Pub Date : 2026-02-01Epub Date: 2025-11-29DOI: 10.1016/j.adro.2025.101940
Tanguy Perennec MD, MSc , Karine A. Al Feghali MD , Dorine de Jong PhD , Oluwaseyi M. Oderinde PhD , Grant Gibbard PhD , Mélanie Dore MD, MSc , Gregory Delpon PhD , Moignier Alexandra PhD , Yves Seroux , Ludovic Ferrer PhD , Matthieu Hatt PhD , Caroline Rousseau MD, PhD , Stéphane Supiot MD, PhD
Purpose
Hypoxia is a well-known major factor contributing to the radioresistance of prostate cancer, which could be counteracted by increasing the dose. This study aimed to demonstrate the dosimetric feasibility of a dose-painting radiation therapy plan for prostate cancer, using a novel ring gantry system, based on the localization of tumoral and hypoxic areas.
Methods and Materials
Seven patients from the Programme d’Action Intégré de Recherche-prostate study, who underwent external-beam radiation therapy for intermediate-risk prostate cancer and exhibited pretherapeutic fluromisonodazole positron emission tomography (PET) uptake in the tumor, were selected. The gross tumor volume (GTV) was delineated on the magnetic resonance imaging, and the hypoxic region within the planning target volume was delineated based on fluromisonodazole PET uptake. Intensity modulated radiation therapy planning was performed based on 3 different prescriptions: standard fractionation (77 Gy in 35 fractions to the planning target volume), with an integrated boost of 95 Gy and 118 Gy in 35 fractions to the GTV and the hypoxic region, moderate hypofractionation (60 Gy in 20 fractions) with a boost of 67 Gy and 91 Gy to the GTV and the hypoxic region, and high hypofractionation (40 Gy in 5 fractions) with a boost of 50 Gy to the GTV and as high as possible to the hypoxic region. Planning was performed on the research version of the RefleXion treatment planning system.
Results
We achieved the prescribed dose in all 7 patients while respecting the usual dose limits for organs at risk.
Conclusions
This study demonstrated the dosimetric feasibility of dose escalation in both the tumor and hypoxic regions in patients with prostate cancer using the RefleXion treatment planning system, without compromising the dose limits for organs at risks.
{"title":"Dosimetric Feasibility of Dose-Painting Radiation Therapy for Targeting Hypoxia in Prostate Cancer on a Novel Ring Gantry Radiation Therapy System","authors":"Tanguy Perennec MD, MSc , Karine A. Al Feghali MD , Dorine de Jong PhD , Oluwaseyi M. Oderinde PhD , Grant Gibbard PhD , Mélanie Dore MD, MSc , Gregory Delpon PhD , Moignier Alexandra PhD , Yves Seroux , Ludovic Ferrer PhD , Matthieu Hatt PhD , Caroline Rousseau MD, PhD , Stéphane Supiot MD, PhD","doi":"10.1016/j.adro.2025.101940","DOIUrl":"10.1016/j.adro.2025.101940","url":null,"abstract":"<div><h3>Purpose</h3><div>Hypoxia is a well-known major factor contributing to the radioresistance of prostate cancer, which could be counteracted by increasing the dose. This study aimed to demonstrate the dosimetric feasibility of a dose-painting radiation therapy plan for prostate cancer, using a novel ring gantry system, based on the localization of tumoral and hypoxic areas.</div></div><div><h3>Methods and Materials</h3><div>Seven patients from the Programme d’Action Intégré de Recherche-prostate study, who underwent external-beam radiation therapy for intermediate-risk prostate cancer and exhibited pretherapeutic fluromisonodazole positron emission tomography (PET) uptake in the tumor, were selected. The gross tumor volume (GTV) was delineated on the magnetic resonance imaging, and the hypoxic region within the planning target volume was delineated based on fluromisonodazole PET uptake. Intensity modulated radiation therapy planning was performed based on 3 different prescriptions: standard fractionation (77 Gy in 35 fractions to the planning target volume), with an integrated boost of 95 Gy and 118 Gy in 35 fractions to the GTV and the hypoxic region, moderate hypofractionation (60 Gy in 20 fractions) with a boost of 67 Gy and 91 Gy to the GTV and the hypoxic region, and high hypofractionation (40 Gy in 5 fractions) with a boost of 50 Gy to the GTV and as high as possible to the hypoxic region. Planning was performed on the research version of the RefleXion treatment planning system.</div></div><div><h3>Results</h3><div>We achieved the prescribed dose in all 7 patients while respecting the usual dose limits for organs at risk.</div></div><div><h3>Conclusions</h3><div>This study demonstrated the dosimetric feasibility of dose escalation in both the tumor and hypoxic regions in patients with prostate cancer using the RefleXion treatment planning system, without compromising the dose limits for organs at risks.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101940"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837458","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}
Pub Date : 2026-02-01Epub Date: 2025-10-25DOI: 10.1016/j.adro.2025.101930
Nicholas A. Gallardo BS , Niema B. Razavian MD , Claire M. Lanier MD , Sydney Smith MSPH , Ralph B. D’Agostino Jr PhD , Rachel F. Shenker MD , Ji H. Lee MD , Ankitha M. Iyer MD , Bart A. Frizzell MD , Ryan T. Hughes MD
Purpose
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.
Methods and Materials
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 > 10% weight loss during RT) or rGT-appropriate (no GT placed and < 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 > 10% during RT.
Results
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.
Conclusions
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.
{"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 , Niema B. Razavian MD , Claire M. Lanier MD , Sydney Smith MSPH , Ralph B. D’Agostino Jr PhD , Rachel F. Shenker MD , Ji H. Lee MD , Ankitha M. Iyer MD , Bart A. Frizzell MD , 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 > 10% weight loss during RT) or rGT-appropriate (no GT placed and < 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 > 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-11-09DOI: 10.1016/j.adro.2025.101954
Tess J. Snoeijink MSc , Jan L. van der Hoek MSc , Anne van den Brekel MSc , Gerhard van Wolfswinkel MSc , Marcel J.R. Janssen MD, PhD , Erik Groot Jebbink PhD , J. Frank W. Nijsen PhD
Purpose
This study aimed to experimentally investigate how injection technique affects the distribution of microspheres during transarterial radioembolization in a successively bifurcating in vitro model.
Methods and Materials
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.
Results
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).
Conclusions
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.
{"title":"Impact of Injection Technique on Microsphere Distribution During Transarterial Radioembolization in a Successively Bifurcating In Vitro Model","authors":"Tess J. Snoeijink MSc , Jan L. van der Hoek MSc , Anne van den Brekel MSc , Gerhard van Wolfswinkel MSc , Marcel J.R. Janssen MD, PhD , Erik Groot Jebbink PhD , 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":"2026-02-01","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}
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.
Methods and Materials
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 >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.
Results
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 (P < .001). On multivariable analysis, M-HFRT patients experienced significantly more grade 1+skin toxicity during RT (odds ratio = 32.3, P < .001), while 1 to 90 days post-RT, M-HFRT patients experienced less grade 1+ toxicity (odds ratio = 0.36, P < .014) after adjusting for boost, age, and chemotherapy. Rates of skin toxicity >90 days post-RT were low overall.
Conclusions
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.
{"title":"Clinical Outcomes and Institutional Experience of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer","authors":"Hiba Othman MD, FRCPC , Aisling Barry MD, FRCPC , Anthony Fyles MD, FRCPC , Danielle Rodin MD, MPH, FRCPC , Ezra Hahn MD, FRCPC , Fei-Fei Liu MD, FRCPC , Joelle Helou MD, FRCPC , Kathy Han MD, MSc, FRCPC , Rachel Glicksman MD, MSc, FRCPC , Naghmeh Isfahanian MD, FRCPC , Zeynep Baskurt MSc, PhD , Michelle Chan , Tom Purdie PhD, MCCPM , Anne Koch MD, FRCPC, PhD , 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 >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> < .001). On multivariable analysis, M-HFRT patients experienced significantly more grade 1+skin toxicity during RT (odds ratio = 32.3, <em>P</em> < .001), while 1 to 90 days post-RT, M-HFRT patients experienced less grade 1+ toxicity (odds ratio = 0.36, <em>P</em> < .014) after adjusting for boost, age, and chemotherapy. Rates of skin toxicity >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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-11-12DOI: 10.1016/j.adro.2025.101941
Graham Boyd MD , Derealise Garcia-Almedina BS , Liam Van Benthuysen CMD , Thomas P. Howard MD, PhD , Rachel B. Jimenez MD
Purpose
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.
Methods and Materials
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.
Results
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.
Conclusions
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.
{"title":"Resident Versus Teaching Faculty Perceptions of Radiation Treatment Plan Education: A National Survey","authors":"Graham Boyd MD , Derealise Garcia-Almedina BS , Liam Van Benthuysen CMD , Thomas P. Howard MD, PhD , 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":"2026-02-01","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}
Pub Date : 2026-02-01Epub Date: 2025-11-22DOI: 10.1016/j.adro.2025.101968
Ziye Zheng MD , Siqi Sun ME , Jiawei Zhu MD , Qingwei Jiang MD , Jing Shen MD , Hongnan Zhen MD , Hui Guan MD , Wenhui Wang MD , Xiaomin Hu PhD , Fuquan Zhang MD , Junfang Yan MD
Purpose
Acute radiation enteritis (RE), particularly diarrhea, remains a major dose-limiting complication in patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT). The study investigated the relationship between dynamic intestinal flora alterations and RE-related diarrhea in patients with LACC undergoing CCRT.
Methods and Materials
This prospective observational cohort study enrolled 83 patients with LACC receiving CCRT in a hospital setting. The patients were categorized into a Mild group (mild diarrhea, adverse events grade < 2, n = 47) and a Severe group (severe diarrhea, grade ≥ 2, n = 36). Fecal samples were collected at baseline (T0), week 4 (T4), and week 8 (T8) after radiation therapy initiation. 16S rRNA sequencing was performed to analyze the microbial composition. Alpha/beta diversity, taxonomic differences, functional pathways, and correlations with clinical indicators were also evaluated.
Results
During CCRT, diarrhea severity peaked at 4 to 5 weeks and gradually decreased in weeks 5 to 8. Significantly decreased alpha diversity at T4 in the Severe group (nadir: 51.10% Firmicutes and 39.10% Bacteroidetes) was partially restored at T8. Beta diversity revealed clustering between the groups at T4. The relative abundances of f__Bacteroidaceae, g__Bacteroides, g__Lachnoclostridium, and s__Bacteroides_vulgatus were higher in the Severe group than in the Mild group at T4, whereas the f__Ruminococcaceae abundance was lower in the Severe group than in the Mild group. g__Bacteroides and g__Lachnoclostridium abundances were significantly and positively correlated with the duration of grade 2 diarrhea. The Severe group demonstrated upregulated amino/nucleotide sugar metabolism and downregulated unsaturated fatty acid biosynthesis. Phenotypic prediction indicated higher pathogenic Bacteroidetes and reduced stress-tolerant Proteobacteria in the Severe group.
Conclusions
Acute RE-related diarrhea severity in patients with cervical cancer undergoing CCRT is associated with intestinal dysbiosis. Severe diarrhea was correlated with reduced alpha diversity, lower Firmicutes/Bacteroidetes ratio, and enriched proinflammatory taxa.
{"title":"Relationship Between Intestinal Flora and Acute Radiation Enteritis in Patients With Advanced Cervical Cancer Undergoing Concurrent Chemoradiotherapy","authors":"Ziye Zheng MD , Siqi Sun ME , Jiawei Zhu MD , Qingwei Jiang MD , Jing Shen MD , Hongnan Zhen MD , Hui Guan MD , Wenhui Wang MD , Xiaomin Hu PhD , Fuquan Zhang MD , Junfang Yan MD","doi":"10.1016/j.adro.2025.101968","DOIUrl":"10.1016/j.adro.2025.101968","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute radiation enteritis (RE), particularly diarrhea, remains a major dose-limiting complication in patients with locally advanced cervical cancer (LACC) undergoing concurrent chemoradiotherapy (CCRT). The study investigated the relationship between dynamic intestinal flora alterations and RE-related diarrhea in patients with LACC undergoing CCRT.</div></div><div><h3>Methods and Materials</h3><div>This prospective observational cohort study enrolled 83 patients with LACC receiving CCRT in a hospital setting. The patients were categorized into a Mild group (mild diarrhea, adverse events grade < 2, n = 47) and a Severe group (severe diarrhea, grade ≥ 2, n = 36). Fecal samples were collected at baseline (T0), week 4 (T4), and week 8 (T8) after radiation therapy initiation. 16S rRNA sequencing was performed to analyze the microbial composition. Alpha/beta diversity, taxonomic differences, functional pathways, and correlations with clinical indicators were also evaluated.</div></div><div><h3>Results</h3><div>During CCRT, diarrhea severity peaked at 4 to 5 weeks and gradually decreased in weeks 5 to 8. Significantly decreased alpha diversity at T4 in the Severe group (nadir: 51.10% Firmicutes and 39.10% Bacteroidetes) was partially restored at T8. Beta diversity revealed clustering between the groups at T4. The relative abundances of f__Bacteroidaceae, g__<em>Bacteroides</em>, g__<em>Lachnoclostridium</em>, and s__<em>Bacteroides_vulgatus</em> were higher in the Severe group than in the Mild group at T4, whereas the f__Ruminococcaceae abundance was lower in the Severe group than in the Mild group. g__<em>Bacteroides</em> and g__<em>Lachnoclostridium</em> abundances were significantly and positively correlated with the duration of grade 2 diarrhea. The Severe group demonstrated upregulated amino/nucleotide sugar metabolism and downregulated unsaturated fatty acid biosynthesis. Phenotypic prediction indicated higher pathogenic Bacteroidetes and reduced stress-tolerant Proteobacteria in the Severe group.</div></div><div><h3>Conclusions</h3><div>Acute RE-related diarrhea severity in patients with cervical cancer undergoing CCRT is associated with intestinal dysbiosis. Severe diarrhea was correlated with reduced alpha diversity, lower Firmicutes/Bacteroidetes ratio, and enriched proinflammatory taxa.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101968"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788009","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}
Pub Date : 2026-02-01Epub Date: 2025-10-24DOI: 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。
{"title":"Multimodal Nuclear Imaging Response as a Prognostic Indicator Following Spine Stereotactic Body Radiation Therapy","authors":"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","doi":"10.1016/j.adro.2025.101942","DOIUrl":"10.1016/j.adro.2025.101942","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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%, <em>P</em> < .001) and OS (76% vs 36%, <em>P</em> < .001). In multivariable analysis, mCR was independently predictive of improved LC (hazard ratio [HR]: 12.76; <em>P</em> = .005) and OS (HR: 4.03; <em>P</em> = .003). Systemic disease stability was also significantly associated with OS (HR: 5.27; <em>P</em> = .001). Early (≤3 months) and intermediate (4-6 months) mCR correlated with 100% LC, while non-mCR was associated with only 40% LC (<em>P</em> = .04 and <em>P</em> = .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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101942"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145788012","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}
Pub Date : 2026-02-01Epub Date: 2025-10-27DOI: 10.1016/j.adro.2025.101936
Paul Riviere MD , Kylie M. Morgan BS , Tyler Nelson BS , Daniel Sabater Minarim BS , Leah Deshler MS , Matthew P. Banegas PhD , Tyler F. Stewart MD , Rana R. McKay MD , Juan Javier-DesLoges MD , John Kellogg Parsons MD , Brent S. Rose MD
Purpose
Among patients with biochemical recurrent (BCR) prostate cancer following radiation therapy, there is no validated method for identifying those at the highest risk for metastases or death from prostate cancer. We characterized the natural history of BCR after radiation therapy and validated the proposed European consensus guidelines for stratification.
Methods and Materials
This retrospective, multicenter, nationwide cohort study used data from patients having postradiation BCR treated in the United States Veterans Administration Health System. High-risk BCR was defined as either Gleason score ≥8 or BCR occurring within 18 months of radiation therapy, per guidelines.
Results
Among 7126 patients who experienced BCR, 35.5% of patients developed metastatic disease and 17.4% died of prostate cancer at 10 years. 38.5% of patients had a high-risk BCR. High-risk BCR resulted in higher 10-year incidence of metastatic disease (56.2% vs 42.0%, adjusted hazard ratio [aHR] = 1.83, 95% CI: 1.69-1.98) and worse prostate cancer-specific survival (69.5% vs 81.6%, aHR = 1.82, 95% CI: 1.63-2.03, P < .001) and all-cause death (67.8% vs 65.0%, aHR = 1.18, 95% CI: 1.11-1.26, P < .001).
Conclusions
A simple, 2-element risk stratification tool using existing clinical data is the first validated tool for identifying patients at risk of metastases or prostate cancer-specific mortality following postradiation BCR. Most patients experiencing BCR in this context do not develop metastases or lethal prostate cancer, making such stratification essential for treatment decision-making and refinement of patient populations for clinical trials.
目的：在放射治疗后生化复发（BCR）前列腺癌患者中，没有有效的方法来识别前列腺癌转移或死亡风险最高的患者。我们描述了放射治疗后BCR的自然病史，并验证了提出的欧洲共识分层指南。方法和材料这项回顾性、多中心、全国性队列研究使用了在美国退伍军人管理局卫生系统接受过BCR治疗的患者的数据。根据指南，高风险BCR定义为Gleason评分≥8或在放射治疗18个月内发生BCR。结果7126例BCR患者中，35.5%的患者发生转移性疾病，17.4%的患者在10年内死于前列腺癌。38.5%的患者存在高危BCR。高风险BCR导致更高的10年转移性疾病发生率（56.2% vs 42.0%，校正危险比[aHR] = 1.83, 95% CI: 1.69-1.98），更差的前列腺癌特异性生存率（69.5% vs 81.6%, aHR = 1.82, 95% CI: 1.63-2.03, P < 001）和全因死亡（67.8% vs 65.0%, aHR = 1.18, 95% CI: 1.11-1.26, P < 001）。结论：使用现有临床数据的简单的2因素风险分层工具是第一个经过验证的工具，用于识别患者在放疗后BCR后的转移风险或前列腺癌特异性死亡率。在这种情况下，大多数经历BCR的患者不会发展为转移性或致命性前列腺癌，因此这种分层对于治疗决策和临床试验患者群体的细化至关重要。
{"title":"Natural History and Risk Stratification of Biochemically Recurrent Prostate Cancer Following Definitive Radiation Therapy","authors":"Paul Riviere MD , Kylie M. Morgan BS , Tyler Nelson BS , Daniel Sabater Minarim BS , Leah Deshler MS , Matthew P. Banegas PhD , Tyler F. Stewart MD , Rana R. McKay MD , Juan Javier-DesLoges MD , John Kellogg Parsons MD , Brent S. Rose MD","doi":"10.1016/j.adro.2025.101936","DOIUrl":"10.1016/j.adro.2025.101936","url":null,"abstract":"<div><h3>Purpose</h3><div>Among patients with biochemical recurrent (BCR) prostate cancer following radiation therapy, there is no validated method for identifying those at the highest risk for metastases or death from prostate cancer. We characterized the natural history of BCR after radiation therapy and validated the proposed European consensus guidelines for stratification.</div></div><div><h3>Methods and Materials</h3><div>This retrospective, multicenter, nationwide cohort study used data from patients having postradiation BCR treated in the United States Veterans Administration Health System. High-risk BCR was defined as either Gleason score ≥8 or BCR occurring within 18 months of radiation therapy, per guidelines.</div></div><div><h3>Results</h3><div>Among 7126 patients who experienced BCR, 35.5% of patients developed metastatic disease and 17.4% died of prostate cancer at 10 years. 38.5% of patients had a high-risk BCR. High-risk BCR resulted in higher 10-year incidence of metastatic disease (56.2% vs 42.0%, adjusted hazard ratio [aHR] = 1.83, 95% CI: 1.69-1.98) and worse prostate cancer-specific survival (69.5% vs 81.6%, aHR = 1.82, 95% CI: 1.63-2.03, <em>P</em> < .001) and all-cause death (67.8% vs 65.0%, aHR = 1.18, 95% CI: 1.11-1.26, <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>A simple, 2-element risk stratification tool using existing clinical data is the first validated tool for identifying patients at risk of metastases or prostate cancer-specific mortality following postradiation BCR. Most patients experiencing BCR in this context do not develop metastases or lethal prostate cancer, making such stratification essential for treatment decision-making and refinement of patient populations for clinical trials.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 2","pages":"Article 101936"},"PeriodicalIF":2.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972998","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}
Pub Date : 2026-02-01Epub Date: 2025-11-09DOI: 10.1016/j.adro.2025.101952
Jordan McDonald MD , Ethan P. Damron MD , Prajnan Das MD, MS, MPH , Eugene J. Koay MD, PhD , Ethan B. Ludmir MD , Bruce D. Minsky MD , Sonal S. Noticewala MD , Grace L. Smith MD, PhD, MPH , Craig Messick MD , Van K. Morris MD , Emma B. Holliday MD
Purpose
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.
Methods and Materials
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.
Results
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.
Conclusions
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.
{"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 , Ethan P. Damron MD , Prajnan Das MD, MS, MPH , Eugene J. Koay MD, PhD , Ethan B. Ludmir MD , Bruce D. Minsky MD , Sonal S. Noticewala MD , Grace L. Smith MD, PhD, MPH , Craig Messick MD , Van K. Morris MD , 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":"2026-02-01","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}
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