Advances in Radiation Oncology最新文献

{"title":"Preoperative Fractionated Stereotactic Radiosurgery for Brain Metastases: A Prospective Pilot Study at a Single Institution","authors":"Alexander Marwaha DO ,&nbsp;Matthew J. Shepard MD ,&nbsp;Yun Liang PhD ,&nbsp;Alexander Yu MD ,&nbsp;Stephen M. Karlovits MD ,&nbsp;Rodney E. Wegner MD","doi":"10.1016/j.adro.2025.101951","DOIUrl":"10.1016/j.adro.2025.101951","url":null,"abstract":"<div><h3>Purpose</h3><div>Brain metastases are a common occurrence in patients with advanced malignancy. Treatment ranges from surgical resection, stereotactic radiosurgery (SRS), whole-brain radiation therapy (WBRT), or some combination thereof. Traditionally, SRS has followed surgical resection to help reduce the risk of local recurrence. In recent years, interest has arisen in treating these patients in the preoperative setting to help reduce the risk of leptomeningeal disease (LMD) and radiation necrosis while preserving rates of local control. This prospective pilot study, originally planned as a phase 2 protocol, investigated the use of 3-fraction preoperative SRS on the Gamma Knife (GK) Icon with the goal of examining those outcomes.</div></div><div><h3>Methods and Materials</h3><div>Patients who had symptomatic and a limited number of brain metastases amenable to surgical resection were prospectively enrolled in this study. Patients were treated with fractionated SRS on the GK Icon to 24 to 27 Gy in 3 fractions followed by surgical resection within 2 weeks. Postoperative MRIs were obtained to assess the extent of resection. Patients were then followed up with standard-of-care MRIs every 3 months for the first 2 years. Rates of local control, distant brain failure, LMD, and delivery of WBRT were recorded on follow-up.</div></div><div><h3>Results</h3><div>Twenty patients were prospectively enrolled in the trial, and an additional 11 were treated off study using 1 to 3 fractions between April 2021 and June 2024. The median age was 64 (31-81), and 55% were females. Primary malignancies were mainly non-small cell lung cancer, melanoma, and esophageal cancer. The median prescription dose was 27 Gy (15-27 Gy) in 3 (1-3) fractions. Surgery was performed at a median of 1 day post-SRS (0-11). All available postoperative MRIs showed gross total resection. Median follow-up was 9 months. One patient experienced a local failure, yielding a 1-year local control rate of 95%. The rate of distant brain failure at 6 and 12 months was 38% at each time point. Three patients (9.6%) developed LMD in follow-up. Six patients ultimately received WBRT, yielding a 1-year WBRT-free survival of 78%. Overall survival at 1 year was 52%. There were no predictors of overall survival, local failure, or distant brain failure on Cox regression. Two patients experienced short-term toxicity, including grade 2 intracranial swelling and one grade 5 hemorrhagic stroke related to a hypertensive crisis. There was no recorded radionecrosis in follow-up.</div></div><div><h3>Conclusions</h3><div>Fractionated preoperative SRS appears to be safe and effective with high rates of local control and low rates of LMD and radionecrosis. Results of ongoing phase 3 studies directly comparing preoperative to postoperative SRS will help further define the appropriate sequencing of therapies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101951"},"PeriodicalIF":2.7,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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

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

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

{"title":"Optimizing Selection of Reactive versus Prophylactic Gastrostomy Tube Placement in Patients Treated with Radiation Therapy for Head and Neck Cancer","authors":"Nicholas A. Gallardo BS ,&nbsp;Niema B. Razavian MD ,&nbsp;Claire M. Lanier MD ,&nbsp;Sydney Smith MSPH ,&nbsp;Ralph B. D’Agostino Jr PhD ,&nbsp;Rachel F. Shenker MD ,&nbsp;Ji H. Lee MD ,&nbsp;Ankitha M. Iyer MD ,&nbsp;Bart A. Frizzell MD ,&nbsp;Ryan T. Hughes MD","doi":"10.1016/j.adro.2025.101930","DOIUrl":"10.1016/j.adro.2025.101930","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop a predictive assessment for determining patients at high risk of reactive gastrostomy tube (GT) placement during radiation therapy (RT) for head and neck cancer.</div></div><div><h3>Methods and Materials</h3><div>Data of patients with head and neck cancer treated with RT from 2018 to 2021 at a single institution were analyzed. Baseline patient characteristics were obtained and used to compare patients receiving prophylactic GT (pGT) with those who did not receive a pGT (reactive, or rGT group). Patients in the rGT group were further categorized as rGT-conditional (had GT placed or experienced &gt; 10% weight loss during RT) or rGT-appropriate (no GT placed and &lt; 10% weight loss during RT). Clinical, disease, and dosimetric factors were abstracted from the medical record, including dose to dysphagia/aspiration-related structures. A mixed linear model was used to assess weight loss through 12 months post-RT. Within the reactive group, multivariable logistic regression was used to develop a model predicting rGT-conditional cases who experienced rGT placement or weight loss &gt; 10% during RT.</div></div><div><h3>Results</h3><div>A total of 202 patients met the inclusion criteria: 86 in the pGT group and 116 in the rGT group. Patients in the pGT group were more likely to have advanced tumor stage, lower baseline functional oral intake scale, bilateral neck RT, concurrent chemotherapy, and higher mean pharynx dose of RT. Weight loss outcomes were similar between groups. Multivariable analysis identified several significant predictors of rGT-conditional cases.</div></div><div><h3>Conclusions</h3><div>Among patients planned for head and neck RT using an rGT paradigm, we identified predictors of GT placement or excessive weight loss on-treatment and developed a predictive model of GT placement in this group. Identifying patients at high risk of substantial weight loss and/or GT placement during RT may optimize personalization of rGT versus pGT. External validation of this model’s ability to predict patients at high risk of ultimately receiving rGT is warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101930"},"PeriodicalIF":2.7,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145881112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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