Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disorder associated with an increased risk of cancer, including a 5-fold higher incidence of breast cancer. Preclinical data suggest heightened radiosensitivity in NF1, raising concerns about toxicity and secondary malignancies after radiation therapy. Clinical data, however, are lacking. This study aimed to evaluate long-term outcomes and treatment-related toxicities in NF1 patients receiving adjuvant radiation therapy for breast cancer.
Methods and Materials
This retrospective single-center study included 27 NF1 patients with nonmetastatic breast cancer treated with surgery and adjuvant radiation therapy between 1995 and 2023. Clinical, pathologic, treatment, and toxicity data were analyzed. Survival was assessed using Kaplan-Meier estimates, and toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events.
Results
Among 27 patients (30 tumors), the median follow-up was 79 months. The 10-year overall and cancer-specific survival rates were 68.3% each, and the metastasis-free survival rate was 68.4%. Local and locoregional control exceeded 92%. Acute radiodermatitis occurred in 83.3% of patients (grade 1-2); no grade ≥ 3 acute or late toxicity was observed. Late toxicities were rare and mild. No radiation-induced malignancy or cardiopulmonary events were reported. Nodal involvement and lymphovascular invasion were significantly associated with poorer survival.
Conclusions
Adjuvant radiation therapy is safe and effective in NF1 patients with breast cancer, despite a notably high incidence of low-grade acute skin toxicity. No serious long-term toxicity or radiation-induced malignancy was observed. Modern dose-sparing techniques should be prioritized, and further prospective studies are needed to refine treatment approaches in this high-risk group.
{"title":"Adjuvant Radiation Therapy in Breast Cancer Patients With Neurofibromatosis Type 1: Safety and Long-Term Outcomes","authors":"Carla Benmatallah MD , Youlia Kirova MD , Pierre Loap MD","doi":"10.1016/j.adro.2025.101931","DOIUrl":"10.1016/j.adro.2025.101931","url":null,"abstract":"<div><h3>Purpose</h3><div>Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disorder associated with an increased risk of cancer, including a 5-fold higher incidence of breast cancer. Preclinical data suggest heightened radiosensitivity in NF1, raising concerns about toxicity and secondary malignancies after radiation therapy. Clinical data, however, are lacking. This study aimed to evaluate long-term outcomes and treatment-related toxicities in NF1 patients receiving adjuvant radiation therapy for breast cancer.</div></div><div><h3>Methods and Materials</h3><div>This retrospective single-center study included 27 NF1 patients with nonmetastatic breast cancer treated with surgery and adjuvant radiation therapy between 1995 and 2023. Clinical, pathologic, treatment, and toxicity data were analyzed. Survival was assessed using Kaplan-Meier estimates, and toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events.</div></div><div><h3>Results</h3><div>Among 27 patients (30 tumors), the median follow-up was 79 months. The 10-year overall and cancer-specific survival rates were 68.3% each, and the metastasis-free survival rate was 68.4%. Local and locoregional control exceeded 92%. Acute radiodermatitis occurred in 83.3% of patients (grade 1-2); no grade ≥ 3 acute or late toxicity was observed. Late toxicities were rare and mild. No radiation-induced malignancy or cardiopulmonary events were reported. Nodal involvement and lymphovascular invasion were significantly associated with poorer survival.</div></div><div><h3>Conclusions</h3><div>Adjuvant radiation therapy is safe and effective in NF1 patients with breast cancer, despite a notably high incidence of low-grade acute skin toxicity. No serious long-term toxicity or radiation-induced malignancy was observed. Modern dose-sparing techniques should be prioritized, and further prospective studies are needed to refine treatment approaches in this high-risk group.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101931"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-10DOI: 10.1016/j.adro.2025.101917
Anthony Y. Zhang BS , Helaine Bertsch MD , Ahmed Chaudhary MD , Andrew Salner MD
Purpose
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.
Methods and Materials
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.
Results
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.
Conclusions
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.
{"title":"Lutetium 177Lu Vipivotide Tetraxetan Efficacy and Toxicity in Advanced Prostate Cancer","authors":"Anthony Y. Zhang BS , Helaine Bertsch MD , Ahmed Chaudhary MD , 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 <sup>177</sup>Lu 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-11-29DOI: 10.1016/j.adro.2025.101895
Kristen A. McConnell PhD, MBA , Maria Valladares BS , Alonso N. Gutierrez PhD, MBA , Nicole Luther BS , Zachary Fellows BS , Lorrie LeGrand MHSc , Michael Chuong MD , Minesh P. Mehta MD , Andrew Wroe PhD
Purpose
Following the guidance of The American Association of Physicists in Medicine (AAPM) Medical Physics Practice Guideline (MPPG) 4a/4b, AAPM Task Groups 100/275, and American Society for Radiation Oncology’s Safety is No Accident, our institution focused on quality improvement to streamline clinical workflows, enable complex treatments, standardize procedures, and positively evolve our practice in proton radiation therapy. A retrospective institutional analysis was completed to map interventions identified prior to data analysis that were likely to affect the evolution of the treatment planning timelines.
Methods and Materials
Care Paths within our Oncology Information System were used to sequence and track clinical workflows since 2017. Data were mined between 2017 to 2023 to obtain the task’s completion and expected completion dates. The task completion offset was calculated to measure the number of days late or early the task was completed. Five quality management interventions were mapped onto control charts for each task to identify the evolution of the practice with each intervention. Average time, SDs, and statistical significance before and after each intervention were also computed. Additionally, total treatment planning times were computed for each patient and histograms, average time, median time, and standard error of the mean were computed and compared by year.
Results
Task completion offsets improved from being, on average, 1.59 to 2.63 days late to 0.06 to 2.25 days early, with control charts visually showing the reduction in mean value, reduction in SD, and ultimately, the processes falling more into control. Interventions 1, 2, and 3 showed the strongest overall statistical impact on task completion offsets. Overall, planning timelines improved from a median of 19 days to 11 days. More importantly, the distributions of overall planning time and spread of these times became Gaussian, demonstrating the characteristics of normalized activity patterns, with a reduction in variability.
Conclusions
The interventions identified before data collection were well associated with the evolution of the treatment planning timeline data. When quantifying with control charts, there were noted decreased task completion offset variabilities across many examined tasks. Additionally, the data showed shortened overall planning timelines during the time that the complexity of protons plans was increased, newer delivery approaches were made available, and more complex clinical scenarios were incorporated.
{"title":"Impact of Quality Improvement Interventions on the Efficiency of Treatment Planning Timelines in a Modern Proton Therapy Clinic","authors":"Kristen A. McConnell PhD, MBA , Maria Valladares BS , Alonso N. Gutierrez PhD, MBA , Nicole Luther BS , Zachary Fellows BS , Lorrie LeGrand MHSc , Michael Chuong MD , Minesh P. Mehta MD , Andrew Wroe PhD","doi":"10.1016/j.adro.2025.101895","DOIUrl":"10.1016/j.adro.2025.101895","url":null,"abstract":"<div><h3>Purpose</h3><div>Following the guidance of The American Association of Physicists in Medicine (AAPM) Medical Physics Practice Guideline (MPPG) 4a/4b, AAPM Task Groups 100/275, and American Society for Radiation Oncology’s <em>Safety is No Accident,</em> our institution focused on quality improvement to streamline clinical workflows, enable complex treatments, standardize procedures, and positively evolve our practice in proton radiation therapy. A retrospective institutional analysis was completed to map interventions identified prior to data analysis that were likely to affect the evolution of the treatment planning timelines.</div></div><div><h3>Methods and Materials</h3><div>Care Paths within our Oncology Information System were used to sequence and track clinical workflows since 2017. Data were mined between 2017 to 2023 to obtain the task’s completion and expected completion dates. The task completion offset was calculated to measure the number of days late or early the task was completed. Five quality management interventions were mapped onto control charts for each task to identify the evolution of the practice with each intervention. Average time, SDs, and statistical significance before and after each intervention were also computed. Additionally, total treatment planning times were computed for each patient and histograms, average time, median time, and standard error of the mean were computed and compared by year.</div></div><div><h3>Results</h3><div>Task completion offsets improved from being, on average, 1.59 to 2.63 days late to 0.06 to 2.25 days early, with control charts visually showing the reduction in mean value, reduction in SD, and ultimately, the processes falling more into control. Interventions 1, 2, and 3 showed the strongest overall statistical impact on task completion offsets. Overall, planning timelines improved from a median of 19 days to 11 days. More importantly, the distributions of overall planning time and spread of these times became Gaussian, demonstrating the characteristics of normalized activity patterns, with a reduction in variability.</div></div><div><h3>Conclusions</h3><div>The interventions identified before data collection were well associated with the evolution of the treatment planning timeline data. When quantifying with control charts, there were noted decreased task completion offset variabilities across many examined tasks. Additionally, the data showed shortened overall planning timelines during the time that the complexity of protons plans was increased, newer delivery approaches were made available, and more complex clinical scenarios were incorporated.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101895"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615560","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 : 2026-01-01Epub Date: 2025-10-24DOI: 10.1016/j.adro.2025.101929
Ronald Chow MD MS, MEng, FACE, FRSPH , Ajay Zheng BS , Chenxi Gao BS , Milo Vermeulen PhD , Francis Yu MS , Irini Yacoub MD , Arpit M. Chhabra MD , J. Isabelle Choi MD , Haibo Lin PhD , Gilmer Valdes PhD , Charles B. Simone II MD, FASTRO, FACRO
Purpose
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.
Methods and Materials
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.
Results
DeepSeek-R1 answered 84.0% of questions correctly, requiring 59 seconds per question. DeepSeek-R1 demonstrated a significant difference in accuracy by question categories (P = .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.
Conclusion
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.
{"title":"ChatGPT Versus DeepSeek: Assessing Artificial Intelligence Performance on Radiation Oncology Examination Questions","authors":"Ronald Chow MD MS, MEng, FACE, FRSPH , Ajay Zheng BS , Chenxi Gao BS , Milo Vermeulen PhD , Francis Yu MS , Irini Yacoub MD , Arpit M. Chhabra MD , J. Isabelle Choi MD , Haibo Lin PhD , Gilmer Valdes PhD , 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-12-11DOI: 10.1016/j.adro.2025.101950
Renke He MD , Shengqiang Xie MD , Lehui Du MD , Wenxuan Li MM , Jianxin Wang PhD , Xianhong Liu PhD , Dai Wu PhD , Yiwei Yang PhD , Baolin Qu MD , Gang Cheng MD , Jianning Zhang MD
Purpose
Preclinical studies have demonstrated that FLASH radiation therapy (RT) delivered at ultrahigh-dose rates exerts a preferential normal tissue-sparing effect. This study aimed to delineate the disparities in delayed cognitive function and biological outcomes of whole-brain irradiation in healthy mice, comparing FLASH-RT with conventional RT (CONV-RT).
Methods and Materials
Eighty adult male C57BL/6J mice were divided into 5 groups: Sham, CONV-RT10Gy, CONV-RT20Gy, FLASH-RT10Gy, and FLASH-RT20Gy. Whole-brain irradiation was conducted on mice using a miniaturized x-ray FLASH platform at field-average dose rates of 2 Gy/min for CONV-RT and 213 Gy/s for FLASH-RT. Two months after irradiation, we assessed the mice’s cognitive function and the number of astrocytes and neurons in the hippocampus, then conducted proteomic analyses of their hippocampus.
Results
Following the administration of a 20 Gy FLASH-RT dose, the incidence of radiodermatitis was markedly lower than that observed with CONV-RT, accompanied by an improvement in survival rates. Compared with the Sham and FLASH-RT groups, the CONV-RT group exhibited reduced exploration of the open arms in the elevated plus maze, diminished preference for the novel arm in the Y-maze, a lower discrimination index in the novel object recognition test, and prolonged latency to reach the platform in the water maze test. Compared with the FLASH-RT group, the CONV-RT group exhibited an increase in astrocytes and a decrease in neurons in the hippocampus. Proteomic analysis revealed that FLASH-RT may improve the oxidative stress damage caused by CONV-RT.
Conclusions
This study demonstrated that FLASH-RT conferred significant advantages over CONV-RT in preserving delayed cognitive function and reducing radiation-induced toxicity in healthy mice. Compared with CONV-RT, FLASH-RT mitigated behavioral deficits across multiple cognitive domains and attenuated hippocampal oxidative stress, highlighting its neuroprotective potential. These findings provided compelling preclinical evidence supporting the therapeutic promise of FLASH-RT as a safer alternative to conventional RT for protecting normal brain function.
{"title":"The Impacts of FLASH Radiation Therapy and Conventional Radiation Therapy on the Cognitive Abilities of Mice","authors":"Renke He MD , Shengqiang Xie MD , Lehui Du MD , Wenxuan Li MM , Jianxin Wang PhD , Xianhong Liu PhD , Dai Wu PhD , Yiwei Yang PhD , Baolin Qu MD , Gang Cheng MD , Jianning Zhang MD","doi":"10.1016/j.adro.2025.101950","DOIUrl":"10.1016/j.adro.2025.101950","url":null,"abstract":"<div><h3>Purpose</h3><div>Preclinical studies have demonstrated that FLASH radiation therapy (RT) delivered at ultrahigh-dose rates exerts a preferential normal tissue-sparing effect. This study aimed to delineate the disparities in delayed cognitive function and biological outcomes of whole-brain irradiation in healthy mice, comparing FLASH-RT with conventional RT (CONV-RT).</div></div><div><h3>Methods and Materials</h3><div>Eighty adult male C57BL/6J mice were divided into 5 groups: Sham, CONV-RT10Gy, CONV-RT20Gy, FLASH-RT10Gy, and FLASH-RT20Gy. Whole-brain irradiation was conducted on mice using a miniaturized x-ray FLASH platform at field-average dose rates of 2 Gy/min for CONV-RT and 213 Gy/s for FLASH-RT. Two months after irradiation, we assessed the mice’s cognitive function and the number of astrocytes and neurons in the hippocampus, then conducted proteomic analyses of their hippocampus.</div></div><div><h3>Results</h3><div>Following the administration of a 20 Gy FLASH-RT dose, the incidence of radiodermatitis was markedly lower than that observed with CONV-RT, accompanied by an improvement in survival rates. Compared with the Sham and FLASH-RT groups, the CONV-RT group exhibited reduced exploration of the open arms in the elevated plus maze, diminished preference for the novel arm in the Y-maze, a lower discrimination index in the novel object recognition test, and prolonged latency to reach the platform in the water maze test. Compared with the FLASH-RT group, the CONV-RT group exhibited an increase in astrocytes and a decrease in neurons in the hippocampus. Proteomic analysis revealed that FLASH-RT may improve the oxidative stress damage caused by CONV-RT.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that FLASH-RT conferred significant advantages over CONV-RT in preserving delayed cognitive function and reducing radiation-induced toxicity in healthy mice. Compared with CONV-RT, FLASH-RT mitigated behavioral deficits across multiple cognitive domains and attenuated hippocampal oxidative stress, highlighting its neuroprotective potential. These findings provided compelling preclinical evidence supporting the therapeutic promise of FLASH-RT as a safer alternative to conventional RT for protecting normal brain function.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101950"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733031","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 : 2026-01-01Epub Date: 2025-10-30DOI: 10.1016/j.adro.2025.101937
Enrique Chajon MD, PhD , Marc Pracht MD , Yan Rolland MD, PhD , France Nguyen MD , Jean-Pierre Bronowicki MD, PhD , Jérôme Durand-Labrunie MD , Véronique Vendrely MD, PhD , Antonio Sa Cunha MD , Valérie Laurent MD, PhD , Emmanuel Rio MD , Samuel Le Sourd MD , Pierre Gustin MD , Patricia C. Said MSc , Mikaela Dimitriu PhD , Benjin D. Facer MD , Omar I. Vivar PhD , Didier Peiffert MD, PhD , Eric Deutsch MD, PhD , Thierry de Baère MD
Purpose
Stereotactic body radiation therapy (SBRT) is a common treatment for unresectable liver cancers; however, delivering ablative doses while minimizing normal tissue toxicity is challenging. NBTXR3, a novel radioenhancer, demonstrated enhanced radiation therapy (RT) efficacy with minimal toxicity in healthy tissue. We evaluated NBTXR3 intratumoral injection followed by SBRT for hepatocellular carcinoma (HCC) or liver metastases.
Methods and Materials
This phase 1, multicenter, dose-escalation trial enrolled adults with unresectable HCC or liver metastases. Five dose levels of NBTXR3 were evaluated (3 + 3 design): 10%, 15%, 22%, 33% and 42% of gross tumor volume (GTV) determined by magnetic resonance imaging. Patients received RT (15 Gy × 3 or 10 Gy × 5 over 5-15 days) starting 1 to 5 days after NBTXR3 injection. Primary endpoints included: incidence of early dose-limiting toxicities (DLTs) and determination of the recommended phase 2 dose (RP2D) of NBTXR3.
Results
Between December 2015 and May 2020, 26 liver lesions in 23 patients with HCC (17 lesions in 15 patients) or liver metastases (9 lesions in 8 patients) were treated. No early DLTs were reported, and the maximum tolerated dose was not reached. The RP2D of NBTXR3 was 42% of GTV. During the treatment period, 6 patients experienced grade ≥3 toxicities; none were NBTXR3-related, one was RT-related (grade 3 fatigue), and 2 were injection procedure–related (grade 3 abdominal pain). During the follow-up period, 2 patients experienced treatment-related grade ≥3 AEs (grade 3 bile duct stenosis related to cancer/RT/NBTXR3, and grade 3 anemia related to cancer/RT/underlying liver disease). No treatment-related deaths were reported. The 12-week objective response rate in treated lesions was 58.3% (7/12) in patients with HCC, and 50.0% (4/8) in patients with liver metastases.
Conclusions
NBTXR3 + RT has a manageable safety profile with no DLTs identified during dose escalation. The RP2D for treatment of HCC or liver metastases is 42% of GTV. Future studies will further evaluate efficacy.
{"title":"Radioenhancing Hafnium Oxide Nanoparticles (NBTXR3) Followed by Stereotactic Body Radiation Therapy in Patients With Hepatocellular Carcinoma and Liver Metastases (NBTXR3-103): Phase 1 Dose-Escalation Trial","authors":"Enrique Chajon MD, PhD , Marc Pracht MD , Yan Rolland MD, PhD , France Nguyen MD , Jean-Pierre Bronowicki MD, PhD , Jérôme Durand-Labrunie MD , Véronique Vendrely MD, PhD , Antonio Sa Cunha MD , Valérie Laurent MD, PhD , Emmanuel Rio MD , Samuel Le Sourd MD , Pierre Gustin MD , Patricia C. Said MSc , Mikaela Dimitriu PhD , Benjin D. Facer MD , Omar I. Vivar PhD , Didier Peiffert MD, PhD , Eric Deutsch MD, PhD , Thierry de Baère MD","doi":"10.1016/j.adro.2025.101937","DOIUrl":"10.1016/j.adro.2025.101937","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic body radiation therapy (SBRT) is a common treatment for unresectable liver cancers; however, delivering ablative doses while minimizing normal tissue toxicity is challenging. NBTXR3, a novel radioenhancer, demonstrated enhanced radiation therapy (RT) efficacy with minimal toxicity in healthy tissue. We evaluated NBTXR3 intratumoral injection followed by SBRT for hepatocellular carcinoma (HCC) or liver metastases.</div></div><div><h3>Methods and Materials</h3><div>This phase 1, multicenter, dose-escalation trial enrolled adults with unresectable HCC or liver metastases. Five dose levels of NBTXR3 were evaluated (3 + 3 design): 10%, 15%, 22%, 33% and 42% of gross tumor volume (GTV) determined by magnetic resonance imaging. Patients received RT (15 Gy × 3 or 10 Gy × 5 over 5-15 days) starting 1 to 5 days after NBTXR3 injection. Primary endpoints included: incidence of early dose-limiting toxicities (DLTs) and determination of the recommended phase 2 dose (RP2D) of NBTXR3.</div></div><div><h3>Results</h3><div>Between December 2015 and May 2020, 26 liver lesions in 23 patients with HCC (17 lesions in 15 patients) or liver metastases (9 lesions in 8 patients) were treated. No early DLTs were reported, and the maximum tolerated dose was not reached. The RP2D of NBTXR3 was 42% of GTV. During the treatment period, 6 patients experienced grade ≥3 toxicities; none were NBTXR3-related, one was RT-related (grade 3 fatigue), and 2 were injection procedure–related (grade 3 abdominal pain). During the follow-up period, 2 patients experienced treatment-related grade ≥3 AEs (grade 3 bile duct stenosis related to cancer/RT/NBTXR3, and grade 3 anemia related to cancer/RT/underlying liver disease). No treatment-related deaths were reported. The 12-week objective response rate in treated lesions was 58.3% (7/12) in patients with HCC, and 50.0% (4/8) in patients with liver metastases.</div></div><div><h3>Conclusions</h3><div>NBTXR3 + RT has a manageable safety profile with no DLTs identified during dose escalation. The RP2D for treatment of HCC or liver metastases is 42% of GTV. Future studies will further evaluate efficacy.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101937"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-24DOI: 10.1016/j.adro.2025.101934
Samuel B. Hayworth MD , Whitney S. Hotsinpiller MD , Joel Pogue PhD , Melissa Tyler CMD , Joseph Harms PhD , Carlos Cardenas PhD , Dennis Stanley PhD , Andrew McDonald MD, MS
Purpose
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.
Methods and Materials
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.
Results
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% > 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.
Conclusions
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.
{"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 , Whitney S. Hotsinpiller MD , Joel Pogue PhD , Melissa Tyler CMD , Joseph Harms PhD , Carlos Cardenas PhD , Dennis Stanley PhD , 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% > 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":"2026-01-01","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}
Pub Date : 2026-01-01Epub Date: 2025-10-25DOI: 10.1016/j.adro.2025.101939
Morgan E. Freret MD, PhD , Divya Yerramilli MD , Victoria S. Brennan MBBch, BAO , Lillian A. Boe PhD , C. Jillian Tsai MD , Oren Cahlon MD , Simon N. Powell MD, PhD, FRCP , Jonathan T. Yang MD, PhD , Sean McBride MD, MA , Puneeth Iyengar MD, PhD , Daniel R. Gomez MD, MBA , Amy J. Xu MD, PhD
Purpose
Radiation therapy has an increasing role in the management of metastatic cancers. Integrating radiation with surgical and systemic approaches is complex, and inappropriate management can lead to prolonged hospitalizations inconsistent with palliative goals. An inpatient radiation oncology consult (IROC) service was created in January 2020 to provide rapid access to specialized care for hospitalized patients. Here, we report outcomes of the IROC service, focusing on quality-of-care metrics including hospital length of stay (LOS), use of hypofractionated approaches, and treatments for patients discharged to hospice.
Methods and Materials
We conducted a pre-post observational study to compare inpatient consults placed before (N = 1507) and after (N = 1509) IROC, from 2019 to 2021. Continuous variables were analyzed using the Mann-Whitney test and categorical variables using Fisher’s exact test.
Results
We found that IROC was associated with reductions in hospital LOS (mean difference 1.0 days, P = .045). Under IROC, inpatient treatment courses were shorter (5.8 vs 5.0 days, P = .007), in part driven by increased adoption of palliative hypofractionated radiation therapy approaches (74% vs 82%, P = .001). The reduction in LOS was greatest for patients discharged to hospice (5.1 vs 3.7 days, P = .036).
Conclusions
The IROC service was associated with reduced hospital LOS, increased use of hypofractionated approaches, and decreased treatments for patients discharged to hospice. Our findings demonstrate the value of a dedicated program addressing radiation delivery to hospitalized patients to improve goal-concordant treatments. The financial impact of reducing low-value care is an important subject for future investigations.
目的：放射治疗在转移性癌症的治疗中发挥着越来越重要的作用。将放疗与外科和全身方法相结合是复杂的，不适当的管理可能导致长期住院，这与姑息治疗的目标不一致。2020年1月建立了住院放射肿瘤学咨询（IROC）服务，为住院患者提供快速获得专业护理的机会。在这里，我们报告了IROC服务的结果，重点关注护理质量指标，包括住院时间（LOS），使用低分割方法，以及出院到临终关怀的患者的治疗。方法和材料我们进行了一项前后观察性研究，比较2019年至2021年IROC之前（N = 1507）和之后（N = 1509）住院患者的就诊情况。连续变量采用Mann-Whitney检验，分类变量采用Fisher精确检验。结果我们发现IROC与住院LOS降低相关（平均差1.0天，P = 0.045）。在IROC下，住院疗程较短（5.8天vs 5.0天，P = 0.007），部分原因是姑息性低分割放射治疗方法的采用增加（74% vs 82%, P = 0.001）。出院至安宁疗护的患者LOS减少最大（5.1 vs 3.7天，P = 0.036）。结论IROC服务与降低医院LOS、增加低分割入路的使用以及减少临终关怀出院患者的治疗有关。我们的研究结果表明，针对住院患者的放射治疗提供一个专门的方案，以提高目标一致性治疗的价值。减少低价值医疗的财政影响是未来调查的一个重要主题。
{"title":"Impact of a Dedicated Inpatient Radiation Oncology Consult Service on Goal-Concordant Care","authors":"Morgan E. Freret MD, PhD , Divya Yerramilli MD , Victoria S. Brennan MBBch, BAO , Lillian A. Boe PhD , C. Jillian Tsai MD , Oren Cahlon MD , Simon N. Powell MD, PhD, FRCP , Jonathan T. Yang MD, PhD , Sean McBride MD, MA , Puneeth Iyengar MD, PhD , Daniel R. Gomez MD, MBA , Amy J. Xu MD, PhD","doi":"10.1016/j.adro.2025.101939","DOIUrl":"10.1016/j.adro.2025.101939","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy has an increasing role in the management of metastatic cancers. Integrating radiation with surgical and systemic approaches is complex, and inappropriate management can lead to prolonged hospitalizations inconsistent with palliative goals. An inpatient radiation oncology consult (IROC) service was created in January 2020 to provide rapid access to specialized care for hospitalized patients. Here, we report outcomes of the IROC service, focusing on quality-of-care metrics including hospital length of stay (LOS), use of hypofractionated approaches, and treatments for patients discharged to hospice.</div></div><div><h3>Methods and Materials</h3><div>We conducted a pre-post observational study to compare inpatient consults placed before (<em>N</em> = 1507) and after (<em>N</em> = 1509) IROC, from 2019 to 2021. Continuous variables were analyzed using the Mann-Whitney test and categorical variables using Fisher’s exact test.</div></div><div><h3>Results</h3><div>We found that IROC was associated with reductions in hospital LOS (mean difference 1.0 days, <em>P</em> = .045). Under IROC, inpatient treatment courses were shorter (5.8 vs 5.0 days, <em>P</em> = .007), in part driven by increased adoption of palliative hypofractionated radiation therapy approaches (74% vs 82%, <em>P</em> = .001). The reduction in LOS was greatest for patients discharged to hospice (5.1 vs 3.7 days, <em>P</em> = .036).</div></div><div><h3>Conclusions</h3><div>The IROC service was associated with reduced hospital LOS, increased use of hypofractionated approaches, and decreased treatments for patients discharged to hospice. Our findings demonstrate the value of a dedicated program addressing radiation delivery to hospitalized patients to improve goal-concordant treatments. The financial impact of reducing low-value care is an important subject for future investigations.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101939"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-12DOI: 10.1016/j.adro.2025.101886
Lubna Hammoudeh MD , Kee-Young Shin MS , Lauren Hertan MD , Monic Krishnan MD , Alex Spektor MD , Mai Anh Huynh MD, PhD , Chloe Fisher BSc , Tracy Balboni MD
Purpose
Bone metastases are a common cause of morbidity among patients with cancer, and radiation therapy (RT) is efficacious for their palliation. However, symptomatic bone metastases can often occur in regions that have received prior RT, limiting doses that can be delivered safely. Stereotactic body radiation therapy (SBRT) enables the delivery of greater doses of RT to the tumor while minimizing reirradiation dose to critical organs at risk.
Methods and Materials
In this prospective, multi-institutional phase 2 trial, 45 patients with bone metastasis in a previously irradiated region were treated with SBRT from February 2017 to November 2021. The primary endpoint was local control at 6 months post RT; secondary aims were rates of acute and chronic toxicity, time to local progression, local progression rate, progression-free survival, and overall survival.
Results
The median age of participants was 62.6 years, and most were male (75.6%). The most common primary tumor types were as follows: prostate (13/45, 28.9%), lung (8/45, 17.8%), and renal cell (5/45, 11.1%). The majority received reirradiation to a spinal lesion (35/45, 77.7%). The most common dose prescriptions were 30 Gy in 5 fractions (24/45, 53.3%) and 35 Gy in 5 fractions (11/45, 24.4%). At 6 months, 42 of 45 treated sites were locally controlled, whereas 3 had progressed at a median of 3.6 months. The local progression-free rate was 89.9% at 2 years. Overall survival was 52% at 2 years. Acute toxicities occurred in 46.7%, most commonly fatigue, nausea, and pain flare; all were grade 1 or 2. In total, 8.9% of participants experienced chronic toxicities, including vertebral fracture and pain flare, all grade 1 or 2 with no myelopathies.
Conclusions
This prospective study of SBRT for reirradiation of bone metastases demonstrated effective local control and reasonable rates of acute and chronic toxicities. Additional research is needed to further ascertain long-term efficacy and treatment-related toxicities.
{"title":"Prospective Evaluation of Stereotactic Body Radiation Therapy for Reirradiation of Bone Metastases","authors":"Lubna Hammoudeh MD , Kee-Young Shin MS , Lauren Hertan MD , Monic Krishnan MD , Alex Spektor MD , Mai Anh Huynh MD, PhD , Chloe Fisher BSc , Tracy Balboni MD","doi":"10.1016/j.adro.2025.101886","DOIUrl":"10.1016/j.adro.2025.101886","url":null,"abstract":"<div><h3>Purpose</h3><div>Bone metastases are a common cause of morbidity among patients with cancer, and radiation therapy (RT) is efficacious for their palliation. However, symptomatic bone metastases can often occur in regions that have received prior RT, limiting doses that can be delivered safely. Stereotactic body radiation therapy (SBRT) enables the delivery of greater doses of RT to the tumor while minimizing reirradiation dose to critical organs at risk.</div></div><div><h3>Methods and Materials</h3><div>In this prospective, multi-institutional phase 2 trial, 45 patients with bone metastasis in a previously irradiated region were treated with SBRT from February 2017 to November 2021. The primary endpoint was local control at 6 months post RT; secondary aims were rates of acute and chronic toxicity, time to local progression, local progression rate, progression-free survival, and overall survival.</div></div><div><h3>Results</h3><div>The median age of participants was 62.6 years, and most were male (75.6%). The most common primary tumor types were as follows: prostate (13/45, 28.9%), lung (8/45, 17.8%), and renal cell (5/45, 11.1%). The majority received reirradiation to a spinal lesion (35/45, 77.7%). The most common dose prescriptions were 30 Gy in 5 fractions (24/45, 53.3%) and 35 Gy in 5 fractions (11/45, 24.4%). At 6 months, 42 of 45 treated sites were locally controlled, whereas 3 had progressed at a median of 3.6 months. The local progression-free rate was 89.9% at 2 years. Overall survival was 52% at 2 years. Acute toxicities occurred in 46.7%, most commonly fatigue, nausea, and pain flare; all were grade 1 or 2. In total, 8.9% of participants experienced chronic toxicities, including vertebral fracture and pain flare, all grade 1 or 2 with no myelopathies.</div></div><div><h3>Conclusions</h3><div>This prospective study of SBRT for reirradiation of bone metastases demonstrated effective local control and reasonable rates of acute and chronic toxicities. Additional research is needed to further ascertain long-term efficacy and treatment-related toxicities.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101886"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973137","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":"2026-01-01","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}
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