Advances in Radiation Oncology最新文献

{"title":"ChatGPT Versus DeepSeek: Assessing Artificial Intelligence Performance on Radiation Oncology Examination Questions","authors":"Ronald Chow MD MS, MEng, FACE, FRSPH ,&nbsp;Ajay Zheng BS ,&nbsp;Chenxi Gao BS ,&nbsp;Milo Vermeulen PhD ,&nbsp;Francis Yu MS ,&nbsp;Irini Yacoub MD ,&nbsp;Arpit M. Chhabra MD ,&nbsp;J. Isabelle Choi MD ,&nbsp;Haibo Lin PhD ,&nbsp;Gilmer Valdes PhD ,&nbsp;Charles B. Simone II MD, FASTRO, FACRO","doi":"10.1016/j.adro.2025.101929","DOIUrl":"10.1016/j.adro.2025.101929","url":null,"abstract":"<div><h3>Purpose</h3><div>Large language models have been assessed for their ability to receive and answer medical questions. Recently, there has been a new large language model named DeepSeek released, which has not been assessed for medical accuracy. This is the first study to assess DeepSeek for accuracy in responding to medical questions.</div></div><div><h3>Methods and Materials</h3><div>We prompted DeepSeek-R1 and several models of ChatGPT with 600 radiation oncology examination questions from national radiation oncology in-service multiple-choice examinations. These questions are used by medical residents in preparation for their certifying board examination and assess knowledge on anatomy, treatment planning, cancer epidemiology, and landmark trials. We recorded each model’s accuracy, total prompt and completion tokens used, and total run time. Accuracy was compared across question categories and between models. Type I error was set at 0.05.</div></div><div><h3>Results</h3><div>DeepSeek-R1 answered 84.0% of questions correctly, requiring 59 seconds per question. DeepSeek-R1 demonstrated a significant difference in accuracy by question categories (<em>P</em> = .012) and was least accurate for questions about landmark studies (74.2% accuracy). ChatGPT o1 answered 89.0% of questions correctly, requiring 10 seconds per question. ChatGPT o1’s accuracy did not significantly differ across question categories (93.5% accurate on questions about landmark studies). DeepSeek-R1 used 7.2% more tokens than ChatGPT o1. At February 2025 prices, DeepSeek-R1 costs up to $1.56, compared with ChatGPT’s $37.96.</div></div><div><h3>Conclusion</h3><div>DeepSeek-R1 is less accurate and answers more slowly compared with ChatGPT o1, but is less costly at the time of this manuscript preparation. Careful analysis and consideration of the current landscape and performance of each model is needed before implementation of DeepSeek-R1 or ChatGPT o1 to determine if the added financial costs of ChatGPT o1 are within the intended goals of improved accuracy and efficiency.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101929"},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Experience Comparing Reduced Planning Target Volume Margins Using Cone Beam Computed Tomography Scan Guided Online Adaptive Radiation Therapy to Nonadaptive, Traditional Margin Plans for Muscle-Invasive Bladder Cancer","authors":"Samuel B. Hayworth MD ,&nbsp;Whitney S. Hotsinpiller MD ,&nbsp;Joel Pogue PhD ,&nbsp;Melissa Tyler CMD ,&nbsp;Joseph Harms PhD ,&nbsp;Carlos Cardenas PhD ,&nbsp;Dennis Stanley PhD ,&nbsp;Andrew McDonald MD, MS","doi":"10.1016/j.adro.2025.101934","DOIUrl":"10.1016/j.adro.2025.101934","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy (RT) for muscle-invasive bladder cancer (MIBC) requires substantial planning target volume (PTV) margins to accommodate bladder-filling variability. We hypothesized that cone beam computed tomography (CBCT) scan guided online adaptive (AD) RT (oART) improves target coverage while reducing normal tissue exposure compared with non-AD RT.</div></div><div><h3>Methods and Materials</h3><div>Over the course of a year, 8 patients with MIBC received oART. Five patients received 55 Gy in 20 fractions to a clinical target volume (CTV) that was expanded from the transurethral resection of a bladder tumor bed and 46 Gy to the remaining bladder; in contrast, 3 patients had the entire bladder designated as the high-dose CTV. PTVs were 7 mm isometric expansions of CTVs for AD treatment and non-AD (scheduled [SC]) treatment plans versus 15 mm for conventional large margin (LM) treatment plans. Target coverage and organ-at-risk (OAR) dosimetry for AD treatment plans were compared with SC and LM treatment plans per fraction using the Wilcoxon paired test. Total treatment time and acute toxicities were assessed.</div></div><div><h3>Results</h3><div>The AD treatment plan was selected for the delivery of all fractions. Daily bladder volumes differed from simulation by a mean of 60 (SD, ± 66) cc. The CTV D98% &gt; 98% was met for 160 (100%) of fractions with AD treatment plans versus 140 (87.5%) for LM and 67 (41.9%) with SC treatment plans. The CTV_high V90% = 100% for all AD treatment plans. Besides rectum_V30, AD treatment plans reduced OAR exposure for all metrics. Target and OAR objectives were met for 62.3%, 55.4%, and 91.2% of SC, LM, and AD treatment plans, respectively. Median fraction time was 24.7 minutes. Acute toxicity included only 3 grade 1 toxicity events and 2 grade 2 genitourinary or gastrointestinal toxicity events, with no occurrences of grade 3 or higher.</div></div><div><h3>Conclusions</h3><div>oART achieved acceptable dosimetry for target volumes with a reduced PTV margin of 7 mm, despite considerable daily bladder volume variation. AD treatment plans improved target coverage and OAR dosimetry. Future patient-centered studies should explore the long-term clinical impact of reduced margin of oART for MIBC.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101934"},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Nuclear Imaging Response as a Prognostic Indicator Following Spine Stereotactic Body Radiation Therapy","authors":"Khaled Dibs MD ,&nbsp;Glenis Tocaj BA ,&nbsp;Joshua Palmer MD ,&nbsp;Raju Raval MD, DPhil ,&nbsp;Sasha Beyer MD, PhD ,&nbsp;Simeng Zhu MD ,&nbsp;Raj Singh MD ,&nbsp;Emile Gogineni DO ,&nbsp;Pavnesh Kumar MD ,&nbsp;Russell Lonser MD ,&nbsp;Evan Thomas MD, PhD ,&nbsp;John Grecula MD, PhD ,&nbsp;Arnab Chakravarti MD ,&nbsp;David Xu MD ,&nbsp;James Elder MD ,&nbsp;Eric Bourekas MD ,&nbsp;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> &lt; .001) and OS (76% vs 36%, <em>P</em> &lt; .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":"2025-10-24","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}

{"title":"A Case of External Beam Radiation Therapy Induced Corneal Damage in the Treatment of Squamoid Eccrine Ductal Carcinoma","authors":"Amelia Momtazzadeh BS ,&nbsp;Ilakiya Raghavendiran ,&nbsp;Christina Henson MD ,&nbsp;Annie Moreau MD ,&nbsp;Elise E. Steinberger MD","doi":"10.1016/j.adro.2025.101935","DOIUrl":"10.1016/j.adro.2025.101935","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101935"},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologically Effective Dose and Dose Rate in Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis","authors":"Jane Jomy MSc ,&nbsp;Ke Xin Lin BMSc ,&nbsp;Radha Sharma BSc ,&nbsp;Rachel Lu BMSc ,&nbsp;Sanchit Kaushal BHSc ,&nbsp;Anna T. Santiago MSc ,&nbsp;Dana Keilty MD, MSc ,&nbsp;David Shultz MD, PhD ,&nbsp;Catherine Coolens PhD ,&nbsp;Michael D. Cusimano MD, PhD ,&nbsp;Gelareh Zadeh MD, PhD ,&nbsp;Mojgan Hodaie MD, PhD ,&nbsp;Suneil K. Kalia MD, PhD ,&nbsp;Farshad Nassiri MD, PhD ,&nbsp;Ying Meng MD ,&nbsp;Derek S. Tsang MD, MSc ,&nbsp;Michael Yan MD, MPH","doi":"10.1016/j.adro.2025.101932","DOIUrl":"10.1016/j.adro.2025.101932","url":null,"abstract":"<div><h3>Purpose</h3><div>Gamma Knife radiosurgery (GKRS) is used in the treatment of trigeminal neuralgia (TN) to deliver precise, focused ionizing radiation to the trigeminal nerve, thereby reducing its ability to transmit pain signals. Understanding the impact of unique radiobiological parameters, such as the biologically effective dose (BED) and dose rate, in GKRS is essential to optimize treatment protocols and ensure predictable therapeutic outcomes. We conducted a systematic review and meta-analysis to evaluate how BED and dose rate impact GKRS effectiveness and toxicity.</div></div><div><h3>Methods and Materials</h3><div>We searched medical and health care databases from inception to May 19, 2024, for publications reporting on the impact of GKRS BED and/or dose rate on TN outcomes. Following 2 rounds of screening conducted in duplicate, we used random-effects meta-analysis and meta-regression to examine the association between dose rate and pain relief.</div></div><div><h3>Results</h3><div>Of 6950 citations identified, 8 publications reported data on BED and dose rate association with GKRS patient outcomes in TN. Eight cohorts reported on 2596 patients in 6 countries. The “beam-on” time ranged from 27 to 171 minutes, and the prescription dose ranged from 62.5 to 95 Gy. The median BED_2.47 was 2105 Gy (range, 1968-2675), the median dose rate was 2.2 Gy/min (range, 2.06-2.81), and the median maximum brainstem dose was 20.7 Gy (range, 14.8-34.7). The meta-analysis suggested that higher dose rates may be associated with higher rates of pain relief (relative risk, 1.36 [95% CI, 1.10-1.67]; <em>P</em> = .005). Meta-regression demonstrated a nonsignificant relationship between dose rate and pain relief, with an estimated 26% increase in the likelihood of pain control for each 1 Gy/min increase in the median dose rate (β, 0.26 [95% CI, −1.09, 1.60]; <em>P</em> = .71).</div></div><div><h3>Conclusions</h3><div>Higher dose rates in GKRS may be associated with better pain relief in TN. Dose rate should be considered in the treatment of TN when using GKRS.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101932"},"PeriodicalIF":2.7,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Combining Radiation Therapy and Antibody Drug Conjugates in Advanced Urothelial and Other Cancers","authors":"Derrick Lock ,&nbsp;Yash S. Soni ,&nbsp;Lindsay Hwang ,&nbsp;Suzanne Cole ,&nbsp;Anishka D’Souza ,&nbsp;Aurelie Garant ,&nbsp;Daniel X. Yang ,&nbsp;Waddah Arafat ,&nbsp;Tian Zhang ,&nbsp;Leslie K. Ballas ,&nbsp;Neil B. Desai","doi":"10.1016/j.adro.2025.101926","DOIUrl":"10.1016/j.adro.2025.101926","url":null,"abstract":"<div><div>Antibody drug conjugates (ADCs) such as enfortumab vedotin and sacituzumab govitecan are novel treatments increasingly used for metastatic urothelial carcinoma. There is limited data evaluating their safety when combined with radiation therapy (RT). A bi-institutional retrospective analysis was performed to characterize toxicity in patients who received RT within 6 months of receipt of ADC. Patients were stratified by intensity of RT (higher vs lower), site of RT, and RT timing relative to ADC. One hundred three patients received 166 courses of RT (66% lower vs 34% higher intensity). In 11% of courses, RT was directed to the pelvis including the bladder. Of 77 (46%) RT courses concurrent with ADC, 7 (12%) patients experienced grade 1-2 toxicity, and 10 (13%) patients experienced grade 3-5 toxicity. All of these were attributed to known ADC toxicities, and only one was possibly influenced by the addition of RT. No patients receiving RT to the bladder experienced high-grade toxicity. This retrospective study thus found no added safety events for patients receiving RT with ADCs, even when administered concurrently. Further data to validate these findings is needed as the use of both ADCs and RT increases in patients with urothelial carcinoma.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101926"},"PeriodicalIF":2.7,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Boron Neutron Capture Therapy as a Novel Approach for Chondrosarcoma: Case Study of Tumor Reduction and Long-term Control","authors":"Junqiang Hong MD ,&nbsp;Yuan-Hao Liu PhD ,&nbsp;Xiaohua Zhu MD, PhD ,&nbsp;Yi-Chiao Teng PhD ,&nbsp;Xiaoyi Lin MD ,&nbsp;Diyun Shu PhD ,&nbsp;Youqun Lai MS ,&nbsp;Ye Cao PhD ,&nbsp;Qiuping Gong BEng ,&nbsp;Shuang Fu BS ,&nbsp;Wenyu Xu MS ,&nbsp;Qiuli Lai BS ,&nbsp;Xingyan Liu PhD ,&nbsp;Ping Zhou PhD ,&nbsp;Mu Mei MS ,&nbsp;Mingang Ying MD, PhD ,&nbsp;Cheng Huang MD, PhD ,&nbsp;Jianji Pan MD, PhD","doi":"10.1016/j.adro.2025.101897","DOIUrl":"10.1016/j.adro.2025.101897","url":null,"abstract":"<div><h3>Purpose</h3><div>Mesenchymal chondrosarcoma (MCS), a rare malignant tumor arising from cartilage-forming tissues, is known for its resistance to conventional therapies. This case report presents the first documented use of boron neutron capture therapy (BNCT) for treating a patient with chondrosarcoma.</div></div><div><h3>Methods and Materials</h3><div>The treatment was carried out using the NeuPex AB-BNCT system in combination with the boron compound NBB-001 (boronophenylalanine) and the NeuMANTA treatment planning system. Over the course of 2 BNCT sessions, the patient experienced significant tumor reduction and a favorable clinical response, with no severe adverse effects reported. The therapy was guided by ¹⁸F-boronophenylalanine positron emission tomography-computed tomography imaging scans for planning and magnetic resonance imaging scans for outcome assessment.</div></div><div><h3>Results</h3><div>The targeted nature of BNCT resulted in a 45.8% reduction in the tumor's maximum dimension, achieving a partial response according to Response Evaluation Criteria in Solid Tumors version 1.1. Most adverse events were mild (grades 1-2) and manageable, with only grade 3 mucositis observed, which was transient and resolved with supportive care.</div></div><div><h3>Conclusions</h3><div>This case study underscored the potential of BNCT as a promising treatment modality for MCS, particularly for tumors that are resistant to conventional radiation therapy. Further research is warranted to refine treatment protocols and explore the broader applicability of BNCT in managing MCS and other challenging malignancies.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101897"},"PeriodicalIF":2.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lutetium 177Lu Vipivotide Tetraxetan Efficacy and Toxicity in Advanced Prostate Cancer","authors":"Anthony Y. Zhang BS ,&nbsp;Helaine Bertsch MD ,&nbsp;Ahmed Chaudhary MD ,&nbsp;Andrew Salner MD","doi":"10.1016/j.adro.2025.101917","DOIUrl":"10.1016/j.adro.2025.101917","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective study aimed to evaluate the efficacy and toxicity of lutetium ¹⁷⁷Lu vipivotide tetraxetan ([LuVT], Pluvicto, Novatis Pharmaceutical Corporation), a peptide receptor radionuclide therapy, in metastatic castration-resistant prostate cancer patients treated at a single institution during the first year of Food and Drug Administration-approved clinical use.</div></div><div><h3>Methods and Materials</h3><div>A total of 45 patients with metastatic castration-resistant prostate cancer and positive prostate-specific membrane antigen positron emission tomography imaging were treated with at least 1 cycle of LuVT therapy between September 2022 and September 2023. Clinical records were reviewed to assess prostate-specific antigen (PSA) response, imaging outcomes, and patient-reported and physician-reported toxicities. PSA responses were classified into complete, excellent (≥50% reduction), partial (10%-49% reduction), no response, and initial response with disease progression. Toxicities were graded with Common Terminology Criteria for Adverse Events v5.0 criteria.</div></div><div><h3>Results</h3><div>Of 45 patients, 44 encompassed the final cohort (1 excluded after a single treatment before death from comorbidity). The mean age was 72.8 years and 88.9% of the cohort was White. A total of 68.9% of the cohort observed PSA biomarker improvement of ≥10%, and 55.6% with ≥50% PSA reduction. Three patients (6.7%) achieved a complete response. Imaging improvements were seen in 8 patients, including 1 with non–PSA-secreting disease. Adverse events were predominantly grade 1 and 2 severities. Most common patient-reported effects included fatigue and flare-related bone pain, with flare reactions noted in 26.7% of patients. None of the toxicities exceeded grade 2 severity. Treatment discontinuation occurred in 33.3% of patients because of a combination of progression, toxicity, lab parameters, or palliative care transition.</div></div><div><h3>Conclusions</h3><div>LuVT therapy demonstrated consistent efficacy and tolerable toxicity in this real-world cohort, with results comparable to the VISION trial. Flare pain reactions and appetite loss emerged as prominent, although tolerable, adverse effects. Limitations include small sample size, lack of long-term follow-up, and a homogenous population with significantly advanced disease.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101917"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Tumor DNA Predicts Response After Definitive Radiation Therapy for Merkel Cell Carcinoma","authors":"Kyle Murchison BS ,&nbsp;Anthony Camargo BA ,&nbsp;Danielle Margalit MD ,&nbsp;Jonathan D. Schoenfeld MD, MPH ,&nbsp;Roy Tishler MD ,&nbsp;Karam Khaddour MD ,&nbsp;Manisha Thakuria MD ,&nbsp;Ann W. Silk MD","doi":"10.1016/j.adro.2025.101918","DOIUrl":"10.1016/j.adro.2025.101918","url":null,"abstract":"<div><h3>Purpose</h3><div>Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high recurrence rate. Circulating tumor DNA (ctDNA) assays are increasingly used to assess treatment response and detect recurrence. This study evaluated the value of ctDNA levels in MCC patients treated with definitive radiation therapy (dRT).</div></div><div><h3>Methods and Materials</h3><div>We identified 48 patients with MCC treated with dRT from 2021-2024 treated at our institute. The level of ctDNA was measured within 90 days before and 180 days after initiating dRT using a tumor-informed multiplex polymerase chain reaction assay targeting up to 16 patient-specific mutations. Disease status at follow-up was categorized as no evidence of disease (NED) or clinical evidence of disease. ctDNA dynamics were compared across disease outcome groups using the Wilcoxon rank-sum test.</div></div><div><h3>Results</h3><div>At baseline, the value of median ctDNA levels were higher in stage 1 versus stage 1-2. Of 23 patients with detectable ctDNA levels at baseline, 15 achieved undetectable levels following dRT. ctDNA levels declined significantly during (<em>P</em> = .0125) and after dRT (<em>P</em> = .0004). Among patients who became NED, ctDNA levels declined rapidly. In contrast, persistent or rising value of ctDNA levels after dRT was associated with recurrence. Nine of 10 patients with detectable ctDNA levels after dRT experienced recurrence, with a median time to recurrence of 117 days. Among patients with undetectable ctDNA levels during dRT, the negative predictive value for recurrence was 90%.</div></div><div><h3>Conclusions</h3><div>ctDNA levels decline rapidly during and after dRT in patients with MCC, particularly in those who achieve NED. Detectable ctDNA levels after dRT are strongly associated with recurrence, supporting the use of ctDNA level as a noninvasive biomarker to assess treatment response and guide posttreatment surveillance.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101918"},"PeriodicalIF":2.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography-Based Radiomics Prediction of Biochemical Failure and Distant Metastasis in Patients With High- and Very High-Risk Localized Prostate Cancer","authors":"Takanori Adachi PhD ,&nbsp;Kota Hirata MS ,&nbsp;Rihito Aizawa MD, PhD ,&nbsp;Hideaki Hirashima PhD ,&nbsp;Takashi Ogata MD ,&nbsp;Mitsuhiro Nakamura PhD ,&nbsp;Takashi Mizowaki MD, PhD","doi":"10.1016/j.adro.2025.101916","DOIUrl":"10.1016/j.adro.2025.101916","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to assess the utility of radiomics features extracted from planning computed tomography (pCT) images in predicting biochemical failure (BF) and distant metastasis (DM) in patients with localized prostate cancer (PCa).</div></div><div><h3>Methods and Materials</h3><div>This retrospective study included 608 patients with high-risk and very high-risk localized PCa who received intensity modulated radiation therapy. Five clinical variables—age, clinical T-stage, Gleason score, prostate-specific antigen level, and prescribed dose—were collected. Additionally, 1316 radiomics features (shape, first-order, and texture) were extracted from pCT images. Patients were randomly classified into training-validation (70%) and test (30%) cohorts, with stratification by BF and DM incidence. Predictive models were developed to estimate BF and DM risk using 3 strategies: a clinical model based on the 5 clinical variables; a radiomics model using 5 selected radiomics features; and a hybrid model combining both. All models were constructed using random survival forest with undersampling, considering death as a competing risk. Models were then applied to the test cohort, stratifying patients into high- and low-score groups by the median risk score. Model performance was evaluated using the concordance index (C-index), where values of 0.5 and 1.0 indicate random and perfect predictions, respectively, with survival differences between the 2 groups assessed using Gray’s test.</div></div><div><h3>Results</h3><div>During a median follow-up of 8.2 years, BF and DM occurred in 178 (29.3%) and 52 (8.6%) patients, respectively. In the test cohort, the C-indices for BF prediction were 0.637, 0.640, and 0.687 for the clinical, radiomics, and hybrid models, respectively (<em>P</em> &lt; .05). For DM prediction, the C-indices were 0.586 (<em>P</em> = .203), 0.588 (<em>P</em> = .153), and 0.599 (<em>P</em> = .099), respectively.</div></div><div><h3>Conclusions</h3><div>Integrating clinical and pCT-based radiomics features enhanced BF prediction in patients with high-risk and very high-risk localized PCa when accounting for competing risks using random survival forest. However, no significant improvement was observed for DM prediction.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101916"},"PeriodicalIF":2.7,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}