Pub Date : 2025-09-18DOI: 10.1016/j.adro.2025.101906
Elena Moreno-Olmedo MD , Ben George PhD , Kasia Owczarczyk MD , David Woolf MD, PhD , John Conibear MD , Andy Gaya MD , Joss Adams MD , Luis Aznar-García PhD , Timothy Sevitt MD , Peter Dickinson MD , Kevin Franks MD , Alex Martin MD , Veni Ezhil MD , Philip Camilleri MD , James Good MD, PhD , Crispin Hiley MD, PhD
Purpose
Stereotactic ablative radiation therapy (SABR) is a standard of care for early-stage lung cancer and thoracic oligometastatic or oligoprogressive disease. However, ultracentral lesions remain challenging because of their proximity to critical mediastinal structures and the associated risk of severe toxicity. Stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) allows for daily plan adaptation and real-time tracking in breath-hold, enhancing target coverage while improving sparing of adjacent organs compared to conventional SABR.
Methods and Materials
This retrospective study analyzed outcomes of SMART-based SABR for ultracentral metastatic lesions in patients with histologically confirmed non-small cell lung cancer (NSCLC). Ultracentral lesions were defined by planning target volume overlapping with the proximal bronchial tree, esophagus, or pulmonary vessels. Endpoints included grade ≥ 3 SMART-related toxicity, freedom from local progression, progression-free survival, and overall survival.
Results
Between 2020 and 2023, 11 patients with 18 ultracentral NSCLC lesions underwent SMART. All treatments were delivered in breath-hold. The median dose was 40 Gy (range, 30-60 Gy) in 5 to 8 fractions. Online plan adaptation was performed for 100% of the 78 delivered fractions. No grade ≥ 3 toxicities were observed. Rates of grade 1 to 2 acute and late toxicities were 54% and 18%, respectively. At a median follow-up of 28 months (range, 5-41 months), 66.7% of patients were alive. One-year freedom from local progression was 93%. Median progression-free survival was 5.8 months (range, 1-39 months), and median overall survival was 20 months (range, 5-41 months).
Conclusions
SMART with daily online adaptation achieved excellent local control and a favorable safety profile in ultracentral NSCLC, comparable to conventional non-adaptive SABR, but without severe toxicity.
{"title":"Safety and Efficacy of Stereotactic Magnetic Resonance-Guided Adaptive Radiation Therapy (SMART) for Ultracentral Metastases in Non-Small Cell Lung Cancer","authors":"Elena Moreno-Olmedo MD , Ben George PhD , Kasia Owczarczyk MD , David Woolf MD, PhD , John Conibear MD , Andy Gaya MD , Joss Adams MD , Luis Aznar-García PhD , Timothy Sevitt MD , Peter Dickinson MD , Kevin Franks MD , Alex Martin MD , Veni Ezhil MD , Philip Camilleri MD , James Good MD, PhD , Crispin Hiley MD, PhD","doi":"10.1016/j.adro.2025.101906","DOIUrl":"10.1016/j.adro.2025.101906","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic ablative radiation therapy (SABR) is a standard of care for early-stage lung cancer and thoracic oligometastatic or oligoprogressive disease. However, ultracentral lesions remain challenging because of their proximity to critical mediastinal structures and the associated risk of severe toxicity. Stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) allows for daily plan adaptation and real-time tracking in breath-hold, enhancing target coverage while improving sparing of adjacent organs compared to conventional SABR.</div></div><div><h3>Methods and Materials</h3><div>This retrospective study analyzed outcomes of SMART-based SABR for ultracentral metastatic lesions in patients with histologically confirmed non-small cell lung cancer (NSCLC). Ultracentral lesions were defined by planning target volume overlapping with the proximal bronchial tree, esophagus, or pulmonary vessels. Endpoints included grade ≥ 3 SMART-related toxicity, freedom from local progression, progression-free survival, and overall survival.</div></div><div><h3>Results</h3><div>Between 2020 and 2023, 11 patients with 18 ultracentral NSCLC lesions underwent SMART. All treatments were delivered in breath-hold. The median dose was 40 Gy (range, 30-60 Gy) in 5 to 8 fractions. Online plan adaptation was performed for 100% of the 78 delivered fractions. No grade ≥ 3 toxicities were observed. Rates of grade 1 to 2 acute and late toxicities were 54% and 18%, respectively. At a median follow-up of 28 months (range, 5-41 months), 66.7% of patients were alive. One-year freedom from local progression was 93%. Median progression-free survival was 5.8 months (range, 1-39 months), and median overall survival was 20 months (range, 5-41 months).</div></div><div><h3>Conclusions</h3><div>SMART with daily online adaptation achieved excellent local control and a favorable safety profile in ultracentral NSCLC, comparable to conventional non-adaptive SABR, but without severe toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101906"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359046","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 : 2025-09-17DOI: 10.1016/j.adro.2025.101903
Fatima Frosan Sheikhzadeh MD , Gertrud Schmich MD , Niklas Recknagel MD , Edgar Smalec , Tasneim Abdelrahman Mohamed , Vicky Soborun MD , Kerem Tuna Tas , Philipp Lishewski , Klemens Zink PhD , Khaled Elsayad MD, PhD , Fabian Eberle MD, PhD , Hilke Vorwerk MD, PhD , Thomas Held MD, PhD , Boris A. Stuck MD, PhD , Sebastian Adeberg MD, PhD , Ahmed Gawish MD, PhD
Purpose
Particle therapy with protons or carbon ions is a promising method for treating locally advanced nasal cavity and paranasal sinus carcinomas (NPSC). This study evaluates the clinical outcomes and toxicities of patients treated with carbon ion radiation therapy with a boost (CIRT-B) at our institution.
Methods and Materials
Patients with NPSC who received combined treatment with CIRT-B and intensity modulated radiation therapy were considered. Local control (LC) and survival rates were estimated using Kaplan-Meier survival analysis and proportional hazards models.
Results
Between 2016 and 2023, a total of 66 patients were included in the analysis. Of these, 53 patients (80%) received primary radiation therapy as their first-line treatment, while 13 patients (20%) underwent salvage reirradiation for recurrent disease. The median total dose administered in the upfront radiation therapy group was 74 Gy (range, 70-78 Gy relative biological effectiveness), whereas the median total dose in the salvage radiation therapy group was 45 Gy (range, 39-51 Gy relative biological effectiveness). The median duration of LC was 21 months in both the upfront and salvage groups. The overall median LC across all patients was 14 months. The 2-year LC rate was 73% for the upfront radiation therapy group and 52% for the salvage radiation therapy group, with a statistically significant difference (P = .038). In terms of early toxicities, there were no grade 4 adverse events reported.
Conclusions
CIRT-B combined with photon radiation therapy is an effective and safe treatment for advanced NPSC in both primary and salvage settings.
{"title":"Particle Therapy in the Multimodal Treatment for Locally Advanced Malignancies of the Nasal Cavity and Paranasal Sinus—Single Institute Experience","authors":"Fatima Frosan Sheikhzadeh MD , Gertrud Schmich MD , Niklas Recknagel MD , Edgar Smalec , Tasneim Abdelrahman Mohamed , Vicky Soborun MD , Kerem Tuna Tas , Philipp Lishewski , Klemens Zink PhD , Khaled Elsayad MD, PhD , Fabian Eberle MD, PhD , Hilke Vorwerk MD, PhD , Thomas Held MD, PhD , Boris A. Stuck MD, PhD , Sebastian Adeberg MD, PhD , Ahmed Gawish MD, PhD","doi":"10.1016/j.adro.2025.101903","DOIUrl":"10.1016/j.adro.2025.101903","url":null,"abstract":"<div><h3>Purpose</h3><div>Particle therapy with protons or carbon ions is a promising method for treating locally advanced nasal cavity and paranasal sinus carcinomas (NPSC). This study evaluates the clinical outcomes and toxicities of patients treated with carbon ion radiation therapy with a boost (CIRT-B) at our institution.</div></div><div><h3>Methods and Materials</h3><div>Patients with NPSC who received combined treatment with CIRT-B and intensity modulated radiation therapy were considered. Local control (LC) and survival rates were estimated using Kaplan-Meier survival analysis and proportional hazards models.</div></div><div><h3>Results</h3><div>Between 2016 and 2023, a total of 66 patients were included in the analysis. Of these, 53 patients (80%) received primary radiation therapy as their first-line treatment, while 13 patients (20%) underwent salvage reirradiation for recurrent disease. The median total dose administered in the upfront radiation therapy group was 74 Gy (range, 70-78 Gy relative biological effectiveness), whereas the median total dose in the salvage radiation therapy group was 45 Gy (range, 39-51 Gy relative biological effectiveness). The median duration of LC was 21 months in both the upfront and salvage groups. The overall median LC across all patients was 14 months. The 2-year LC rate was 73% for the upfront radiation therapy group and 52% for the salvage radiation therapy group, with a statistically significant difference (<em>P</em> = .038). In terms of early toxicities, there were no grade 4 adverse events reported.</div></div><div><h3>Conclusions</h3><div>CIRT-B combined with photon radiation therapy is an effective and safe treatment for advanced NPSC in both primary and salvage settings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101903"},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412562","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 : 2025-09-16DOI: 10.1016/j.adro.2025.101900
Una Ryg MD , Wolfgang Lilleby MD, PhD , Line Brennhaug Nilsen PhD , Taran Paulsen Hellebust PhD, MSc , Therese Seierstad PhD, MSc , Knut Håkon Hole MD, PhD
Purpose
Local failure of prostate cancer after definitive radiation therapy is associated with poor prognosis. Studies on reirradiation have primarily focused on toxicity and oncologic outcome and only partially reported recurrence patterns. Investigating the recurrence pattern may help guide future therapy decisions.
Methods and Materials
Thirty-three men with local recurrence of prostate cancer after primary definitive radiation therapy were enrolled between 2012 and 2018 (median age 69.8 years [IQR: 6.8], median prostate-specific antigen 4.1 ng/mL [IQR: 3.8]). Twenty-three patients received reirradiation with focal high dose-rate brachytherapy, and 10 received stereotactic body radiation therapy to the prostate with (8/10) or without (2/10) a simultaneous integrated boost to the recurrent tumor. The sites of recurrences were examined with multiparametric magnetic resonance imaging and compared with the dose distribution maps.
Results
During the median 99 months (IQR: 56) follow-up, 25 patients had biochemical rerecurrence. Twenty had adequate imaging. Five patients had rerecurrences solely inside the high-dose region, and 7 had both inside and outside the high-dose region. Two patients with a prostatic recurrence received whole-gland stereotactic body radiation therapy without a boost to the tumor. Four had a combination of rerecurrence within the prostate as well as regional lymph node metastases. One patient had a prostatic rerecurrence and a single bone metastasis. One patient had prostatic rerecurrence, lymph node metastases, and bone metastases. No patients had only regional or distant metastases.
Conclusions
After reirradiation of prostate cancer, the tumor frequently recurred within the prostate, both inside and outside the high-dose region. About 1 in 3 patients also had regional or distant metastatic disease at rerecurrence.
{"title":"Image-Based Recurrence Patterns After Reirradiation in Prostate Cancer with Long-Term Follow-Up","authors":"Una Ryg MD , Wolfgang Lilleby MD, PhD , Line Brennhaug Nilsen PhD , Taran Paulsen Hellebust PhD, MSc , Therese Seierstad PhD, MSc , Knut Håkon Hole MD, PhD","doi":"10.1016/j.adro.2025.101900","DOIUrl":"10.1016/j.adro.2025.101900","url":null,"abstract":"<div><h3>Purpose</h3><div>Local failure of prostate cancer after definitive radiation therapy is associated with poor prognosis. Studies on reirradiation have primarily focused on toxicity and oncologic outcome and only partially reported recurrence patterns. Investigating the recurrence pattern may help guide future therapy decisions.</div></div><div><h3>Methods and Materials</h3><div>Thirty-three men with local recurrence of prostate cancer after primary definitive radiation therapy were enrolled between 2012 and 2018 (median age 69.8 years [IQR: 6.8], median prostate-specific antigen 4.1 ng/mL [IQR: 3.8]). Twenty-three patients received reirradiation with focal high dose-rate brachytherapy, and 10 received stereotactic body radiation therapy to the prostate with (8/10) or without (2/10) a simultaneous integrated boost to the recurrent tumor. The sites of recurrences were examined with multiparametric magnetic resonance imaging and compared with the dose distribution maps.</div></div><div><h3>Results</h3><div>During the median 99 months (IQR: 56) follow-up, 25 patients had biochemical rerecurrence. Twenty had adequate imaging. Five patients had rerecurrences solely inside the high-dose region, and 7 had both inside and outside the high-dose region. Two patients with a prostatic recurrence received whole-gland stereotactic body radiation therapy without a boost to the tumor. Four had a combination of rerecurrence within the prostate as well as regional lymph node metastases. One patient had a prostatic rerecurrence and a single bone metastasis. One patient had prostatic rerecurrence, lymph node metastases, and bone metastases. No patients had only regional or distant metastases.</div></div><div><h3>Conclusions</h3><div>After reirradiation of prostate cancer, the tumor frequently recurred within the prostate, both inside and outside the high-dose region. About 1 in 3 patients also had regional or distant metastatic disease at rerecurrence.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101900"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412669","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 : 2025-09-16DOI: 10.1016/j.adro.2025.101905
Michael J. Zelefsky MD, David Byun MD, Matthew Long BS, Gabriel Fuligni BS, Hesheng Wang PhD, Siming Lu PhD, Ting Chen PhD, David Barbee PhD
Purpose
This study aims to evaluate the feasibility of delivering escalated doses to the dominant intraprostatic lesion (DIL) as noted on T2-weighted magnetic resonance imaging and diffusion-weighted imaging while maintaining dose to the surrounding normal tissue structures within dose-volume constraints.
Methods and Materials
A total of 50 consecutive patients were treated with prostate stereotactic body radiation therapy (SBRT), via a simultaneous integrated boost to the DIL, on a 1.5-Tesla magnetic resonance imaging linear accelerator platform. These patients were treated with SBRT to 40 Gy in 5 fractions every other day, and the DIL was simultaneously boosted to 45 Gy in 5 fractions. No patient was treated with androgen deprivation therapy. The normal tissue structures and the prostate and DIL were recontoured, and a postfraction plan was generated to retrospectively generate the doses delivered to the prostate and the DIL boost target for each of these 250 therapy sessions.
Results
On postfraction dosimetric analysis, the median dose to 95% (D95) of the DIL was 45.3 Gy (initial plan: 45.9 Gy; P < .05), and 44 Gy or more was delivered to the DIL in 84% of the treated fractions. The median D95 to the prostate was 40.4 Gy (initial plan: 40.7 Gy; P < .05). Despite excellent target coverage, the rectum, urethra, and bladder dose constraints were generally maintained. At 6 months from completion of therapy, the median prostate-specific antigen result was 1.1 ng/mL (range, 0-5.6 ng/mL) compared to the median pre-SBRT prostate-specific antigen of 6.8 ng/mL (range, 3.45-31 ng/mL). No patient developed late grade 3 or higher urinary or rectal toxicities at median follow-up of 10.8 months (range, 6.4-15.7 months).
Conclusions
With real-time adaptive planning on a magnetic resonance imaging linear accelerator, dose escalation was achieved in most cases with the intended doses without significantly compromising the dose-volume constraints of the surrounding normal tissue structures. These dosimetric findings were associated with an excellent tolerance profile at 12 months and a low incidence of urinary or rectal toxicity.
目的本研究旨在评估在t2加权磁共振成像和弥散加权成像上显示的前列腺内病变（DIL）上递增剂量的可行性，同时在剂量-体积限制下保持对周围正常组织结构的剂量。方法和材料总共50例连续患者在1.5特斯拉磁共振成像直线加速器平台上接受前列腺立体定向全身放射治疗（SBRT），通过同时集成DIL提升。这些患者每隔一天接受5次SBRT治疗至40 Gy，同时将DIL分5次提高至45 Gy。没有患者接受雄激素剥夺治疗。重新绘制正常组织结构、前列腺和DIL的轮廓，并生成一个后分割计划，以回顾性地生成在这250个治疗过程中每次给予前列腺和DIL增强目标的剂量。结果经分级后剂量学分析，95% DIL的中位剂量（D95）为45.3 Gy（初始计划为45.9 Gy; P < 0.05）， 84%的治疗组DIL的中位剂量≥44 Gy。前列腺的中位D95为40.4 Gy（初始计划为40.7 Gy; P < 0.05）。尽管靶覆盖范围很好，但直肠、尿道和膀胱的剂量限制通常保持不变。在治疗结束后6个月，中位前列腺特异性抗原结果为1.1 ng/mL（范围0-5.6 ng/mL），而sbrt前的中位前列腺特异性抗原为6.8 ng/mL（范围3.45-31 ng/mL）。在中位随访10.8个月（6.4-15.7个月）期间，没有患者出现晚期3级或更高级别的泌尿或直肠毒性。结论利用磁共振成像直线加速器的实时自适应规划，在大多数情况下可以实现剂量递增，而不会明显影响周围正常组织结构的剂量-体积限制。这些剂量学结果与12个月时良好的耐受性和低尿或直肠毒性发生率相关。
{"title":"Dose Intensification to the Dominant Intraprostatic Lesion During Prostate Stereotactic Body Radiation Therapy Delivered on a Magnetic Resonance Imaging Linear Accelerator: Feasibility and Early Clinical Outcomes","authors":"Michael J. Zelefsky MD, David Byun MD, Matthew Long BS, Gabriel Fuligni BS, Hesheng Wang PhD, Siming Lu PhD, Ting Chen PhD, David Barbee PhD","doi":"10.1016/j.adro.2025.101905","DOIUrl":"10.1016/j.adro.2025.101905","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the feasibility of delivering escalated doses to the dominant intraprostatic lesion (DIL) as noted on T2-weighted magnetic resonance imaging and diffusion-weighted imaging while maintaining dose to the surrounding normal tissue structures within dose-volume constraints.</div></div><div><h3>Methods and Materials</h3><div>A total of 50 consecutive patients were treated with prostate stereotactic body radiation therapy (SBRT), via a simultaneous integrated boost to the DIL, on a 1.5-Tesla magnetic resonance imaging linear accelerator platform. These patients were treated with SBRT to 40 Gy in 5 fractions every other day, and the DIL was simultaneously boosted to 45 Gy in 5 fractions. No patient was treated with androgen deprivation therapy. The normal tissue structures and the prostate and DIL were recontoured, and a postfraction plan was generated to retrospectively generate the doses delivered to the prostate and the DIL boost target for each of these 250 therapy sessions.</div></div><div><h3>Results</h3><div>On postfraction dosimetric analysis, the median dose to 95% (D95) of the DIL was 45.3 Gy (initial plan: 45.9 Gy; <em>P</em> < .05), and 44 Gy or more was delivered to the DIL in 84% of the treated fractions. The median D95 to the prostate was 40.4 Gy (initial plan: 40.7 Gy; <em>P</em> < .05). Despite excellent target coverage, the rectum, urethra, and bladder dose constraints were generally maintained. At 6 months from completion of therapy, the median prostate-specific antigen result was 1.1 ng/mL (range, 0-5.6 ng/mL) compared to the median pre-SBRT prostate-specific antigen of 6.8 ng/mL (range, 3.45-31 ng/mL). No patient developed late grade 3 or higher urinary or rectal toxicities at median follow-up of 10.8 months (range, 6.4-15.7 months).</div></div><div><h3>Conclusions</h3><div>With real-time adaptive planning on a magnetic resonance imaging linear accelerator, dose escalation was achieved in most cases with the intended doses without significantly compromising the dose-volume constraints of the surrounding normal tissue structures. These dosimetric findings were associated with an excellent tolerance profile at 12 months and a low incidence of urinary or rectal toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101905"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412561","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 : 2025-09-15DOI: 10.1016/j.adro.2025.101904
Mayu Hagiwara MS , Ryusuke Suzuki PhD , Seishin Takao PhD , Rumiko Kinoshita MD, PhD , Shizusa Yamazaki MS , Keiji Nakazato MS , Hideki Kojima MP , Takayuki Hashimoto MD, PhD , Keiji Kobashi PhD , Yasuhiro Onodera PhD , Hisanori Fukunaga MD, PhD , Hidefumi Aoyama MD, PhD , Michael F Gensheimer MD , Masahiro Mizuta PhD , Hiroki Shirato MD, PhD
Purpose
This study aims to develop a supporting tool to calculate the most appropriate prescribing absorbed dose and number of fractions for precise reirradiation.
Methods and Materials
After deformable image registration of the initial computed tomography to the computed tomography at reirradiation, an initial biological effective dose (BED) taking into account the recovery from the initial irradiation is calculated voxel-by-voxel for each organ at risk (OAR). Using a commercial radiation therapy planning system, the clinical target volume for reirradiation (CTV2) is made. Keeping the BEDtumor’s α/β to CTV2, cumulative BEDOAR’s α/β(CBEDOAR’s α/β) in each voxel of critical OARs is calculated by changing the number of fractions in a stepwise process. The most appropriate prescribing absorbed dose to the target and the number of fractions in reirradiation is determined by using CBEDOAR’s α/β-volume histogram for critical OARs. The function of the tool was validated in silico using 3 scenarios in 2 patients: a patient with a lung cancer at the peripheral lung parenchyma and at the hilar lymphatic region at different times, and in a patient with a metastatic internal mammary lymph node relapsed after postoperative radiation therapy for breast cancer.
Results
In scenario 1, giving 57 Gy in 22 fractions (57 Gy/22 Fr) to the CTV2 at the right hilum, the maximum CBEDα/β=2 was 124.078 Gy, and the mean CBEDα/β=2 of the whole lung parenchyma excluding gross tumor volume was 18.332 Gy. In scenario 2, 44.152 Gy/7 Fr to the target was suggested to be most appropriate. In scenario 3, 71.675 Gy/30 Fr proton therapy to the target was recommended in which the maximum CBEDα/β=2 in the aorta near the recurrence site was 145.796 Gy, and the volume of CBEDα/β=2 ≥ 100 Gy was 0.800 cm3, both are within the constraints.
Conclusions
The tool was suggested to be useful to find the most appropriate prescribing absorbed dose to the target as well as the number of fractions for precise reirradiation.
{"title":"A Precise Reirradiation Supporting Tool Initiative (PRISTIN) for Prescribing Absorbed Dose and Number of Fractions in Reirradiation","authors":"Mayu Hagiwara MS , Ryusuke Suzuki PhD , Seishin Takao PhD , Rumiko Kinoshita MD, PhD , Shizusa Yamazaki MS , Keiji Nakazato MS , Hideki Kojima MP , Takayuki Hashimoto MD, PhD , Keiji Kobashi PhD , Yasuhiro Onodera PhD , Hisanori Fukunaga MD, PhD , Hidefumi Aoyama MD, PhD , Michael F Gensheimer MD , Masahiro Mizuta PhD , Hiroki Shirato MD, PhD","doi":"10.1016/j.adro.2025.101904","DOIUrl":"10.1016/j.adro.2025.101904","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to develop a supporting tool to calculate the most appropriate prescribing absorbed dose and number of fractions for precise reirradiation.</div></div><div><h3>Methods and Materials</h3><div>After deformable image registration of the initial computed tomography to the computed tomography at reirradiation, an initial biological effective dose (BED) taking into account the recovery from the initial irradiation is calculated voxel-by-voxel for each organ at risk (OAR). Using a commercial radiation therapy planning system, the clinical target volume for reirradiation (CTV2) is made. Keeping the BED<sub>tumor’s α/β</sub> to CTV2, cumulative BED<sub>OAR’s α/β</sub>(CBED<sub>OAR’s α/β</sub>) in each voxel of critical OARs is calculated by changing the number of fractions in a stepwise process. The most appropriate prescribing absorbed dose to the target and the number of fractions in reirradiation is determined by using CBED<sub>OAR’s α/β</sub>-volume histogram for critical OARs. The function of the tool was validated in silico using 3 scenarios in 2 patients: a patient with a lung cancer at the peripheral lung parenchyma and at the hilar lymphatic region at different times, and in a patient with a metastatic internal mammary lymph node relapsed after postoperative radiation therapy for breast cancer.</div></div><div><h3>Results</h3><div>In scenario 1, giving 57 Gy in 22 fractions (57 Gy/22 Fr) to the CTV2 at the right hilum, the maximum CBED<sub>α/β=2</sub> was 124.078 Gy, and the mean CBED<sub>α/β=2</sub> of the whole lung parenchyma excluding gross tumor volume was 18.332 Gy. In scenario 2, 44.152 Gy/7 Fr to the target was suggested to be most appropriate. In scenario 3, 71.675 Gy/30 Fr proton therapy to the target was recommended in which the maximum CBED<sub>α/β=2</sub> in the aorta near the recurrence site was 145.796 Gy, and the volume of CBED<sub>α/β=2</sub> ≥ 100 Gy was 0.800 cm<sup>3</sup>, both are within the constraints.</div></div><div><h3>Conclusions</h3><div>The tool was suggested to be useful to find the most appropriate prescribing absorbed dose to the target as well as the number of fractions for precise reirradiation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101904"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145263498","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 : 2025-09-15DOI: 10.1016/j.adro.2025.101902
Bo Liu PhD , Savita Dandapani MD, PhD , Yun Li MD, PhD , Scott Glaser MD , Helen Chen MD , Tanya Dorff MD , Dave Yamauchi MD , Quan Chen PhD , Kun Qing PhD , Chengyu Shi PhD , Angela J. Da Silva PhD , Karine A. Al Feghali MD , An Liu PhD , Terence Williams MD, PhD , Jeffrey Y.C. Wong MD
Purpose
The RefleXion X1 Medical Radiotherapy System (RefleXion Medical) is a novel radiation therapy (RT) device capable of delivering real-time positron emission tomography (PET) scan-guided or biology-guided RT (BgRT). The purpose of this pilot study was to evaluate the performance of its PET imaging subsystem to detect 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (18F-DCFPyl) prostate-specific membrane antigen [PSMA] PET scan signal as the foundation for BgRT in patients with prostate cancer.
Methods and Materials
Patients underwent a standard diagnostic 18F-DCFPyl PSMA PET scan. If at least 1 PET-scan-avid tumor was identified, the patient was then scanned on the RefleXion X1 unit. The target volume, activity concentration, and normalized target signal were determined, and BgRT planning was performed.
Results
In 20 patients, at least 1 PSMA PET-scan-avid tumor was identified for BgRT planning (5 lymph node metastases, 7 bone metastases, 7 prostate glands, and 1 prostate bed). In 18 patients, the PET-scan-avid tumor was visualized on the RefleXion X1 PET scan, whereas in 2 patients, the tumor was too close to the PET scan activity in the bladder to be clearly visualized. BgRT planning was feasible and met stereotactic body RT organ dose constraints in 8 (40%) patients (3 prostate glands, 3 bones, and 2 lymph nodes). BgRT was not feasible in 12 (60%) patients because of low target activity concentration (<5 kBq/mL), low normalized target signal intensity (<2.7), or proximity of the PET-scan-avid tumor to the bladder.
Conclusions
This is the first study to demonstrate the feasibility of using 18F-DCFPyl scan imaging for BgRT planning on the RefleXion X1 system in patients with prostate cancer. BgRT using targeted PET scan radiopharmaceuticals to guide RT represents a promising new dimension in radiation oncology and warrants further investigation.
{"title":"A Prospective First-In-Human Pilot Study 18F-DCFPyL Prostate-Specific Membrane Antigen Imaging on the RefleXion X1 Positron Emission Tomography-Computed Tomograpghy Subsystem in Patients with Prostate Cancer","authors":"Bo Liu PhD , Savita Dandapani MD, PhD , Yun Li MD, PhD , Scott Glaser MD , Helen Chen MD , Tanya Dorff MD , Dave Yamauchi MD , Quan Chen PhD , Kun Qing PhD , Chengyu Shi PhD , Angela J. Da Silva PhD , Karine A. Al Feghali MD , An Liu PhD , Terence Williams MD, PhD , Jeffrey Y.C. Wong MD","doi":"10.1016/j.adro.2025.101902","DOIUrl":"10.1016/j.adro.2025.101902","url":null,"abstract":"<div><h3>Purpose</h3><div>The RefleXion X1 Medical Radiotherapy System (RefleXion Medical) is a novel radiation therapy (RT) device capable of delivering real-time positron emission tomography (PET) scan-guided or biology-guided RT (BgRT). The purpose of this pilot study was to evaluate the performance of its PET imaging subsystem to detect 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (<sup>18</sup>F-DCFPyl) prostate-specific membrane antigen [PSMA] PET scan signal as the foundation for BgRT in patients with prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>Patients underwent a standard diagnostic <sup>18</sup>F-DCFPyl PSMA PET scan. If at least 1 PET-scan-avid tumor was identified, the patient was then scanned on the RefleXion X1 unit. The target volume, activity concentration, and normalized target signal were determined, and BgRT planning was performed.</div></div><div><h3>Results</h3><div>In 20 patients, at least 1 PSMA PET-scan-avid tumor was identified for BgRT planning (5 lymph node metastases, 7 bone metastases, 7 prostate glands, and 1 prostate bed). In 18 patients, the PET-scan-avid tumor was visualized on the RefleXion X1 PET scan, whereas in 2 patients, the tumor was too close to the PET scan activity in the bladder to be clearly visualized. BgRT planning was feasible and met stereotactic body RT organ dose constraints in 8 (40%) patients (3 prostate glands, 3 bones, and 2 lymph nodes). BgRT was not feasible in 12 (60%) patients because of low target activity concentration (<5 kBq/mL), low normalized target signal intensity (<2.7), or proximity of the PET-scan-avid tumor to the bladder.</div></div><div><h3>Conclusions</h3><div>This is the first study to demonstrate the feasibility of using <sup>18</sup>F-DCFPyl scan imaging for BgRT planning on the RefleXion X1 system in patients with prostate cancer. BgRT using targeted PET scan radiopharmaceuticals to guide RT represents a promising new dimension in radiation oncology and warrants further investigation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101902"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359044","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 : 2025-09-13DOI: 10.1016/j.adro.2025.101901
Joel A. Pogue PhD , Jingwei Duan PhD , Joseph Harms PhD , Sean Sullivan BS , Courtney Stanley DMP , Richard A. Popple PhD , Natalie Viscariello PhD , Dennis N. Stanley PhD , Drexel Hunter Boggs MD , Carlos E. Cardenas PhD
Purpose
Cone beam computed tomography guided online adaptive radiation therapy (OART) for stereotactic accelerated partial breast irradiation (APBI) can help mitigate the effects of interfraction lumpectomy bed variation. However, OART leads to a prolonged treatment time due to daily reoptimization of the treatment plan, potentially increasing patient discomfort and intrafraction variation. Here, we investigate the feasibility of using a stereotactic radiation therapy optimization feature, high-fidelity (HF) mode, through an in silico analysis of the entire APBI OART session.
Methods and Materials
This retrospective in silico institutional review board–approved study included 25 patient data sets; 10 training patients allowed for iterative tuning of an HF planning strategy aiming to reduce optimization time with comparable plan quality to our previous non-HF planning strategy. Five OART treatment fractions were emulated for the remaining 15 patients in a virtual treatment planning and delivery system using both templates (with/without HF), resulting in the analysis of 330 validation cohort plans, including reference/nonadaptive/adaptive plans (initial plan/recalculated initial plan/reoptimized plan). Dose-volume-histogram metrics, optimization times, and patient-specific quality assurance results were compared with/without HF via the Wilcoxon paired test.
Results
HF adaptive planning resulted in improved per-fraction breast V100%/50% (0.2%/3.3%), Ribs D0.01cc (0.2 Gy), and Paddick conformity/gradient indices (0.01/0.17), but led to marginally inferior planning target volume V100% (0.2%) and lung V30% (0.2%) compared to non-HF (P < .005). HF planning reduced the median online optimization time by 54% (5.4 minutes) per fraction, significantly improving treatment efficiency. There were no statistically significant differences in patient-specific quality assurance delivery accuracy, as indicated by the gamma passing rate (P ≥ .29), with both HF and non-HF plans achieving >97% at 3%/3 mm.
Conclusions
This work demonstrates that leveraging Ethos v2.0 HF mode may significantly improve stereotactic OART treatment efficiency for volumetric modulated arc therapy APBI, with >50% reduction in optimization time observed while maintaining plan quality on a nonclinical system, potentially leading to reduced patient discomfort and mitigated intrafraction variations.
{"title":"Leveraging High-Fidelity Mode for Improved Online Adaptive Stereotactic Accelerated Partial Breast Treatment Efficiency","authors":"Joel A. Pogue PhD , Jingwei Duan PhD , Joseph Harms PhD , Sean Sullivan BS , Courtney Stanley DMP , Richard A. Popple PhD , Natalie Viscariello PhD , Dennis N. Stanley PhD , Drexel Hunter Boggs MD , Carlos E. Cardenas PhD","doi":"10.1016/j.adro.2025.101901","DOIUrl":"10.1016/j.adro.2025.101901","url":null,"abstract":"<div><h3>Purpose</h3><div>Cone beam computed tomography guided online adaptive radiation therapy (OART) for stereotactic accelerated partial breast irradiation (APBI) can help mitigate the effects of interfraction lumpectomy bed variation. However, OART leads to a prolonged treatment time due to daily reoptimization of the treatment plan, potentially increasing patient discomfort and intrafraction variation. Here, we investigate the feasibility of using a stereotactic radiation therapy optimization feature, high-fidelity (HF) mode, through an in silico analysis of the entire APBI OART session.</div></div><div><h3>Methods and Materials</h3><div>This retrospective in silico institutional review board–approved study included 25 patient data sets; 10 training patients allowed for iterative tuning of an HF planning strategy aiming to reduce optimization time with comparable plan quality to our previous non-HF planning strategy. Five OART treatment fractions were emulated for the remaining 15 patients in a virtual treatment planning and delivery system using both templates (with/without HF), resulting in the analysis of 330 validation cohort plans, including reference/nonadaptive/adaptive plans (initial plan/recalculated initial plan/reoptimized plan). Dose-volume-histogram metrics, optimization times, and patient-specific quality assurance results were compared with/without HF via the Wilcoxon paired test.</div></div><div><h3>Results</h3><div>HF adaptive planning resulted in improved per-fraction breast V100%/50% (0.2%/3.3%), Ribs D0.01cc (0.2 Gy), and Paddick conformity/gradient indices (0.01/0.17), but led to marginally inferior planning target volume V100% (0.2%) and lung V30% (0.2%) compared to non-HF (<em>P</em> < .005). HF planning reduced the median online optimization time by 54% (5.4 minutes) per fraction, significantly improving treatment efficiency. There were no statistically significant differences in patient-specific quality assurance delivery accuracy, as indicated by the gamma passing rate (<em>P</em> ≥ .29), with both HF and non-HF plans achieving >97% at 3%/3 mm.</div></div><div><h3>Conclusions</h3><div>This work demonstrates that leveraging Ethos v2.0 HF mode may significantly improve stereotactic OART treatment efficiency for volumetric modulated arc therapy APBI, with >50% reduction in optimization time observed while maintaining plan quality on a nonclinical system, potentially leading to reduced patient discomfort and mitigated intrafraction variations.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101901"},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412670","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}
Hypofractionation has become part of the standard of care for many disease sites but not for head/neck cancers due to concerns about toxicity. However, this may change as evidence emerges. To assess the tolerability and efficacy of moderate hypofractionation, we conducted a study on intermediate- and high-risk oropharyngeal carcinoma patients using a simultaneous modulated accelerated radiation therapy regimen.
Methods and Materials
Thirty oropharyngeal carcinoma patients were enrolled, categorized as (1) Intermediate-risk: Human papillomavirus (HPV) positive-tobacco smokers with >10 pack-years with N2/N3 nodal stage or HPV-negative nonsmoker with T2/T3 stage; or (2) High risk: HPV-negative smokers with T2/T3 or HPV-negative with T4 or N2b/N3 stage. Radiation therapy was planned using volumetric modulated arc therapy with simultaneous integrated boost to deliver 64 Gy in 25 fractions to the gross disease, along with concurrent weekly cisplatin 40 mg/m2.
Results
Twenty-seven patients completed 80% of the planned radiation treatment (≥20 fractions), whereas 87% of patients received concurrent chemotherapy with a median cumulative dose of 200 mg. After 3 months, 90.5% of the patients showed clinical complete response, and 65% showed positron emission tomography-based metabolic complete response. Four out of 6 patients with positron emission tomography-based partial response achieved complete remission with salvage therapy. After a median follow-up of 33 months, the median overall survival was 16.7 months, and the 3-year overall survival rate was 44.4%. A majority (88.9%) of the patients experienced grade ≤ 2 acute toxicities during treatment. A significant improvement in the quality of-life score was observed at 3 and 12 months post treatment.
Conclusions
We share our experience with limited sample size for hypofractionated concurrent chemoradiation, and our primary endpoint of complete clinical response was met. Offering the advantage of shorter treatment time with comparable outcomes, this regimen needs to be tested on a larger population.
{"title":"Efficacy and Toxicity of Simultaneous Modulated Accelerated Radiation Therapy (SMART) in Intermediate- and High-Risk Oropharyngeal Carcinoma","authors":"Smrithi Sathish MD , Pooja Sethi MD , Vijayaprabhu Neelakandan PhD, MSc , Dhanapathi Halanaik MD , Sivaraman Ganesan MS , Sreerekha Jinkala MD , Bharagav Shreeram Gundapuneedi MD","doi":"10.1016/j.adro.2025.101898","DOIUrl":"10.1016/j.adro.2025.101898","url":null,"abstract":"<div><h3>Purpose</h3><div>Hypofractionation has become part of the standard of care for many disease sites but not for head/neck cancers due to concerns about toxicity. However, this may change as evidence emerges. To assess the tolerability and efficacy of moderate hypofractionation, we conducted a study on intermediate- and high-risk oropharyngeal carcinoma patients using a simultaneous modulated accelerated radiation therapy regimen.</div></div><div><h3>Methods and Materials</h3><div>Thirty oropharyngeal carcinoma patients were enrolled, categorized as (1) <strong>Intermediate-risk</strong>: Human papillomavirus (HPV) positive-tobacco smokers with >10 pack-years with N2/N3 nodal stage or HPV-negative nonsmoker with T2/T3 stage; or (2) <strong>High risk</strong>: HPV-negative smokers with T2/T3 or HPV-negative with T4 or N2b/N3 stage. Radiation therapy was planned using volumetric modulated arc therapy with simultaneous integrated boost to deliver 64 Gy in 25 fractions to the gross disease, along with concurrent weekly cisplatin 40 mg/m<sup>2</sup>.</div></div><div><h3>Results</h3><div>Twenty-seven patients completed 80% of the planned radiation treatment (≥20 fractions), whereas 87% of patients received concurrent chemotherapy with a median cumulative dose of 200 mg. After 3 months, 90.5% of the patients showed clinical complete response, and 65% showed positron emission tomography-based metabolic complete response. Four out of 6 patients with positron emission tomography-based partial response achieved complete remission with salvage therapy. After a median follow-up of 33 months, the median overall survival was 16.7 months, and the 3-year overall survival rate was 44.4%. A majority (88.9%) of the patients experienced grade ≤ 2 acute toxicities during treatment. A significant improvement in the quality of-life score was observed at 3 and 12 months post treatment.</div></div><div><h3>Conclusions</h3><div>We share our experience with limited sample size for hypofractionated concurrent chemoradiation, and our primary endpoint of complete clinical response was met. Offering the advantage of shorter treatment time with comparable outcomes, this regimen needs to be tested on a larger population.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101898"},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519000","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 : 2025-09-13DOI: 10.1016/j.adro.2025.101899
Kira R. Newell BA , Zoe O. Ferguson-Steele BA , David Shin BA , Min Gyu Noh MD , Sudhakar Pipavath MD , Joseph Tsai MD, PhD , Kristi Hendrickson PhD , Tyler Gutschenritter MD , John Kang MD, PhD
Purpose
Radiation therapy dose visualizations created by radiation oncologists are not accessible to diagnostic radiologists; however, access may improve interpretation accuracy and confidence when applied to surveillance imaging of patients with radiation therapy-treated thoracic malignancies.
Methods and Materials
In a prospective analysis of retrospectively acquired data, 32 imaging series of patients treated with radiation therapy for thoracic malignancies (14 men, 18 women; mean age, 71 years ± SD 10.35 years) were interpreted. One cardiothoracic radiology attending and 1 radiology resident interpreted pretreatment, treatment planning, and posttreatment computed tomography (CT) images in anonymized software sessions first without, then—after a 1 month “washout period”—with access to radiation therapy dose overlays. Readers then labeled treated lesion(s) and treatment effect(s) and recorded their confidence using a Likert scale (1-5) and agreement with yes/no statements. Binary data were analyzed with McNemar’s and Fisher’s tests, whereas Likert scale data were analyzed with paired 2-sided t tests.
Results
With the addition of radiation dose visualization, the identification of all treated lesions increased from 61% to 81% of CT series (P < .001). This was most pronounced in CT series with multiple treated lesions (15%-54% of CT series, P = .004). Confidence in identification ability also increased from a rating of 4.1 to 4.8 on a scale of 1 to 5 (P < .001), and the desire to access the chart for additional patient information decreased from 3.63 to 3.28 (P = .005).
Conclusions
Access to radiation dose visualization was associated with increased correct identification rate of irradiated lesions and treatment effects, as well as radiologists' confidence in said identifications.
{"title":"Radiation Dose Overlay Improves Radiologists' Interpretation of Post-therapy Computed Tomography Imaging for Thoracic Malignancies","authors":"Kira R. Newell BA , Zoe O. Ferguson-Steele BA , David Shin BA , Min Gyu Noh MD , Sudhakar Pipavath MD , Joseph Tsai MD, PhD , Kristi Hendrickson PhD , Tyler Gutschenritter MD , John Kang MD, PhD","doi":"10.1016/j.adro.2025.101899","DOIUrl":"10.1016/j.adro.2025.101899","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy dose visualizations created by radiation oncologists are not accessible to diagnostic radiologists; however, access may improve interpretation accuracy and confidence when applied to surveillance imaging of patients with radiation therapy-treated thoracic malignancies.</div></div><div><h3>Methods and Materials</h3><div>In a prospective analysis of retrospectively acquired data, 32 imaging series of patients treated with radiation therapy for thoracic malignancies (14 men, 18 women; mean age, 71 years ± SD 10.35 years) were interpreted. One cardiothoracic radiology attending and 1 radiology resident interpreted pretreatment, treatment planning, and posttreatment computed tomography (CT) images in anonymized software sessions first without, then—after a 1 month “washout period”—with access to radiation therapy dose overlays. Readers then labeled treated lesion(s) and treatment effect(s) and recorded their confidence using a Likert scale (1-5) and agreement with yes/no statements. Binary data were analyzed with McNemar’s and Fisher’s tests, whereas Likert scale data were analyzed with paired 2-sided <em>t</em> tests.</div></div><div><h3>Results</h3><div>With the addition of radiation dose visualization, the identification of all treated lesions increased from 61% to 81% of CT series (<em>P</em> < .001). This was most pronounced in CT series with multiple treated lesions (15%-54% of CT series, <em>P</em> = .004). Confidence in identification ability also increased from a rating of 4.1 to 4.8 on a scale of 1 to 5 (<em>P</em> < .001), and the desire to access the chart for additional patient information decreased from 3.63 to 3.28 (<em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>Access to radiation dose visualization was associated with increased correct identification rate of irradiated lesions and treatment effects, as well as radiologists' confidence in said identifications.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101899"},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576307","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 : 2025-08-30DOI: 10.1016/j.adro.2025.101896
Jerome Jean-Joseph MSc , Christoph Westerhausen PhD , Johannes Doescher MD , Bruno Maerkl MD , Zoha Roushan MSc , Maria Neu MD , Tilman Janzen PhD , Klaus-Henning Kahl MD , Georg Stueben MD , Nikolaos Balagiannis MD
Purpose
This study evaluates the Augsburg Nasopharyngeal Applicator (ANA), a novel nasal brachytherapy device designed for early-stage nasopharyngeal carcinoma (T1–T2 stages). ANA leverages nasal anatomy to overcome limitations of oral applicators, optimizing tumor targeting while sparing adjacent tissues, such as the soft palate and oral mucosa.
Methods and Materials
ANA was developed using sagittal computed tomography-based anatomic measurements and computer-aided design modeling. Structural integrity was validated through nonlinear finite-element analysis, mechanical stress testing (including Euler buckling tests), and displacement testing (30 min vibration at 5 Hz with 2 cm amplitude). Dosimetry was verified using radiochromic film with 3%/3 mm gamma analysis criteria, following the TG-43 formalism for dose calculation. Insertion feasibility was assessed in a postmortem model under institutional autopsy protocols.
Results
ANA (with nylon 6/6 catheter) withstood displacements up to 30 mm without failure. Simulated motion tests demonstrated positional stability (<1 mm displacement). Dosimetry achieved a 97.5% gamma pass rate (clinical acceptability threshold: 95%), with the 20 mm curvature configuration reducing soft palate doses by >50% compared to standard oral applicators (eg, Rotterdam design). Postmortem insertion was completed in 10 min, with endoscopic confirmation of positioning accuracy within 1 mm.
Conclusions
ANA demonstrates precise positioning, mechanical stability under simulated physiologic motion (<1 mm displacement), and clinically significant dose sparing (>50% reduction to the soft palate with the 20 mm curvature configuration). Its nasal approach and anatomic adaptability position it as a promising alternative to oral applicators. These proof-of-concept findings support the need for phase 1/2 clinical trials to evaluate safety and efficacy in patients.
{"title":"Development and Validation of the Augsburg Nasopharyngeal Applicator: Enhancing Efficacy in Nasal Route Brachytherapy","authors":"Jerome Jean-Joseph MSc , Christoph Westerhausen PhD , Johannes Doescher MD , Bruno Maerkl MD , Zoha Roushan MSc , Maria Neu MD , Tilman Janzen PhD , Klaus-Henning Kahl MD , Georg Stueben MD , Nikolaos Balagiannis MD","doi":"10.1016/j.adro.2025.101896","DOIUrl":"10.1016/j.adro.2025.101896","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the Augsburg Nasopharyngeal Applicator (ANA), a novel nasal brachytherapy device designed for early-stage nasopharyngeal carcinoma (T1–T2 stages). ANA leverages nasal anatomy to overcome limitations of oral applicators, optimizing tumor targeting while sparing adjacent tissues, such as the soft palate and oral mucosa.</div></div><div><h3>Methods and Materials</h3><div>ANA was developed using sagittal computed tomography-based anatomic measurements and computer-aided design modeling. Structural integrity was validated through nonlinear finite-element analysis, mechanical stress testing (including Euler buckling tests), and displacement testing (30 min vibration at 5 Hz with 2 cm amplitude). Dosimetry was verified using radiochromic film with 3%/3 mm gamma analysis criteria, following the TG-43 formalism for dose calculation. Insertion feasibility was assessed in a postmortem model under institutional autopsy protocols.</div></div><div><h3>Results</h3><div>ANA (with nylon 6/6 catheter) withstood displacements up to 30 mm without failure. Simulated motion tests demonstrated positional stability (<1 mm displacement). Dosimetry achieved a 97.5% gamma pass rate (clinical acceptability threshold: 95%), with the 20 mm curvature configuration reducing soft palate doses by >50% compared to standard oral applicators (eg, Rotterdam design). Postmortem insertion was completed in 10 min, with endoscopic confirmation of positioning accuracy within 1 mm.</div></div><div><h3>Conclusions</h3><div>ANA demonstrates precise positioning, mechanical stability under simulated physiologic motion (<1 mm displacement), and clinically significant dose sparing (>50% reduction to the soft palate with the 20 mm curvature configuration). Its nasal approach and anatomic adaptability position it as a promising alternative to oral applicators. These proof-of-concept findings support the need for phase 1/2 clinical trials to evaluate safety and efficacy in patients.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101896"},"PeriodicalIF":2.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156160","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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