> deviations of up to 4.3 Gy for the 83.9 Gy EQD<sub>2</sub> prescription, whereas most probable values resulted in disparities as significant as 10 Gy. We used our α/β value distributions to create uncertainty distributions for EQD<sub>2</sub> and discovered that the 83.9 Gy prescription in EQD<sub>2</sub> had average variations of up to 8% from the intended dose.</div></div><div><h3>Conclusion</h3><div>There was large variation in <em>in vitro</em> α/β values which presented as a right-skewed log-normal distribution with a most probable value of ∼4.3 Gy for cervical cancer. Adenocarcinoma showed somewhat lower average α/β values compared with squamous cell carcinoma, but the difference was not substantial enough to draw definitive conclusions. Lower α/β values resulted in higher EQD<sub>2</sub> for HDR-BT compared with α/β values at 10 Gy. This suggests that more accurate and potentially lower α/β values should be used for cervical cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 3","pages":"Article 101725"},"PeriodicalIF":2.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445301","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}

引用次数: 0