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Multimodal Nuclear Imaging Response as a Prognostic Indicator Following Spine Stereotactic Body Radiation Therapy 多模态核成像反应作为脊柱立体定向放射治疗后的预后指标
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-24 DOI: 10.1016/j.adro.2025.101942
Khaled Dibs MD , Glenis Tocaj BA , Joshua Palmer MD , Raju Raval MD, DPhil , Sasha Beyer MD, PhD , Simeng Zhu MD , Raj Singh MD , Emile Gogineni DO , Pavnesh Kumar MD , Russell Lonser MD , Evan Thomas MD, PhD , John Grecula MD, PhD , Arnab Chakravarti MD , David Xu MD , James Elder MD , Eric Bourekas MD , Dukagjin M. Blakaj MD, PhD

Purpose

Magnetic resonance imaging (MRI) is the primary modality for diagnosing and monitoring spinal metastases, but its interpretation can be complicated by nontumor-related changes like fibrosis or osteoradionecrosis. Nuclear imaging can complement MRI in evaluating treatment response. Yet, the prognostic significance of nuclear metabolic response after spine stereotactic body radiation therapy (SBRT) remains underexplored. This study evaluates the utility of nuclear imaging in assessing post-SBRT treatment response and its association with local control (LC) and survival outcomes.

Methods and Materials

This retrospective study evaluated spine metastases treated with SBRT focusing on pre- and first available posttreatment positron emission tomography (PET) or bone scans to assess nuclear metabolic response. PET responses were categorized as complete response (CR), partial response, stable disease, or disease progression, while bone scan interpretations were based on nuclear medicine reports. MRI was used for LC assessment. Predictors of LC and overall survival (OS) were identified via Cox regression analyses. Additionally, metabolic responses within the first 3 months and between 4 and 6 months post-SBRT were correlated with 2-year outcomes.

Results

Of the 53 patients, 66% underwent PET imaging and 34% underwent bone scans. Nuclear imaging revealed a metabolic CR in 74%, partial response in 13%, stable disease in 5%, and disease progression in 8%. Patients achieving metabolic CR (mCR) had significantly better 2-year LC (97% vs 60%, P < .001) and OS (76% vs 36%, P < .001). In multivariable analysis, mCR was independently predictive of improved LC (hazard ratio [HR]: 12.76; P = .005) and OS (HR: 4.03; P = .003). Systemic disease stability was also significantly associated with OS (HR: 5.27; P = .001). Early (≤3 months) and intermediate (4-6 months) mCR correlated with 100% LC, while non-mCR was associated with only 40% LC (P = .04 and P = .018, respectively). Among 10 patients who had local recurrence, one of them had mCR and the other one near mCR on concurrent PET scan suggesting pseudoprogression.

Conclusions

Multimodal nuclear imaging could provide a valuable functional insight in evaluating response after spine SBRT and may help overcome limitations of MRI. A metabolic CR is a strong independent predictor of LC and survival. Prospective studies with standardized imaging protocols are warranted to guide adaptive treatment strategies.
目的磁共振成像(MRI)是诊断和监测脊柱转移的主要方法,但其解释可能因非肿瘤相关的变化而复杂化,如纤维化或骨放射性坏死。核成像可以补充MRI评价治疗效果。然而,脊柱立体定向放射治疗(SBRT)后核代谢反应的预后意义仍未得到充分探讨。本研究评估了核成像在评估sbrt后治疗反应及其与局部控制(LC)和生存结果的关系中的应用。方法和材料本回顾性研究评估了SBRT治疗的脊柱转移瘤,重点关注治疗前和治疗后首次可用的正电子发射断层扫描(PET)或骨扫描来评估核代谢反应。PET反应分为完全缓解(CR)、部分缓解、疾病稳定或疾病进展,而骨扫描解释则基于核医学报告。MRI用于LC评估。通过Cox回归分析确定LC和总生存期(OS)的预测因子。此外,sbrt后前3个月和4 - 6个月的代谢反应与2年的结果相关。结果53例患者中,66%接受PET显像,34%接受骨扫描。核成像显示代谢CR占74%,部分缓解占13%,疾病稳定占5%,疾病进展占8%。达到代谢CR (mCR)的患者具有更好的2年LC (97% vs 60%, P < 0.001)和OS (76% vs 36%, P < 0.001)。在多变量分析中,mCR可独立预测LC(风险比[HR]: 12.76; P = 0.005)和OS(风险比[HR]: 4.03; P = 0.003)的改善。系统性疾病稳定性也与OS显著相关(HR: 5.27; P = .001)。早期(≤3个月)和中期(4-6个月)mCR与100% LC相关,而非mCR仅与40% LC相关(P = 0.04和P = 0.018)。在10例局部复发的患者中,同时PET扫描1例为mCR,另1例为mCR附近,提示假性进展。结论多模态核成像可为评价脊柱SBRT术后反应提供有价值的功能信息,有助于克服MRI的局限性。代谢CR是LC和生存的一个强有力的独立预测因子。标准化成像协议的前瞻性研究有必要指导适应性治疗策略。
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引用次数: 0
A Case of External Beam Radiation Therapy Induced Corneal Damage in the Treatment of Squamoid Eccrine Ductal Carcinoma 外束放射治疗鳞状上皮导管癌致角膜损伤1例
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-24 DOI: 10.1016/j.adro.2025.101935
Amelia Momtazzadeh BS , Ilakiya Raghavendiran , Christina Henson MD , Annie Moreau MD , Elise E. Steinberger MD
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引用次数: 0
Biologically Effective Dose and Dose Rate in Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis 伽玛刀放射治疗三叉神经痛的生物有效剂量和剂量率:系统回顾和荟萃分析
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-23 DOI: 10.1016/j.adro.2025.101932
Jane Jomy MSc , Ke Xin Lin BMSc , Radha Sharma BSc , Rachel Lu BMSc , Sanchit Kaushal BHSc , Anna T. Santiago MSc , Dana Keilty MD, MSc , David Shultz MD, PhD , Catherine Coolens PhD , Michael D. Cusimano MD, PhD , Gelareh Zadeh MD, PhD , Mojgan Hodaie MD, PhD , Suneil K. Kalia MD, PhD , Farshad Nassiri MD, PhD , Ying Meng MD , Derek S. Tsang MD, MSc , Michael Yan MD, MPH

Purpose

Gamma Knife radiosurgery (GKRS) is used in the treatment of trigeminal neuralgia (TN) to deliver precise, focused ionizing radiation to the trigeminal nerve, thereby reducing its ability to transmit pain signals. Understanding the impact of unique radiobiological parameters, such as the biologically effective dose (BED) and dose rate, in GKRS is essential to optimize treatment protocols and ensure predictable therapeutic outcomes. We conducted a systematic review and meta-analysis to evaluate how BED and dose rate impact GKRS effectiveness and toxicity.

Methods and Materials

We searched medical and health care databases from inception to May 19, 2024, for publications reporting on the impact of GKRS BED and/or dose rate on TN outcomes. Following 2 rounds of screening conducted in duplicate, we used random-effects meta-analysis and meta-regression to examine the association between dose rate and pain relief.

Results

Of 6950 citations identified, 8 publications reported data on BED and dose rate association with GKRS patient outcomes in TN. Eight cohorts reported on 2596 patients in 6 countries. The “beam-on” time ranged from 27 to 171 minutes, and the prescription dose ranged from 62.5 to 95 Gy. The median BED2.47 was 2105 Gy (range, 1968-2675), the median dose rate was 2.2 Gy/min (range, 2.06-2.81), and the median maximum brainstem dose was 20.7 Gy (range, 14.8-34.7). The meta-analysis suggested that higher dose rates may be associated with higher rates of pain relief (relative risk, 1.36 [95% CI, 1.10-1.67]; P = .005). Meta-regression demonstrated a nonsignificant relationship between dose rate and pain relief, with an estimated 26% increase in the likelihood of pain control for each 1 Gy/min increase in the median dose rate (β, 0.26 [95% CI, −1.09, 1.60]; P = .71).

Conclusions

Higher dose rates in GKRS may be associated with better pain relief in TN. Dose rate should be considered in the treatment of TN when using GKRS.
目的伽玛刀放射外科(GKRS)用于治疗三叉神经痛(TN),向三叉神经提供精确、聚焦的电离辐射,从而降低其传递疼痛信号的能力。了解独特的放射生物学参数(如生物有效剂量(BED)和剂量率)对GKRS的影响对于优化治疗方案和确保可预测的治疗结果至关重要。我们进行了系统回顾和荟萃分析,以评估BED和剂量率如何影响GKRS的有效性和毒性。方法和材料我们检索了从成立到2024年5月19日的医疗和卫生保健数据库,以获取有关GKRS BED和/或剂量率对TN结局影响的出版物。在重复进行了两轮筛选后,我们使用随机效应荟萃分析和荟萃回归来检验剂量率和疼痛缓解之间的关系。在确定的6950篇引用中,8篇出版物报告了BED和剂量率与TN GKRS患者结局相关的数据。8个队列报告了6个国家的2596名患者。照射时间从27分钟到171分钟不等,处方剂量从62.5 Gy到95 Gy不等。中位BED2.47为2105 Gy(范围,1968-2675),中位剂量率为2.2 Gy/min(范围,2.06-2.81),中位最大脑干剂量为20.7 Gy(范围,14.8-34.7)。荟萃分析表明,较高的剂量率可能与较高的疼痛缓解率相关(相对风险,1.36 [95% CI, 1.10-1.67]; P = 0.005)。meta回归显示剂量率与疼痛缓解之间无显著关系,中位剂量率每增加1 Gy/min,疼痛控制的可能性估计增加26% (β, 0.26 [95% CI, - 1.09, 1.60]; P = 0.71)。结论GKRS的剂量率越高,对TN疼痛的缓解效果越好,在使用GKRS治疗TN时应考虑剂量率。
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引用次数: 0
Safety of Combining Radiation Therapy and Antibody Drug Conjugates in Advanced Urothelial and Other Cancers 放射治疗联合抗体药物偶联物治疗晚期尿路上皮和其他癌症的安全性
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-22 DOI: 10.1016/j.adro.2025.101926
Derrick Lock , Yash S. Soni , Lindsay Hwang , Suzanne Cole , Anishka D’Souza , Aurelie Garant , Daniel X. Yang , Waddah Arafat , Tian Zhang , Leslie K. Ballas , Neil B. Desai
Antibody drug conjugates (ADCs) such as enfortumab vedotin and sacituzumab govitecan are novel treatments increasingly used for metastatic urothelial carcinoma. There is limited data evaluating their safety when combined with radiation therapy (RT). A bi-institutional retrospective analysis was performed to characterize toxicity in patients who received RT within 6 months of receipt of ADC. Patients were stratified by intensity of RT (higher vs lower), site of RT, and RT timing relative to ADC. One hundred three patients received 166 courses of RT (66% lower vs 34% higher intensity). In 11% of courses, RT was directed to the pelvis including the bladder. Of 77 (46%) RT courses concurrent with ADC, 7 (12%) patients experienced grade 1-2 toxicity, and 10 (13%) patients experienced grade 3-5 toxicity. All of these were attributed to known ADC toxicities, and only one was possibly influenced by the addition of RT. No patients receiving RT to the bladder experienced high-grade toxicity. This retrospective study thus found no added safety events for patients receiving RT with ADCs, even when administered concurrently. Further data to validate these findings is needed as the use of both ADCs and RT increases in patients with urothelial carcinoma.
抗体药物偶联物(adc)如enfortumab vedotin和sacituzumab govitecan是越来越多地用于转移性尿路上皮癌的新型治疗方法。评估它们与放射治疗(RT)联合使用的安全性的数据有限。进行了双机构回顾性分析,以表征在接受ADC的6个月内接受RT的患者的毒性。根据放疗强度(高vs低)、放疗部位和相对于ADC的放疗时间对患者进行分层。103例患者接受了166个疗程的放疗(低强度66% vs高强度34%)。在11%的疗程中,RT被定向到骨盆包括膀胱。在77例(46%)与ADC同时进行的RT治疗中,7例(12%)患者出现1-2级毒性,10例(13%)患者出现3-5级毒性。所有这些都归因于已知的ADC毒性,只有一个可能受到添加RT的影响。没有接受膀胱RT的患者出现高级别毒性。因此,这项回顾性研究发现,即使同时给予adc,接受RT治疗的患者也没有增加安全事件。由于adc和RT在尿路上皮癌患者中的使用增加,需要进一步的数据来验证这些发现。
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引用次数: 0
Boron Neutron Capture Therapy as a Novel Approach for Chondrosarcoma: Case Study of Tumor Reduction and Long-term Control 硼中子俘获治疗作为软骨肉瘤的新方法:肿瘤缩小和长期控制的案例研究
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-16 DOI: 10.1016/j.adro.2025.101897
Junqiang Hong MD , Yuan-Hao Liu PhD , Xiaohua Zhu MD, PhD , Yi-Chiao Teng PhD , Xiaoyi Lin MD , Diyun Shu PhD , Youqun Lai MS , Ye Cao PhD , Qiuping Gong BEng , Shuang Fu BS , Wenyu Xu MS , Qiuli Lai BS , Xingyan Liu PhD , Ping Zhou PhD , Mu Mei MS , Mingang Ying MD, PhD , Cheng Huang MD, PhD , Jianji Pan MD, PhD

Purpose

Mesenchymal chondrosarcoma (MCS), a rare malignant tumor arising from cartilage-forming tissues, is known for its resistance to conventional therapies. This case report presents the first documented use of boron neutron capture therapy (BNCT) for treating a patient with chondrosarcoma.

Methods and Materials

The treatment was carried out using the NeuPex AB-BNCT system in combination with the boron compound NBB-001 (boronophenylalanine) and the NeuMANTA treatment planning system. Over the course of 2 BNCT sessions, the patient experienced significant tumor reduction and a favorable clinical response, with no severe adverse effects reported. The therapy was guided by 18F-boronophenylalanine positron emission tomography-computed tomography imaging scans for planning and magnetic resonance imaging scans for outcome assessment.

Results

The targeted nature of BNCT resulted in a 45.8% reduction in the tumor's maximum dimension, achieving a partial response according to Response Evaluation Criteria in Solid Tumors version 1.1. Most adverse events were mild (grades 1-2) and manageable, with only grade 3 mucositis observed, which was transient and resolved with supportive care.

Conclusions

This case study underscored the potential of BNCT as a promising treatment modality for MCS, particularly for tumors that are resistant to conventional radiation therapy. Further research is warranted to refine treatment protocols and explore the broader applicability of BNCT in managing MCS and other challenging malignancies.
摘要:间充质软骨肉瘤(MCS)是一种发生于软骨形成组织的罕见恶性肿瘤,因其对常规治疗的耐药性而闻名。本病例报告提出了首次记录使用硼中子捕获疗法(BNCT)治疗软骨肉瘤患者。方法和材料采用NeuPex AB-BNCT系统联合硼化合物NBB-001(硼苯丙氨酸)和NeuMANTA治疗计划系统进行治疗。在2次BNCT治疗过程中,患者经历了显著的肿瘤缩小和良好的临床反应,没有严重的不良反应报告。治疗由18f -硼苯丙氨酸正电子发射断层扫描-计算机断层扫描成像计划和磁共振成像扫描结果评估指导。结果BNCT的靶向性使肿瘤的最大尺寸缩小了45.8%,根据实体瘤1.1版的反应评价标准实现了部分反应。大多数不良事件是轻微的(1-2级)和可控的,仅观察到3级粘膜炎,这是短暂的,并通过支持治疗解决。该病例研究强调了BNCT作为MCS的一种有希望的治疗方式的潜力,特别是对于传统放射治疗耐药的肿瘤。需要进一步的研究来完善治疗方案,并探索BNCT在治疗MCS和其他具有挑战性的恶性肿瘤中的更广泛适用性。
{"title":"Boron Neutron Capture Therapy as a Novel Approach for Chondrosarcoma: Case Study of Tumor Reduction and Long-term Control","authors":"Junqiang Hong MD ,&nbsp;Yuan-Hao Liu PhD ,&nbsp;Xiaohua Zhu MD, PhD ,&nbsp;Yi-Chiao Teng PhD ,&nbsp;Xiaoyi Lin MD ,&nbsp;Diyun Shu PhD ,&nbsp;Youqun Lai MS ,&nbsp;Ye Cao PhD ,&nbsp;Qiuping Gong BEng ,&nbsp;Shuang Fu BS ,&nbsp;Wenyu Xu MS ,&nbsp;Qiuli Lai BS ,&nbsp;Xingyan Liu PhD ,&nbsp;Ping Zhou PhD ,&nbsp;Mu Mei MS ,&nbsp;Mingang Ying MD, PhD ,&nbsp;Cheng Huang MD, PhD ,&nbsp;Jianji Pan MD, PhD","doi":"10.1016/j.adro.2025.101897","DOIUrl":"10.1016/j.adro.2025.101897","url":null,"abstract":"<div><h3>Purpose</h3><div>Mesenchymal chondrosarcoma (MCS), a rare malignant tumor arising from cartilage-forming tissues, is known for its resistance to conventional therapies. This case report presents the first documented use of boron neutron capture therapy (BNCT) for treating a patient with chondrosarcoma.</div></div><div><h3>Methods and Materials</h3><div>The treatment was carried out using the NeuPex AB-BNCT system in combination with the boron compound NBB-001 (boronophenylalanine) and the NeuMANTA treatment planning system. Over the course of 2 BNCT sessions, the patient experienced significant tumor reduction and a favorable clinical response, with no severe adverse effects reported. The therapy was guided by <sup>18</sup>F-boronophenylalanine positron emission tomography-computed tomography imaging scans for planning and magnetic resonance imaging scans for outcome assessment.</div></div><div><h3>Results</h3><div>The targeted nature of BNCT resulted in a 45.8% reduction in the tumor's maximum dimension, achieving a partial response according to Response Evaluation Criteria in Solid Tumors version 1.1. Most adverse events were mild (grades 1-2) and manageable, with only grade 3 mucositis observed, which was transient and resolved with supportive care.</div></div><div><h3>Conclusions</h3><div>This case study underscored the potential of BNCT as a promising treatment modality for MCS, particularly for tumors that are resistant to conventional radiation therapy. Further research is warranted to refine treatment protocols and explore the broader applicability of BNCT in managing MCS and other challenging malignancies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101897"},"PeriodicalIF":2.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324504","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
Lutetium 177Lu Vipivotide Tetraxetan Efficacy and Toxicity in Advanced Prostate Cancer Lutetium 177Lu Vipivotide Tetraxetan治疗晚期前列腺癌的疗效和毒性
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-10 DOI: 10.1016/j.adro.2025.101917
Anthony Y. Zhang BS , Helaine Bertsch MD , Ahmed Chaudhary MD , Andrew Salner MD

Purpose

This retrospective study aimed to evaluate the efficacy and toxicity of lutetium 177Lu vipivotide tetraxetan ([LuVT], Pluvicto, Novatis Pharmaceutical Corporation), a peptide receptor radionuclide therapy, in metastatic castration-resistant prostate cancer patients treated at a single institution during the first year of Food and Drug Administration-approved clinical use.

Methods and Materials

A total of 45 patients with metastatic castration-resistant prostate cancer and positive prostate-specific membrane antigen positron emission tomography imaging were treated with at least 1 cycle of LuVT therapy between September 2022 and September 2023. Clinical records were reviewed to assess prostate-specific antigen (PSA) response, imaging outcomes, and patient-reported and physician-reported toxicities. PSA responses were classified into complete, excellent (≥50% reduction), partial (10%-49% reduction), no response, and initial response with disease progression. Toxicities were graded with Common Terminology Criteria for Adverse Events v5.0 criteria.

Results

Of 45 patients, 44 encompassed the final cohort (1 excluded after a single treatment before death from comorbidity). The mean age was 72.8 years and 88.9% of the cohort was White. A total of 68.9% of the cohort observed PSA biomarker improvement of ≥10%, and 55.6% with ≥50% PSA reduction. Three patients (6.7%) achieved a complete response. Imaging improvements were seen in 8 patients, including 1 with non–PSA-secreting disease. Adverse events were predominantly grade 1 and 2 severities. Most common patient-reported effects included fatigue and flare-related bone pain, with flare reactions noted in 26.7% of patients. None of the toxicities exceeded grade 2 severity. Treatment discontinuation occurred in 33.3% of patients because of a combination of progression, toxicity, lab parameters, or palliative care transition.

Conclusions

LuVT therapy demonstrated consistent efficacy and tolerable toxicity in this real-world cohort, with results comparable to the VISION trial. Flare pain reactions and appetite loss emerged as prominent, although tolerable, adverse effects. Limitations include small sample size, lack of long-term follow-up, and a homogenous population with significantly advanced disease.
目的:本回顾性研究旨在评估一种肽受体放射性核素疗法lutetium 177Lu vipivotide tetraxetan ([LuVT], Pluvicto, Novatis Pharmaceutical Corporation)在美国食品和药物管理局批准临床使用的第一年在单一机构治疗的转移性去势抵抗前列腺癌患者的疗效和毒性。方法与材料在2022年9月至2023年9月期间,对45例转移性去势抵抗性前列腺癌和前列腺特异性膜抗原阳性的正电子发射断层扫描患者进行至少1个周期的LuVT治疗。我们回顾了临床记录,以评估前列腺特异性抗原(PSA)反应、影像学结果以及患者报告和医生报告的毒性。PSA反应分为完全、极好(减少≥50%)、部分(减少10%-49%)、无反应和随着疾病进展的初始反应。根据不良事件通用术语标准v5.0标准对毒性进行分级。结果45例患者中,44例纳入最终队列(1例在死亡前因合并症接受单一治疗后被排除在外)。平均年龄为72.8岁,88.9%的队列是白人。共有68.9%的队列观察到PSA生物标志物改善≥10%,55.6%的队列观察到PSA降低≥50%。3例患者(6.7%)获得完全缓解。8例患者影像学改善,包括1例非psa分泌性疾病。不良事件以1级和2级为主。最常见的患者反应包括疲劳和耀斑相关的骨痛,26.7%的患者有耀斑反应。所有毒性均未超过2级严重程度。由于进展、毒性、实验室参数或姑息治疗过渡的综合原因,有33.3%的患者停药。结论:在这个真实世界的队列中,sluvt治疗显示出一致的疗效和可耐受的毒性,结果与VISION试验相当。急性疼痛反应和食欲减退是突出的,尽管可以容忍,不良反应。局限性包括样本量小,缺乏长期随访,同质人群明显进展。
{"title":"Lutetium 177Lu Vipivotide Tetraxetan Efficacy and Toxicity in Advanced Prostate Cancer","authors":"Anthony Y. Zhang BS ,&nbsp;Helaine Bertsch MD ,&nbsp;Ahmed Chaudhary MD ,&nbsp;Andrew Salner MD","doi":"10.1016/j.adro.2025.101917","DOIUrl":"10.1016/j.adro.2025.101917","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective study aimed to evaluate the efficacy and toxicity of lutetium <sup>177</sup>Lu vipivotide tetraxetan ([LuVT], Pluvicto, Novatis Pharmaceutical Corporation), a peptide receptor radionuclide therapy, in metastatic castration-resistant prostate cancer patients treated at a single institution during the first year of Food and Drug Administration-approved clinical use.</div></div><div><h3>Methods and Materials</h3><div>A total of 45 patients with metastatic castration-resistant prostate cancer and positive prostate-specific membrane antigen positron emission tomography imaging were treated with at least 1 cycle of LuVT therapy between September 2022 and September 2023. Clinical records were reviewed to assess prostate-specific antigen (PSA) response, imaging outcomes, and patient-reported and physician-reported toxicities. PSA responses were classified into complete, excellent (≥50% reduction), partial (10%-49% reduction), no response, and initial response with disease progression. Toxicities were graded with Common Terminology Criteria for Adverse Events v5.0 criteria.</div></div><div><h3>Results</h3><div>Of 45 patients, 44 encompassed the final cohort (1 excluded after a single treatment before death from comorbidity). The mean age was 72.8 years and 88.9% of the cohort was White. A total of 68.9% of the cohort observed PSA biomarker improvement of ≥10%, and 55.6% with ≥50% PSA reduction. Three patients (6.7%) achieved a complete response. Imaging improvements were seen in 8 patients, including 1 with non–PSA-secreting disease. Adverse events were predominantly grade 1 and 2 severities. Most common patient-reported effects included fatigue and flare-related bone pain, with flare reactions noted in 26.7% of patients. None of the toxicities exceeded grade 2 severity. Treatment discontinuation occurred in 33.3% of patients because of a combination of progression, toxicity, lab parameters, or palliative care transition.</div></div><div><h3>Conclusions</h3><div>LuVT therapy demonstrated consistent efficacy and tolerable toxicity in this real-world cohort, with results comparable to the VISION trial. Flare pain reactions and appetite loss emerged as prominent, although tolerable, adverse effects. Limitations include small sample size, lack of long-term follow-up, and a homogenous population with significantly advanced disease.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101917"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615557","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
Circulating Tumor DNA Predicts Response After Definitive Radiation Therapy for Merkel Cell Carcinoma 循环肿瘤DNA预测默克尔细胞癌最终放射治疗后的反应
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-10 DOI: 10.1016/j.adro.2025.101918
Kyle Murchison BS , Anthony Camargo BA , Danielle Margalit MD , Jonathan D. Schoenfeld MD, MPH , Roy Tishler MD , Karam Khaddour MD , Manisha Thakuria MD , Ann W. Silk MD

Purpose

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high recurrence rate. Circulating tumor DNA (ctDNA) assays are increasingly used to assess treatment response and detect recurrence. This study evaluated the value of ctDNA levels in MCC patients treated with definitive radiation therapy (dRT).

Methods and Materials

We identified 48 patients with MCC treated with dRT from 2021-2024 treated at our institute. The level of ctDNA was measured within 90 days before and 180 days after initiating dRT using a tumor-informed multiplex polymerase chain reaction assay targeting up to 16 patient-specific mutations. Disease status at follow-up was categorized as no evidence of disease (NED) or clinical evidence of disease. ctDNA dynamics were compared across disease outcome groups using the Wilcoxon rank-sum test.

Results

At baseline, the value of median ctDNA levels were higher in stage 1 versus stage 1-2. Of 23 patients with detectable ctDNA levels at baseline, 15 achieved undetectable levels following dRT. ctDNA levels declined significantly during (P = .0125) and after dRT (P = .0004). Among patients who became NED, ctDNA levels declined rapidly. In contrast, persistent or rising value of ctDNA levels after dRT was associated with recurrence. Nine of 10 patients with detectable ctDNA levels after dRT experienced recurrence, with a median time to recurrence of 117 days. Among patients with undetectable ctDNA levels during dRT, the negative predictive value for recurrence was 90%.

Conclusions

ctDNA levels decline rapidly during and after dRT in patients with MCC, particularly in those who achieve NED. Detectable ctDNA levels after dRT are strongly associated with recurrence, supporting the use of ctDNA level as a noninvasive biomarker to assess treatment response and guide posttreatment surveillance.
目的:上皮细胞癌(MCC)是一种罕见的侵袭性皮肤癌,复发率高。循环肿瘤DNA (ctDNA)检测越来越多地用于评估治疗反应和检测复发。本研究评估ctDNA水平在接受明确放射治疗(dRT)的MCC患者中的价值。方法和材料我们确定了48例2021-2024年在我们研究所接受dRT治疗的MCC患者。ctDNA水平在开始dRT前90天和开始dRT后180天内测量,使用肿瘤知情的多重聚合酶链反应测定,靶向多达16个患者特异性突变。随访时的疾病状态分为无疾病证据(NED)或有疾病临床证据。使用Wilcoxon秩和检验比较不同疾病结局组的ctDNA动态。结果基线时,1期ctDNA中位值高于1-2期。在23例基线ctDNA水平可检测的患者中,15例在dRT后达到了不可检测的水平。ctDNA水平在dRT期间(P = 0.0125)和dRT后显著下降(P = 0.0004)。在成为NED的患者中,ctDNA水平迅速下降。相反,dRT后持续或升高的ctDNA水平与复发有关。在dRT后检测到ctDNA水平的10例患者中有9例出现复发,平均复发时间为117天。在dRT期间检测不到ctDNA水平的患者中,复发的阴性预测值为90%。结论:MCC患者的dna水平在dRT期间和之后迅速下降,特别是那些达到NED的患者。dRT后可检测的ctDNA水平与复发密切相关,支持ctDNA水平作为评估治疗反应和指导治疗后监测的无创生物标志物的使用。
{"title":"Circulating Tumor DNA Predicts Response After Definitive Radiation Therapy for Merkel Cell Carcinoma","authors":"Kyle Murchison BS ,&nbsp;Anthony Camargo BA ,&nbsp;Danielle Margalit MD ,&nbsp;Jonathan D. Schoenfeld MD, MPH ,&nbsp;Roy Tishler MD ,&nbsp;Karam Khaddour MD ,&nbsp;Manisha Thakuria MD ,&nbsp;Ann W. Silk MD","doi":"10.1016/j.adro.2025.101918","DOIUrl":"10.1016/j.adro.2025.101918","url":null,"abstract":"<div><h3>Purpose</h3><div>Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high recurrence rate. Circulating tumor DNA (ctDNA) assays are increasingly used to assess treatment response and detect recurrence. This study evaluated the value of ctDNA levels in MCC patients treated with definitive radiation therapy (dRT).</div></div><div><h3>Methods and Materials</h3><div>We identified 48 patients with MCC treated with dRT from 2021-2024 treated at our institute. The level of ctDNA was measured within 90 days before and 180 days after initiating dRT using a tumor-informed multiplex polymerase chain reaction assay targeting up to 16 patient-specific mutations. Disease status at follow-up was categorized as no evidence of disease (NED) or clinical evidence of disease. ctDNA dynamics were compared across disease outcome groups using the Wilcoxon rank-sum test.</div></div><div><h3>Results</h3><div>At baseline, the value of median ctDNA levels were higher in stage 1 versus stage 1-2. Of 23 patients with detectable ctDNA levels at baseline, 15 achieved undetectable levels following dRT. ctDNA levels declined significantly during (<em>P</em> = .0125) and after dRT (<em>P</em> = .0004). Among patients who became NED, ctDNA levels declined rapidly. In contrast, persistent or rising value of ctDNA levels after dRT was associated with recurrence. Nine of 10 patients with detectable ctDNA levels after dRT experienced recurrence, with a median time to recurrence of 117 days. Among patients with undetectable ctDNA levels during dRT, the negative predictive value for recurrence was 90%.</div></div><div><h3>Conclusions</h3><div>ctDNA levels decline rapidly during and after dRT in patients with MCC, particularly in those who achieve NED. Detectable ctDNA levels after dRT are strongly associated with recurrence, supporting the use of ctDNA level as a noninvasive biomarker to assess treatment response and guide posttreatment surveillance.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101918"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519041","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
Computed Tomography-Based Radiomics Prediction of Biochemical Failure and Distant Metastasis in Patients With High- and Very High-Risk Localized Prostate Cancer 基于计算机断层扫描的放射组学预测高、高危局限性前列腺癌患者的生化失败和远处转移
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-08 DOI: 10.1016/j.adro.2025.101916
Takanori Adachi PhD , Kota Hirata MS , Rihito Aizawa MD, PhD , Hideaki Hirashima PhD , Takashi Ogata MD , Mitsuhiro Nakamura PhD , Takashi Mizowaki MD, PhD

Purpose

This study aims to assess the utility of radiomics features extracted from planning computed tomography (pCT) images in predicting biochemical failure (BF) and distant metastasis (DM) in patients with localized prostate cancer (PCa).

Methods and Materials

This retrospective study included 608 patients with high-risk and very high-risk localized PCa who received intensity modulated radiation therapy. Five clinical variables—age, clinical T-stage, Gleason score, prostate-specific antigen level, and prescribed dose—were collected. Additionally, 1316 radiomics features (shape, first-order, and texture) were extracted from pCT images. Patients were randomly classified into training-validation (70%) and test (30%) cohorts, with stratification by BF and DM incidence. Predictive models were developed to estimate BF and DM risk using 3 strategies: a clinical model based on the 5 clinical variables; a radiomics model using 5 selected radiomics features; and a hybrid model combining both. All models were constructed using random survival forest with undersampling, considering death as a competing risk. Models were then applied to the test cohort, stratifying patients into high- and low-score groups by the median risk score. Model performance was evaluated using the concordance index (C-index), where values of 0.5 and 1.0 indicate random and perfect predictions, respectively, with survival differences between the 2 groups assessed using Gray’s test.

Results

During a median follow-up of 8.2 years, BF and DM occurred in 178 (29.3%) and 52 (8.6%) patients, respectively. In the test cohort, the C-indices for BF prediction were 0.637, 0.640, and 0.687 for the clinical, radiomics, and hybrid models, respectively (P < .05). For DM prediction, the C-indices were 0.586 (P = .203), 0.588 (P = .153), and 0.599 (P = .099), respectively.

Conclusions

Integrating clinical and pCT-based radiomics features enhanced BF prediction in patients with high-risk and very high-risk localized PCa when accounting for competing risks using random survival forest. However, no significant improvement was observed for DM prediction.
目的本研究旨在评估从规划计算机断层扫描(pCT)图像中提取的放射组学特征在预测局限性前列腺癌(PCa)患者生化失败(BF)和远处转移(DM)中的应用价值。方法与材料本回顾性研究纳入608例接受调强放疗的高危和极高危局部前列腺癌患者。收集5个临床变量:年龄、临床t分期、Gleason评分、前列腺特异性抗原水平和处方剂量。此外,从pCT图像中提取1316个放射组学特征(形状、一阶和纹理)。患者随机分为训练验证组(70%)和测试组(30%),并按BF和DM发生率分层。采用3种策略建立预测模型来估计BF和DM风险:基于5个临床变量的临床模型;使用5个选定的放射组学特征的放射组学模型;以及一种结合两者的混合模式。所有模型均采用欠采样随机生存森林构建,将死亡视为竞争风险。然后将模型应用于测试队列,根据中位风险评分将患者分为高分组和低分组。使用一致性指数(C-index)评估模型性能,其中0.5和1.0分别表示随机和完美预测,使用Gray检验评估两组之间的生存差异。结果在8.2年的中位随访期间,BF和DM分别发生178例(29.3%)和52例(8.6%)。在试验队列中,临床模型、放射组学模型和混合模型预测BF的c指数分别为0.637、0.640和0.687 (P < 0.05)。预测糖尿病的c指数分别为0.586 (P = .203)、0.588 (P = .153)和0.599 (P = .099)。结论在考虑随机生存森林的竞争风险时,结合临床和基于ct的放射组学可以增强高风险和非常高风险局部PCa患者的BF预测。然而,DM预测没有明显改善。
{"title":"Computed Tomography-Based Radiomics Prediction of Biochemical Failure and Distant Metastasis in Patients With High- and Very High-Risk Localized Prostate Cancer","authors":"Takanori Adachi PhD ,&nbsp;Kota Hirata MS ,&nbsp;Rihito Aizawa MD, PhD ,&nbsp;Hideaki Hirashima PhD ,&nbsp;Takashi Ogata MD ,&nbsp;Mitsuhiro Nakamura PhD ,&nbsp;Takashi Mizowaki MD, PhD","doi":"10.1016/j.adro.2025.101916","DOIUrl":"10.1016/j.adro.2025.101916","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to assess the utility of radiomics features extracted from planning computed tomography (pCT) images in predicting biochemical failure (BF) and distant metastasis (DM) in patients with localized prostate cancer (PCa).</div></div><div><h3>Methods and Materials</h3><div>This retrospective study included 608 patients with high-risk and very high-risk localized PCa who received intensity modulated radiation therapy. Five clinical variables—age, clinical T-stage, Gleason score, prostate-specific antigen level, and prescribed dose—were collected. Additionally, 1316 radiomics features (shape, first-order, and texture) were extracted from pCT images. Patients were randomly classified into training-validation (70%) and test (30%) cohorts, with stratification by BF and DM incidence. Predictive models were developed to estimate BF and DM risk using 3 strategies: a clinical model based on the 5 clinical variables; a radiomics model using 5 selected radiomics features; and a hybrid model combining both. All models were constructed using random survival forest with undersampling, considering death as a competing risk. Models were then applied to the test cohort, stratifying patients into high- and low-score groups by the median risk score. Model performance was evaluated using the concordance index (C-index), where values of 0.5 and 1.0 indicate random and perfect predictions, respectively, with survival differences between the 2 groups assessed using Gray’s test.</div></div><div><h3>Results</h3><div>During a median follow-up of 8.2 years, BF and DM occurred in 178 (29.3%) and 52 (8.6%) patients, respectively. In the test cohort, the C-indices for BF prediction were 0.637, 0.640, and 0.687 for the clinical, radiomics, and hybrid models, respectively (<em>P</em> &lt; .05). For DM prediction, the C-indices were 0.586 (<em>P</em> = .203), 0.588 (<em>P</em> = .153), and 0.599 (<em>P</em> = .099), respectively.</div></div><div><h3>Conclusions</h3><div>Integrating clinical and pCT-based radiomics features enhanced BF prediction in patients with high-risk and very high-risk localized PCa when accounting for competing risks using random survival forest. However, no significant improvement was observed for DM prediction.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101916"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474217","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
The Empty Bladder is Preferred in Some Cases of Radiation Therapy for Rectal Cancer 在某些直肠癌的放射治疗中,空膀胱是首选
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-03 DOI: 10.1016/j.adro.2025.101872
Inna Ospovat MD, Albert Schlocker MSc, Natan Shtraus MSc, Ravit Geva MD, Shani Hazan BSc, Tatyana Shevchuk MSc, Alexander Barenboim MD, Ido Wolf MD, Orit Gutfeld MD, Viacheslav Soyfer MD
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引用次数: 0
Novel Molecular Subtyping Predicts Locoregional Recurrence in Triple-negative Breast Cancer 新的分子分型预测三阴性乳腺癌局部复发
IF 2.7 Q3 ONCOLOGY Pub Date : 2025-10-02 DOI: 10.1016/j.adro.2025.101909
Shali Shao MS , Wei Shi PhD , Li Zhang PhD , Qixian Zhang PhD , Jin Meng PhD , Zhaozhi Yang PhD , Miao Mo PhD , Zhen Zhang PhD , Xiaomao Guo PhD , Xiaoli Yu PhD

Purpose

Immunohistochemistry (IHC)-based molecular subtyping provides a comprehensive profile of triple-negative breast cancer (TNBC). We aimed to elucidate patterns of locoregional recurrence (LRR) in different subtypes of TNBC.

Methods and Materials

In this study, 352 patients with breast cancer treated with mastectomy and postmastectomy radiation therapy from November 2019 to March 2022 were retrospectively analyzed. Based on IHC, these patients were classified into the basal-like immune-suppressed (BLIS) and non-BLIS groups. We compared LRR as the first event, disease-free survival, and overall survival (OS) between the 2 groups. Univariate and multivariate analysis was performed.

Results

The median follow-up time was 44.6 months. Twenty-six LRR (including 9 isolated LRR) and 70 distant metastases (DMs) were observed. The cumulative incidence of LRR was significantly different between the 2 groups, with an LRR rate of 5.8% in the non-BLIS group and 14.9% in the BLIS group (P = .005). The difference in OS was also significant (91.9% vs 83.0%, P = .01). However, there was no significant difference in disease-free survival between the non-BLIS and BLIS groups (80.2% vs 74.5%, P = .35). Multivariate analysis demonstrated that IHC-based molecular subtyping was an independently prognostic factor for LRR and OS (P = .03; P = .03).

Conclusions

This study demonstrated that the BLIS subtype appears to be at a higher risk of developing LRR, and IHC-based molecular subtyping might be used as prognostic biomarkers to guide postmastectomy radiation therapy in patients with TNBC. New strategies that improve locoregional control rates in patients with BLIS are warranted.
目的:基于免疫组织化学(IHC)的分子分型提供了三阴性乳腺癌(TNBC)的全面概况。我们的目的是阐明不同亚型TNBC的局部复发(LRR)模式。方法与材料本研究回顾性分析2019年11月至2022年3月352例接受乳房切除术和乳房切除术后放疗的乳腺癌患者。根据免疫组化,将这些患者分为基底样免疫抑制(BLIS)组和非BLIS组。我们比较了两组之间的LRR作为第一事件、无病生存期和总生存期(OS)。进行单因素和多因素分析。结果中位随访时间为44.6个月。观察到26例LRR(包括9例分离性LRR)和70例远处转移(DMs)。两组间LRR累积发生率差异有统计学意义,非BLIS组LRR为5.8%,BLIS组LRR为14.9% (P = 0.005)。OS的差异也很显著(91.9% vs 83.0%, P = 0.01)。然而,非BLIS组和BLIS组的无病生存率无显著差异(80.2% vs 74.5%, P = 0.35)。多因素分析显示,基于ihc的分子分型是LRR和OS的独立预后因素(P = .03; P = .03)。结论BLIS亚型发生LRR的风险较高,基于ihc的分子分型可作为指导TNBC患者乳腺切除术后放疗的预后生物标志物。提高BLIS患者局部控制率的新策略是必要的。
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引用次数: 0
期刊
Advances in Radiation Oncology
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