Advances in Radiation Oncology最新文献

{"title":"Successful Stereotactic Body Radiation Therapy for Prostate Cancer in a Patient With Prior Total Colectomy and Ileal Pouch-Anal Anastomosis: A Case Report and Technical Considerations","authors":"Takero Hirata MD, PhD , Shinichiro Fukuhara MD, PhD , Kentaro Takezawa MD, PhD , Naoki Kai MS , Masataka Nakai MD , Yasutoshi Fumimoto MD , Nobuyuki Tamaki MD , Shotaro Tatekawa MD, PhD , Kazuhiko Hayashi MD, PhD , Keisuke Tamari MD, PhD , Taigo Kato MD, PhD , Koji Hatano MD, PhD , Atsunari Kawashima MD, PhD , Shinichi Shimizu MD, PhD , Norio Nonomura MD, PhD , Kazuhiko Ogawa MD, PhD","doi":"10.1016/j.adro.2025.101965","DOIUrl":"10.1016/j.adro.2025.101965","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 3","pages":"Article 101965"},"PeriodicalIF":2.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802197","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":"A Comparative, Multiobserver Analysis of Nodal Contouring Methods in Pelvic Online Cone Beam-Based Adaptive Radiation Therapy","authors":"Ethan Wang BSA ,&nbsp;Michael Dohopolski MD ,&nbsp;Allen Yen MD,&nbsp;Julia Jiazhen Shi BS,&nbsp;Brian Hrycushko PhD,&nbsp;David Parsons PhD,&nbsp;Yulun Liu PhD,&nbsp;Zohaib Iqbal PhD,&nbsp;Kevin Albuquerque MD","doi":"10.1016/j.adro.2025.101959","DOIUrl":"10.1016/j.adro.2025.101959","url":null,"abstract":"<div><h3>Purpose</h3><div>In online cone beam computed tomography (CBCT)-based adaptive radiation therapy (ART), nodal recontouring ensures sufficient nodal coverage by accounting for anatomic change but is uniquely challenging due to small target size and time pressure. This study evaluates the accuracy of rigid propagation versus artificial intelligence-guided deformation (AID) for nodal autosegmentation via comparison to nodal recontours delineated with unlimited time (ie, benchmark contours).</div></div><div><h3>Methods and Materials</h3><div>We analyzed 25 nodal structures from 16 patients receiving pelvic online CBCT-based ART with nodal boost. Nodal structure sampling was informed by an initial power analysis. For each structure, we obtained rigidly propagated and AID-generated contours in addition to 2 benchmark contours and the clinical contour used in adapted plan generation. We calculated dice similarity coefficient (DSC), false-positive dice, false-negative dice, and 95% Hausdorff distance (HD95) between clinical, propagated, and AID contours against benchmark pairs and DSC and HD95 between benchmark pairs. The failure rate of nonbenchmark contours relative to benchmark pairs was calculated as the proportion of contours with an HD95 &gt; 5 mm. We calculated the normalized D100, normalized D95, V100, and V95 of the adapted plan dose over all contours. Clinical tumor volume contours were used for all comparisons.</div></div><div><h3>Results</h3><div>Median DSC versus benchmark contours were 0.68 for rigidly propagated and 0.58 for AID contours. A significant difference in false-negative dice (<em>P</em> = .01, Cohen’s d 0.806) was identified in benchmark-to-propagated versus benchmark-to-AID comparison. The failure rate of rigidly propagated, AID, and clinical contours was 20%, 48%, and 28% respectively. The median DSC between benchmark contours was 0.75. No significant differences across dose metrics were identified between contour types.</div></div><div><h3>Conclusions</h3><div>Rigid propagation is superior to AID for initial contour generation in pelvic CBCT-based ART. Increased contouring time and image quality may improve contour quality and reduce interobserver variability but may be limited by the influence of individual contouring preferences.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101959"},"PeriodicalIF":2.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145921702","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":"Accuracy of Photon Dose Calculation on Photon-Counting Computed Tomography—A Comparison Study Based on Virtual Monoenergetic and Electron Density (Rho) Images for Pancreatic Cases","authors":"Xin Wu MS ,&nbsp;Patrick Wohlfahrt PhD ,&nbsp;Jainil Shah PhD ,&nbsp;Ludovica Lofino MD ,&nbsp;Manisha Palta MD ,&nbsp;Qiuwen Wu PhD ,&nbsp;Q. Jackie Wu PhD ,&nbsp;Yang Sheng PhD","doi":"10.1016/j.adro.2025.101957","DOIUrl":"10.1016/j.adro.2025.101957","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;Photon-counting computed tomography (PCCT) offers versatile anatomic information because of better energy discrimination and higher spatial resolution than conventional energy-integrating computed tomography (CT). With its rapid applications in diagnostic imaging, its potential within radiation oncology remains largely unexplored. Successful radiation therapy (RT) relies on both high-quality images to delineate tumor volume and accurate physical information of the anatomy for dose calculation. Specific to RT, dose calculation stands as a pivotal component in the process of treatment planning. This proof-of-concept study aimed to assess the accuracy of dose calculation and build the benchmark using PCCT images from a clinically operating NAEOTOM Alpha PCCT scanner from Siemens Healthineers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods and Materials&lt;/h3&gt;&lt;div&gt;A total of 29 patients receiving abdominal contrast-enhanced PCCT scans were included in this study with institutional review board approval. The following 2 sets of reconstructed images were selected for this study: (1) virtual monoenergetic images (VMIs) of 70 keV, which resembles the conventional CT image at 120 kVp, and (2) electron density (Rho) images derived from PCCT, which provides direct physical information for photon dose calculation. In addition to the default Hounsfield look-up table (HLUT) implemented in a treatment planning system, which is suitable for conventional CT images, a specific HLUT converting 70 keV VMI CT numbers to relative electron density was established following the consensus guidelines. Patient’s organs were contoured using a deep-learning-based autosegmentation model in syngo.via RT Image Suite from Siemens Healthineers. An elective and a gross tumor volume were simulated in the pancreatic region for treatment planning within this study. All patients were planned with a 9-field intensity modulated RT with simultaneous integral boost regimen 25/33 Gy using an in-house deep-learning-based autoplanning model. Planning guidelines followed the institutional pancreas stereotactic body RT protocol. Eleven dose-volume histogram (DVH) metrics were included for comparison of 3-dose calculation approaches (conventional, 70 keV VMI and Rho).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The results revealed minimal dosimetry differences between 70 keV VMI and Rho images, with DVH metric percentage differences predominantly within 1% range (max: -1.60%) and 3-dimensional gamma analysis (1 mm/1%) pass rate &gt;98% for most cases. The patient with the largest differences showed an average DVH metric difference of -1.32% and 3-dimensional gamma pass rate of 94.82%. Overall isodose distribution remained similar between 2 images for each patient. Dose calculation using the default HLUT in Eclipse showed DVH differences within a 1.5% range.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The results demonstrated good agreement in dose calculation between 70 keV VMI and Rho images. For ","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101957"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837442","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":"Neurocognitive Function and Quality of Life After Multifraction Radiosurgery for Large Resected and Intact Brain Metastases: Results of a Prospective Clinical Trial","authors":"James R. Janopaul-Naylor MD ,&nbsp;Anny Reyes MS ,&nbsp;Yichun Cao MPH ,&nbsp;Jeffrey Switchenko PhD, MS ,&nbsp;Jeffrey J. Olson MD ,&nbsp;Jim Zhong MD ,&nbsp;Hui-Kuo Shu MD, PhD ,&nbsp;Cady K. Block PhD ,&nbsp;Bree R. Eaton MD","doi":"10.1016/j.adro.2025.101956","DOIUrl":"10.1016/j.adro.2025.101956","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic radiosurgery (SRS) is the standard of care for brain metastases, providing effective local tumor control while avoiding the neurocognitive effects of whole-brain radiation therapy. However, large brain metastases have been excluded from the randomized studies of single-fraction SRS, and there are limited data regarding neurocognitive outcomes with multifraction radiosurgery approaches for large intact or resected brain metastases.</div></div><div><h3>Methods and Materials</h3><div>We performed a prospective phase 1 dose-escalation study of multifraction SRS for intact or resected brain metastases 3 to 6 cm in diameter from 2012 to 2021. Patients longitudinally completed the Hopkins Verbal Learning Test (HVLT), Mini-Mental State Examination, Functional Assessment of Cancer Therapy—Brain, and Medical Outcomes Cognitive Scale. Reliable Change Index is used to assess HVLT change from baseline to 4 months. Significance is defined as greater than 1 SD change. Analysis of variance comparisons were performed for clinicodemographic characteristics associated with neurocognitive outcomes or quality-of-life metrics.</div></div><div><h3>Results</h3><div>Of the 24 patients treated in the trial, 15 completed both baseline and 4-month neurocognitive assessments. For the 15 patients with neurocognitive assessments, median age was 57 years (range, 37-74 years), median baseline Karnofsky Performance Status was 80 (range, 70-90), and median volume of radiation target was 15.9 cm³ (range, 7.7-57.2 cm³). At 4 months, 20% of patients had a significant decline in HVLT Total Recall scores, 33% had no significant change, and 47% had significant improvement. Mean neurocognitive function and quality-of-life scores were either stable or improved over time up to the last evaluation at 25 months. There were no clinical or treatment characteristics significantly associated with changes in neurocognitive function or quality-of-life scores.</div></div><div><h3>Conclusions</h3><div>Of the evaluable patients with large brain metastases treated with dose-escalated, multifraction SRS, the majority of patients demonstrated stable or improved neurocognitive function and quality of life in follow-up.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101956"},"PeriodicalIF":2.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972997","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":"Clinical Outcomes and Institutional Experience of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer","authors":"Hiba Othman MD, FRCPC ,&nbsp;Aisling Barry MD, FRCPC ,&nbsp;Anthony Fyles MD, FRCPC ,&nbsp;Danielle Rodin MD, MPH, FRCPC ,&nbsp;Ezra Hahn MD, FRCPC ,&nbsp;Fei-Fei Liu MD, FRCPC ,&nbsp;Joelle Helou MD, FRCPC ,&nbsp;Kathy Han MD, MSc, FRCPC ,&nbsp;Rachel Glicksman MD, MSc, FRCPC ,&nbsp;Naghmeh Isfahanian MD, FRCPC ,&nbsp;Zeynep Baskurt MSc, PhD ,&nbsp;Michelle Chan ,&nbsp;Tom Purdie PhD, MCCPM ,&nbsp;Anne Koch MD, FRCPC, PhD ,&nbsp;Jennifer Croke MD, MHPE, FRCPC","doi":"10.1016/j.adro.2025.101948","DOIUrl":"10.1016/j.adro.2025.101948","url":null,"abstract":"<div><h3>Purpose</h3><div>Prompted by COVID-19 and publication of the FAST-Forward study, our institution rapidly implemented ultrahypofractionated radiation therapy (U-HFRT) for patients with early-stage breast cancer. Our objective was to evaluate our early experience and toxicity outcomes for U-HFRT.</div></div><div><h3>Methods and Materials</h3><div>Patients with consecutive stage 0-II breast cancer treated with adjuvant whole breast radiation therapy (RT) were evaluated. Patient demographics and treatment characteristics were extracted and categorized into 2 cohorts: U-HFRT, 26 Gy/5 fractions (F) and M (moderate)-HFRT, 40.05 Gy/15F. Physician-assessed skin toxicity was evaluated using the Radiation Therapy Oncology Group radiation morbidity scale at baseline/during RT, 1 to 90 days post-RT and &gt;90 days post-RT. Descriptive statistics summarized patient demographics and treatment characteristics and were stratified based on dose fractionation. A multivariable logistic model evaluated associations between toxicity and fractionation.</div></div><div><h3>Results</h3><div>Between May 2020 and March 2021, 320 patients were evaluated: 133 (41.6%) received U-HFRT and 187 (58.4%) received M-HFRT. For the U-HFRT cohort, median age at diagnosis was 65.4 years (range, 57-73), 71% had hormone receptor-positive invasive disease, and 18% had ductal carcinoma in-situ. All patients received whole breast RT, and 33% received a boost. U-HFRT was used more in patients who were older, hormone receptor-positive, and did not receive a boost (<em>P</em> &lt; .001). On multivariable analysis, M-HFRT patients experienced significantly more grade 1+skin toxicity during RT (odds ratio = 32.3, <em>P</em> &lt; .001), while 1 to 90 days post-RT, M-HFRT patients experienced less grade 1+ toxicity (odds ratio = 0.36, <em>P</em> &lt; .014) after adjusting for boost, age, and chemotherapy. Rates of skin toxicity &gt;90 days post-RT were low overall.</div></div><div><h3>Conclusions</h3><div>This study reports real-world clinical outcomes of patients with stage 0-II breast cancer treated with U-HFRT. We observed low rates of acute skin toxicity compared to M-HFRT, confirming its acceptability as a standard regimen for select patients. Longer term follow-up would be necessary to confirm clinical outcomes in terms of both local control and late normal tissue toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101948"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837457","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":"Resident Versus Teaching Faculty Perceptions of Radiation Treatment Plan Education: A National Survey","authors":"Graham Boyd MD ,&nbsp;Derealise Garcia-Almedina BS ,&nbsp;Liam Van Benthuysen CMD ,&nbsp;Thomas P. Howard MD, PhD ,&nbsp;Rachel B. Jimenez MD","doi":"10.1016/j.adro.2025.101941","DOIUrl":"10.1016/j.adro.2025.101941","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation treatment plan (RTP) evaluation is a critical, but often undertaught component of radiation oncology training. We hypothesized that radiation oncology residents and attendings would hold different attitudes regarding resident knowledge and comfort with RTP review.</div></div><div><h3>Methods and Materials</h3><div>A web-based survey was developed and distributed to residents (35 items) and attendings (28 items) at 14 geographically diverse Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs. The survey consisted of a combination of multiple-choice questions, Likert-style, and free-text responses.</div></div><div><h3>Results</h3><div>One hundred sixty-nine residents and 71 faculty received the survey (response rate: 43% and 28%, respectively). Approximately half (47%) of residents reported reviewing fewer than half of all treatment plans for their patients. While 20% of residents reported “often” or “always” reviewing treatment plans with an attending, 31% reported “rarely” or “never” doing so. More than half (56%) of residents felt they had inadequate exposure to RTP review. More than half (54%) did not feel confident or competent independently evaluating RTPs. In contrast, 85% of attendings reported reviewing at least half of all treatment plans alongside residents and 90% of faculty agreed or strongly agreed that residents were competent at RTP evaluation by the end of a rotation. Both residents and faculty perceived that challenges in schedule alignment and interest of the other party were common barriers to adequate RTP exposure and both agreed that a systematic approach to RTP review and a dedicated educational resource would improve the ability to evaluate a RTP.</div></div><div><h3>Conclusions</h3><div>A majority of residents reported inadequate RTP education and a lack of confidence and competence in evaluating RTPs. There was discordance between resident and faculty perceptions of RTP education and resident competence, but both groups agreed that residents would benefit from a dedicated resource on RTP review. Future work should focus on the development of a systematic guideline and accompanying tools for RTP evaluation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101941"},"PeriodicalIF":2.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972999","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":"The Impact of Radiation Dose to Bowel on the Risk of Developing Gastrointestinal Toxicities When Treating Abdominopelvic Soft-Tissue Sarcomas With Preoperative Radiation Therapy","authors":"Alison Yoder MD ,&nbsp;Tucker Netherton PhD ,&nbsp;Xin Wang PhD ,&nbsp;Tze Lim PhD ,&nbsp;Catherine Wang PhD ,&nbsp;Dershan Luo PhD ,&nbsp;Congjun Wang PhD ,&nbsp;Sara Thrower PhD ,&nbsp;Callistus Nguyen PhD ,&nbsp;Heather Lyu MD ,&nbsp;Christopher Scally MD ,&nbsp;Christina Roland MD ,&nbsp;Devarati Mitra MD PhD ,&nbsp;Andrew Bishop MD ,&nbsp;Ahsan Farooqi MD PhD ,&nbsp;B Ashleigh Guadagnolo MD","doi":"10.1016/j.adro.2025.101953","DOIUrl":"10.1016/j.adro.2025.101953","url":null,"abstract":"<div><h3>Purpose</h3><div>Abdominopelvic soft-tissue sarcomas (AP-STS) are selectively treated with radiation therapy (RT) followed by surgery. We investigated dosimetric factors predictive of acute and long-term gastrointestinal (GI) toxicities in patients treated with preoperative RT for AP-STS.</div></div><div><h3>Methods and Materials</h3><div>We performed a retrospective cohort study of patients treated for nonmetastatic AP-STS with preoperative RT and surgery from 2005 to 2020. Individual loops of small and large bowel, as well as a “Bowel Bag” space, were autocontoured using a clinically validated deep learning-based approach (nnU-Net) and then manually reviewed. Chi-square or Fisher’s exact test was used to assess how bowel dosimetry related to the development of GI toxicities. In particular, the effect on GI toxicity of exceeding bowel constraints as defined in the consensus guidelines was evaluated. Recurrence outcomes were analyzed using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>We evaluated 76 patients with a median follow-up of 46 months (IQR, 42-50). Approximately half of the tumors were located in the retroperitoneal space (n = 39, 51%). A total of 60 patients (79%) presented with <em>de novo</em> disease, and 21% (n = 16) were recurrent presentations that had not received prior RT. Fourteen patients (18%) had a local recurrence alone, 23 (30%) a distant recurrence alone, and 3 (4%) combined local and distant recurrence. As a result of RT, 23 patients (30%) had acute grade 1 to 2 diarrhea, and 14 (18%) had grade 1 nausea. There were no acute grade 3 toxicities. Six patients (8%) had any long-term RT-related toxicity, including 1 small bowel obstruction. Patients were more likely to have an acute GI toxicity if bowel bag V45&gt;195 cm³ (<em>P</em> = .05).</div></div><div><h3>Conclusions</h3><div>Traditional RT volumetric bowel dose constraints are frequently exceeded, given the large size of AP-STS at presentation and the corresponding large RT volumes. Exceeding the conventional bowel dosimetric constraints should not dissuade the use of RT, but instead signal the need for aggressive prophylactic management of potential toxicities.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101953"},"PeriodicalIF":2.7,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145735319","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 Injection Technique on Microsphere Distribution During Transarterial Radioembolization in a Successively Bifurcating In Vitro Model","authors":"Tess J. Snoeijink MSc ,&nbsp;Jan L. van der Hoek MSc ,&nbsp;Anne van den Brekel MSc ,&nbsp;Gerhard van Wolfswinkel MSc ,&nbsp;Marcel J.R. Janssen MD, PhD ,&nbsp;Erik Groot Jebbink PhD ,&nbsp;J. Frank W. Nijsen PhD","doi":"10.1016/j.adro.2025.101954","DOIUrl":"10.1016/j.adro.2025.101954","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to experimentally investigate how injection technique affects the distribution of microspheres during transarterial radioembolization in a successively bifurcating in vitro model.</div></div><div><h3>Methods and Materials</h3><div>A symmetrical phantom, bifurcating 3 times into 8 outlets, was incorporated into a flow circuit. A blood-mimicking fluid was pumped through the phantom using a physiological representative waveform. A microcatheter was placed into the lumen of the phantom, and holmium-165 microspheres were administered with a conventional administration device and a newly designed controlled administration device, containing a rotating syringe to keep the microspheres in suspension during administration. Two clinicians performed manual injections to establish clinically relevant injection rates. Then, different injection profiles were tested using syringe pumps: pulsed vs continuous injections (24 mL/min), and reduced continuous injection rates (10 and 5 mL/min). Microspheres were collected at each outlet and their distribution over the 8 outlets was analyzed.</div></div><div><h3>Results</h3><div>Continuous high injection rates led to more homogeneous radial distributions of microspheres over the right side of the phantom (outlet 5-8 received 16.5%-23.1% of the microspheres per outlet) compared with the clinically standard used pulsed injections (outlet 5-8 received 11.3%-40.1% of the microspheres per outlet). In contrast, reduced continuous injection rates led to more selective distributions (outlet 5-8 received 2.5%-68.8% of the microspheres at 10 mL/min and 1.0%-80.0% at 5 mL/min).</div></div><div><h3>Conclusions</h3><div>Injection technique strongly influences the distribution of microspheres. During high continuous injections, more mixing between microspheres and blood-mimicking fluid was observed. This led to more uniform radial microsphere distributions, creating a more predictive setting for transarterial radioembolization.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101954"},"PeriodicalIF":2.7,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665620","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":"Can Patients With Recurrent or Primary Squamous Cell Carcinoma of the Anus in a Previously Irradiated Pelvis Receive Definitive Reirradiation?","authors":"Jordan McDonald MD ,&nbsp;Ethan P. Damron MD ,&nbsp;Prajnan Das MD, MS, MPH ,&nbsp;Eugene J. Koay MD, PhD ,&nbsp;Ethan B. Ludmir MD ,&nbsp;Bruce D. Minsky MD ,&nbsp;Sonal S. Noticewala MD ,&nbsp;Grace L. Smith MD, PhD, MPH ,&nbsp;Craig Messick MD ,&nbsp;Van K. Morris MD ,&nbsp;Emma B. Holliday MD","doi":"10.1016/j.adro.2025.101952","DOIUrl":"10.1016/j.adro.2025.101952","url":null,"abstract":"<div><h3>Purpose</h3><div>Although salvage surgery is the standard of care for locoregionally recurrent anal cancer, few local options exist for inoperable pelvic recurrences. Newly diagnosed anal cancer arising in a previously irradiated field also provides a unique treatment challenge, as delivery of standard doses would result in unsafe cumulative dose to pelvic structures. We aimed to evaluate efficacy and toxicity of a hyperfractionated accelerated reirradiation (reRT) regimen for such patients.</div></div><div><h3>Methods and Materials</h3><div>Patients treated with hyperfractionated accelerated reRT at a single institution between 2005 and 2024 for nonmetastatic inoperable locoregionally recurrent anal cancer or primary anal cancer in a previously irradiated field were included. The reRT regimen consisted of 1.5 Gy in twice daily fractions separated by 6 hours to a median (range) of 39 (30-51) Gy. Complete clinical response rates, recurrence rates, and toxicities were reported.</div></div><div><h3>Results</h3><div>The median (IQR) follow-up was 13.4 (7.5-42.2) months. Twenty-six (74.3%) patients were treated with reRT for recurrent anal cancer, and 9 (25.7%) patients were treated with reRT for a new squamous cell carcinoma of the anus (SCCA) primary after prior pelvic radiation. The complete clinical response rate was 46.2% among patients with recurrent anal cancer and 77.8% among patients with a new SCCA primary after prior pelvic radiation. Two-year locoregional recurrence rate was 64.0% among patients with recurrent anal cancer and 22.0% among patients treated with reRT for a new SCCA primary after prior pelvic radiation. Eight patients (22.9%) developed acute grade 3 toxicity and 10 (28.6%) developed late grade 3-4 toxicity.</div></div><div><h3>Conclusions</h3><div>Hyperfractionated accelerated reRT results in promising complete clinical response rates that appear to translate into durable pelvic control for patients with recurrent anal cancer or a new SCCA primary after prior pelvic radiation. Acute toxicity appears similar to initial standard chemoradiation, but limiting reRT doses to 39 Gy may reduce the risk of serious late toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101952"},"PeriodicalIF":2.7,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145665621","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":"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}