Advances in Radiation Oncology最新文献

{"title":"Radiation-Induced Lymphopenia is a Causal Mediator of Survival After Chemoradiation Therapy for Esophagus Cancer","authors":"Yiqing Chen MSc ,&nbsp;Yan Chu PhD ,&nbsp;Peter S.N. van Rossum MD, PhD ,&nbsp;Clemens Grassberger PhD ,&nbsp;Steven H. Lin MD, PhD ,&nbsp;Radhe Mohan PhD ,&nbsp;Brian P. Hobbs PhD","doi":"10.1016/j.adro.2024.101579","DOIUrl":"10.1016/j.adro.2024.101579","url":null,"abstract":"<div><h3>Purpose</h3><p>Radiation-induced lymphopenia (RIL) is common during chemoradiation therapy. Severe lymphopenia is associated with reduced survival. Proton beam therapy (PBT), with its substantially more compact dose distributions, spares circulating lymphocytes and immune organs at risk to a greater extent than photon therapy. Recent studies comparing PBT to photon radiation therapy, specifically intensity-modulated radiation therapy (IMRT) for esophageal cancer (EC), showed that the incidence of grade 4 RIL (G4RIL) is significantly reduced among patients receiving PBT for EC. However, whether the extent of this reduction has a direct causative link with improved survival is unknown. This study applies causal mediation analysis to answer this question.</p></div><div><h3>Methods and Materials</h3><p>We retrospectively assessed 734 patients treated with concurrent chemoradiation therapy for biopsy-proven EC from 2004 to 2017. To address the potential for bias in the choice of radiation modality, propensity score analysis was used to evaluate and reduce imbalances between the PBT and IMRT cohorts. Causal mediation analysis was applied to decompose the total effect of radiation modality on overall survival (OS) into indirect (mediated through G4RIL) and direct effects.</p></div><div><h3>Results</h3><p>We found that PBT was associated with a significantly lower incidence of G4RIL and prolonged OS compared with IMRT (odds ratio, 0.41; 95% CI, 0.28-0.60; <em>P</em> &lt; .001). In the propensity-matched cohort of 506 patients (253 PBT, 253 IMRT), G4RIL risk reduction with PBT versus IMRT translated into a 5% reduction in the relative rate of death (<em>P</em> = .032). Mediation of G4RIL explained ∼14.5% of the difference in OS.</p></div><div><h3>Conclusions</h3><p>G4RIL was found to mediate survival; however, a statistically significant direct effect of PBT on survival was not observed. In other words, the statistical significance of survival benefit from protons over photons in this EC cohort was lost in the absence of G4RIL risk reduction.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101579"},"PeriodicalIF":2.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001428/pdfft?md5=8700e3d1bb3a630172295360a8a952bf&pid=1-s2.0-S2452109424001428-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic Functional Outcomes Following Regional Nodal Irradiation for Breast Cancer Using Volumetric Modulated Arc Therapy","authors":"Anthony F. Yu MD, MS ,&nbsp;Charlie White PhD ,&nbsp;Zhigang Zhang PhD ,&nbsp;Jennifer E. Liu MD ,&nbsp;Erin F. Gillespie MD ,&nbsp;Beryl McCormick MD ,&nbsp;Atif J. Khan MD ,&nbsp;Richard M. Steingart MD ,&nbsp;Simon N. Powell MD, PhD ,&nbsp;Oren Cahlon MD ,&nbsp;Lior Z. Braunstein MD","doi":"10.1016/j.adro.2024.101581","DOIUrl":"10.1016/j.adro.2024.101581","url":null,"abstract":"<div><h3>Purpose</h3><p>Regional nodal irradiation (RNI) for breast cancer yields improvements in disease outcomes, yet comprehensive target coverage often increases cardiac radiation therapy (RT) dose. Volumetric modulated arc therapy (VMAT) may mitigate high-dose cardiac exposure, although it often increases the volume of low-dose exposure. The cardiac implications of this dosimetric configuration (in contrast to historic 3D conformal techniques) remain uncertain.</p></div><div><h3>Methods and Materials</h3><p>Eligible patients receiving adjuvant RNI using VMAT for locoregional breast cancer were prospectively enrolled in an IRB-approved study. Echocardiograms were performed prior to RT, at the conclusion of RT, and 6 months following RT. Echocardiographic parameters were measured by a single reader and measures were compared pre- and post-RT via the signed-rank test. Changes in echocardiographic parameters over time were compared to mean and max heart doses via the Spearman correlation test.</p></div><div><h3>Results</h3><p>Among 19 evaluable patients (median age 38 years), 89% (n = 17) received doxorubicin and 37% (n = 7) received trastuzumab/pertuzumab combination therapy. All patients received VMAT-based whole-breast/chest wall and RNI. The average mean heart dose was 456 cGy (range, 187-697 cGy) and the average max heart dose was 3001 cGy (1560-4793 cGy). Among salient echocardiographic parameters, no significant decrement in cardiac function was observed when comparing pre-RT to 6 months post-RT: mean left ventricular ejection fraction (LVEF) was 61.8% (SD 4.4%) pre-RT and 62.7% (SD 3.8%) 6 months post-RT (<em>P</em> = .493); mean global longitudinal strain (GLS) was –19.3% (SD 2.2%) pre-RT and –19.6% (SD 1.8%) 6 months post-RT (<em>P</em> = .627). No individual patient exhibited reduced LVEF or sustained decrement in GLS. No correlations were observed for changes in LVEF or GLS when compared to mean or maximum heart doses (<em>P</em> &gt; .1 for all).</p></div><div><h3>Conclusions</h3><p>VMAT for left-sided RNI yielded no significant early decrement in echocardiographic parameters of cardiac function, including LVEF and GLS, within this limited cohort. No patient exhibited significant LVEF changes, and none exhibited sustained decrements in GLS. VMAT may be a reasonable approach to cardiac avoidance in patients requiring RNI, including those receiving anthracyclines and HER2-directed therapy. Larger cohorts with longer follow-ups will be needed to validate these findings.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101581"},"PeriodicalIF":2.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001441/pdfft?md5=f086438632f3ea7e61ec0506485e2fd3&pid=1-s2.0-S2452109424001441-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Ultrahypofractionated Radiation Therapy for Soft Tissue Sarcomas: Low Rate of Wound Complications","authors":"Alexander Mattmann MMed ,&nbsp;Christoph Glanzmann MD ,&nbsp;Bruno Fuchs MD, PhD ,&nbsp;Beata Bode MD ,&nbsp;Gabriela Studer MD ,&nbsp;Swiss Sarcoma Network","doi":"10.1016/j.adro.2024.101562","DOIUrl":"10.1016/j.adro.2024.101562","url":null,"abstract":"<div><h3>Purpose</h3><p>Normofractionated preoperative radiation therapy (nRT) with 50 Gy applied in 25 fractions represents the most widely used radiation therapy (RT) regimen in combined local treatment of soft tissue sarcomas (STSs). STSs are characterized by a low <em>α/β</em> ratio of 4 to 5 Gy, which may translate into a higher sensitivity for hypofractionation. Increasing data from cohorts and phase 2 trials on ultrahypofractionated RT (uhRT) regimens are available. We prospectively assessed our preoperative uhRT sarcoma patient cohort with a focus on short-term wound complications (WCs).</p></div><div><h3>Methods and Materials</h3><p>This is a prospective registry analysis of a single-center patient cohort, treated from 03.2020 to 10.2023 with uhRT (25 Gy in 5 fractions in 1 week). The same radiation oncologists (G.S./C.G.) and surgeon (B.F.) performed the treatment (61/61 and 58/60), as well as the same reference pathologist (B.B.) confirmed all histopathologic diagnoses. WC (according to CAN-NCIC-SR2 trial) and intermediate local control (LC) rates were assessed and compared with outcome data of a previously published cohort of 67 extremity/trunk sarcoma patients treated with nRT by the same authors (7% WC, 98% LC at 3 years).</p></div><div><h3>Results</h3><p>After a mean/median follow-up of 19/19 months (range, 0-46), LC at 1.5 years was 94%. Surgery was performed at a mean/median of 20/16 days (range, 4-60) after uhRT completion. WC were observed in 7/60 operated patients (12%), and in 5/51 (10%) extremity/trunk lesions. Early tolerance was excellent, limited to G0 to G1, even in 3 patients with prior RT to the same region. Clear resection margins were achieved in 55/60 patients (92%). Pathologic necrosis of ≥95% was reported in 5% and 75% achieved less than 50% necrosis.</p></div><div><h3>Conclusions</h3><p>These results show low rates of WC and high LC for uhRT and are comparable with our previously published nRT data. This study supports the routine use of preoperative uhRT for STS.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 10","pages":"Article 101562"},"PeriodicalIF":2.2,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001258/pdfft?md5=13ab9f5fbdaeaf3249732d9525070fdb&pid=1-s2.0-S2452109424001258-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Magnetic Resonance–Guided Daily Adaptive Radiation Therapy for Localized Prostate Cancer: Acute and Late Patient-Reported Toxicity Outcomes","authors":"Killian Nugent FFR, RCSI ,&nbsp;Prantik Das FRCR ,&nbsp;Dan Ford FRCR ,&nbsp;Ami Sabharwal FRCR ,&nbsp;Carla Perna FRCR ,&nbsp;Nicola Dallas FRCR ,&nbsp;Jason Lester FRCR ,&nbsp;Philip Camilleri FRCR","doi":"10.1016/j.adro.2024.101574","DOIUrl":"10.1016/j.adro.2024.101574","url":null,"abstract":"<div><h3>Purpose</h3><p>To report acute and late bowel, urinary, and sexual dysfunction patient-reported outcome measures, among patients with localized prostate cancer who underwent stereotactic magnetic resonance–guided daily adaptive radiation therapy (SMART).</p></div><div><h3>Methods and Materials</h3><p>All patients who completed a baseline 12-item Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events questionnaire, before undergoing SMART with 36.25 Gy in 5 fractions, were subsequently followed up with the same graded questionnaire at set time points. Latest prostate-specific antigen levels were recorded. The percentage of patients who reported no change from their baseline adverse event (AE) or reported a new ≥ “frequent or almost constant” or “severe grade or higher” AE grade during follow-up was calculated. The maximum 12-item Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events grade for each item was recorded for each patient. The percentage of toxicity levels for each separate AE item at set time points was calculated.</p></div><div><h3>Results</h3><p>The total number of patients was 69 with a median follow-up of 27 months. Median age of the cohort was 73 years (range, 54-85 years). The median pretreatment prostate-specific antigen level, T stage, and Gleason score were 7.5 mmol/L (range, 4.5-32 mmol/L), T2b (range, T2-T3b), and 7 (3 + 4; range, 6-9), respectively. No patient had biochemical failure during follow-up. Regarding bowel symptoms, &gt;80% of men reported no change from baseline toxicity during follow-up. New ≥ frequent or almost constant diarrhea was reported in 9% of patients. “Almost constant” diarrhea peaked at 1 month but was absent at &gt;33 months. Regarding urinary symptoms, increased urinary urgency was the most common complaint (39%). Twenty percent of men reported new ≥ frequent or almost constant urinary urgency incidence peaking at 1 month but absent at &gt;33 months. New “severe” sexual dysfunction was seen in 26% of patients and was persistent at &gt;33 months.</p></div><div><h3>Conclusions</h3><p>Our study is one the largest patient-reported outcomes study after prostate SMART. It shows acceptable levels of toxicity even up to 2 years after treatment.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101574"},"PeriodicalIF":2.2,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001374/pdfft?md5=2f27057ef5715b14ca7d268453995e9f&pid=1-s2.0-S2452109424001374-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Ion Beam Radiation Therapy as Part of a Trimodal Therapy for Non-small Cell Superior Sulcus Tumors: The INKA Study","authors":"Fabian Weykamp MD ,&nbsp;Lukas Schaub MD ,&nbsp;Martin Eichhorn MD ,&nbsp;Hauke Winter MD ,&nbsp;Peter Schirmacher MD, PhD ,&nbsp;Michael Thomas MD ,&nbsp;Uwe Haberkorn MD ,&nbsp;Malte Ellerbrock ,&nbsp;Sebastian Adeberg MD ,&nbsp;Jürgen Debus MD, PhD ,&nbsp;Klaus Herfarth MD","doi":"10.1016/j.adro.2024.101573","DOIUrl":"10.1016/j.adro.2024.101573","url":null,"abstract":"<div><h3>Purpose</h3><p>Superior sulcus tumors are frequently treated with neoadjuvant chemoradiation therapy (nCRT) followed by surgery via a trimodal approach. The INKA study evaluated the replacement of photon irradiation by carbon ion radiation therapy (C12-RT) in this regimen.</p></div><div><h3>Methods and Materials</h3><p>The prospective INKA study included patients with locally advanced non-small cell superior sulcus tumors (&lt;cN3 cM0). Patients received 2 cycles of cisplatin and vinorelbine as per local standard. During the second cycle, 39 Gy(Relative biological effectiveness (RBE)) of hypofractionated C12-RT in 13 fractions were applied. Surgery following fludeoxyglucose F18 positron emission tomography–computed tomography restaging was performed 2 weeks later. The primary endpoint was feasibility and safety measured by the incidence of Common Terminology Criteria for Adverse Events (version 4.0) grade 3/4 toxicity and/or discontinuation because of any reason. Secondary endpoints included the morphologic (Response Evaluation Criteria in Solid Tumors 1.0), metabolic (Positron Emission Tomography Response Criteria in Solid Tumors 1.0), and histopathologic response after nCRT as well as quality of life measurement (QLQ-C30/LC13).</p></div><div><h3>Results</h3><p>Between 2015 and 2020, 14 patients were included and received nCRT. No grade 3/4 toxicity occurred, with no discontinuation because of toxicity. Before surgery, 8 patients (57%) showed a partial response on computed tomography scan. Thirteen patients showed a metabolic response (metabolic complete remission (mCR), 1; metabolic partial remission (mPR), 12). Three patients (21%) were deemed inoperable after nCRT. In patients with resection, a pathologic Complete remission (CR) was seen in 2 patients (19%) and near-complete remission (&lt;10% vital tumor cells) in 6 patients (55%). Pain score was more than half of that at baseline (mean, 69.2 ± 26.2 vs 30.6 ± 29.1; <em>P</em> = .005) after completion of nCRT and before surgery.</p></div><div><h3>Conclusions</h3><p>The INKA trial is the first study to evaluate nCRT with C12-RT and showed excellent response, low toxicity, and rapid pain relief.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101573"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001362/pdfft?md5=7bae0f519a92a891d3aa779614bacc3b&pid=1-s2.0-S2452109424001362-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Randomized Trial Comparing 2 Devices for Deep Inspiration Breath Hold Management in Breast Radiation Therapy: Results of the BRAVEHeart Trial","authors":"Hilary L. Byrne PhD ,&nbsp;Elisabeth Steiner PhD ,&nbsp;Jeremy Booth PhD ,&nbsp;Gillian Lamoury BMed ,&nbsp;Marita Morgia MBBS ,&nbsp;Susan Carroll MBBS ,&nbsp;Kylie Richardson ,&nbsp;Leigh Ambrose MARTP ,&nbsp;Kuldeep Makhija ,&nbsp;Cameron Stanton MSc ,&nbsp;Benjamin Zwan PhD ,&nbsp;Michael Carr MSc ,&nbsp;Maegan Stewart PhD ,&nbsp;Regina Bromley MSc ,&nbsp;John Atyeo PhD ,&nbsp;Shona Silvester MMedSc ,&nbsp;Natalie Plant MHSc ,&nbsp;Paul Keall PhD","doi":"10.1016/j.adro.2024.101572","DOIUrl":"10.1016/j.adro.2024.101572","url":null,"abstract":"<div><h3>Purpose</h3><p>The Breast Radiotherapy Audio Visual Enhancement for sparing the Heart (BRAVEHeart) trial prospectively randomized patients with left-sided breast cancer to 1 of 2 deep inspiration breath hold biofeedback devices: a novel chest surface tracking system and an abdominal block tracking system. The primary hypothesis was that the accuracy of chest tracking would be higher than that of abdominal tracking as the chest is a more direct surrogate of the breast target.</p></div><div><h3>Methods and Materials</h3><p>Patients with left-sided breast cancer were treated in deep inspiration breath hold with intensity modulated radiation therapy delivery. Patients were randomized to either the novel chest surface system or abdominal block system for active management of breath hold with visual feedback. On both trial arms, the unallocated system was monitored passively. A total of 239,296 cine electronic portal imaging device images were analyzed retrospectively to extract the chest wall position. Treatment accuracy was quantified as the deviation of the internal chest wall during treatment relative to the planned position from the digitally reconstructed radiograph. The correlation between motion of the external surrogate and internal chest wall was calculated per-breath hold. Ease of use was assessed with questionnaires for both radiation therapists and patients and appointment length recorded.</p></div><div><h3>Results</h3><p>Data from 26 participants were available for analysis. No difference was found in delivered treatment accuracy between arms. Across all patients and fractions, the median correlation between internal chest wall movement and external surrogate was 0.69 for the chest surface and 0.17 for the abdominal block. Patients found it easy to follow visual feedback from both systems. No difference was found in appointment length between arms.</p></div><div><h3>Conclusions</h3><p>No statistical evidence was found for superior treatment accuracy, satisfaction, or appointment length for the novel chest surface tracking device compared with the abdominal block system. During deep inspiration breath hold, the median per-breath hold correlation of internal chest wall movement to the motion of the chest surface was higher than the median correlation of the abdominal block to the chest surface.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101572"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001350/pdfft?md5=19ca82eaa5d654d9d1e8467002b6d58d&pid=1-s2.0-S2452109424001350-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expenditures and Use of Hypofractionated Radiation Therapy Treating Breast Cancer Among Medicare Advantage Enrollees, 2009 to 2017","authors":"Loren Saulsberry PhD,&nbsp;Chuanhong Liao MS,&nbsp;Dezheng Huo MD, PhD","doi":"10.1016/j.adro.2024.101568","DOIUrl":"10.1016/j.adro.2024.101568","url":null,"abstract":"<div><h3>Purpose</h3><p>Technology advances in cancer care have paralleled rapidly increasing expenditures in radiation therapy. The use and costs of shorter cancer radiation therapy offer potential utility in clinical practice. We evaluate use and expenditures of Medicare Advantage (MA) beneficiaries receiving hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) in the United States and examine the relationship of patient characteristics with HF-WBI use.</p></div><div><h3>Methods and Materials</h3><p>We performed a retrospective analysis of radiation therapy in MA beneficiaries using private employer-sponsored insurance claims for a pooled cross-sectional evaluation from 2009 to 2017. The study population included female MA beneficiaries with early-stage breast cancer treated with lumpectomy and whole breast irradiation.</p></div><div><h3>Results</h3><p>A total of 9957 women received HF-WBI, and 18,920 received CF-WBI. Older age, greater distance from home to treatment facility, and a higher proportion of college graduates in the community of residence were associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HF-WBI versus CF-WBI (adjusted difference, $4113; 95% CI, $4030-$4,197). Mean patient out-of-pocket expenditure for HF-WBI was $426 less than that of CF-WBI. Across US states, geographic variation existed in the ratio of costs for HF-WBI relative to CF-WBI (range, 0.41-0.87).</p></div><div><h3>Conclusions</h3><p>HF-WBI use among MA beneficiaries with breast cancer has dramatically increased over time, surpassing CF-HBI as the dominant form of radiation therapy. HF-WBI clinical adoption has outpaced any continual cost decrease, despite wide variation across US states for this shorter radiation therapy treatment. As MA enrollment continues to expand, identifying the drivers of HF-WBI use and the sources of variation in costs of HF-WBI will help direct the quality of cancer care delivered to Medicare beneficiaries.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101568"},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001313/pdfft?md5=a6284526993467d7929d523cbef50b0b&pid=1-s2.0-S2452109424001313-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Underuse of Postoperative Radiation After Nipple-Sparing Mastectomy for Standard Radiation Indications","authors":"Wesley J. Talcott MD, MBA ,&nbsp;Gustavo N. Marta MD, PhD ,&nbsp;Meena S. Moran MD","doi":"10.1016/j.adro.2024.101569","DOIUrl":"10.1016/j.adro.2024.101569","url":null,"abstract":"<div><h3>Purpose</h3><p>Nipple areola complex-sparing surgeries, such as nipple-sparing mastectomy (NSM), are increasingly used for women with early-stage breast cancer. In the postoperative setting, 2 major indications for postoperative radiation (PORT) with/without regional nodal irradiation (RNI) are: positive margins (margin+) and pathologically involved lymph nodes (pN+). The frequency of these adverse pathologic features and the rate of PORT utilization following NSM for these 2 indications are unknown. We determined the frequency of margin+ and pN+ following NSM compared with nipple-sparing lumpectomy/breast-conserving surgery [BCS] and identified trends in appropriate PORT administration for these standard indications in the NSM setting.</p></div><div><h3>Methods and Materials</h3><p>Using the National Cancer Database (NCDB), women diagnosed with cT1 to cT3,N0M0 invasive carcinoma between 2004 and 2017 who underwent NSM were compared with those who underwent BCS (with nipple preservation). The frequencies of margin+ and pN+ by surgical subtype and use of PORT with/without RNI were assessed by cohort to determine if the type of surgery was associated with radiation delivery. Overall survival between the 2 cohorts was also compared. We performed univariable/multivariable logistic and Cox regression with ORs to control for confounders.</p></div><div><h3>Results</h3><p>Of 624,075 women included, 611,907 underwent BCS, and 12,168 underwent NSM. The surgical margin+ rate was significantly higher for NSM at 4.5% (n = 544) than for BCS at 3.7% (n = 22,449) (<em>P</em> &lt; .001) and remained significant on multivariable analysis (MVA; OR, 1.13; CI, 1.03-1.25; <em>P</em> = .012). Use of PORT for margins+ was significantly lower by MVA after NSM (OR, 0.07; CI, 0.06-0.09; <em>P</em> &lt; .001). Similarly, pN+ rate was significantly higher for NSM at 22.5% (n = 2740) versus BCS at 13.5% (n = 82,288) (<em>P</em> &lt; .001), retaining significance on MVA (OR, 1.12; CI, 1.06-1.19; <em>P</em> &lt; .001). For pN+ undergoing NSM, PORT with RNI was delivered significantly less often on MVA (OR, 0.73; CI, 0.67-0.81; <em>P</em> &lt; .001). Neither high-risk subgroup had differences in overall survival on MVA.</p></div><div><h3>Conclusions</h3><p>NSM is associated with a higher rate of margin+ and pN+ compared with BCS. Radiation is underused after NSM for these standard indications. Our results highlight the need to further refine patient selection for NSM and the importance of communicating the higher potential for adverse pathologic features (and thus, the potential need for radiation) to patients undergoing NSM.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101569"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001325/pdfft?md5=01c5de86b1891fdf19575a41b5e164c5&pid=1-s2.0-S2452109424001325-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of Dosimetry Improvement With or Without Patient Surface Guidance","authors":"Ke Sheng PhD, FAAPM, DABR ,&nbsp;Minsong Cao PhD ,&nbsp;Andrew Godley PhD ,&nbsp;Mu-Han Lin PhD ,&nbsp;Lukas Henze MEng ,&nbsp;Laura Hammond MSc ,&nbsp;Laurence Delombaerde PhD ,&nbsp;Kirsten Hierholz Dipl -Ing ,&nbsp;Jana Kouptsidis MSc","doi":"10.1016/j.adro.2024.101570","DOIUrl":"10.1016/j.adro.2024.101570","url":null,"abstract":"<div><h3>Purpose</h3><p>Noncoplanar beams and arcs are routinely used to improve dosimetry for intracranial cases, but their application for extracranial cases has been hampered by the risk of collision. This has led to conservative beam selection whose impact on plan dosimetry has not been previously studied.</p></div><div><h3>Methods and Materials</h3><p>A full-body 3-dimensional patient surface was acquired using optical cameras for a single lung patient at the time of computed tomography simulation. Eight stereotactic body radiation therapy (SBRT) plans were created for the patient, with varying degrees of noncoplanarity and deliverability. The plans included volumetric modulated arc therapy and intensity modulated radiation therapy (IMRT) plans ranging from simple, coplanar arcs to multiple noncoplanar arcs and IMRT beams. A total of 70 fields were created across the 8 plans, of which 21 fields were undeliverable with a 5-cm buffer. Organs-at-risk (OARs) metrics including R50, Dmax 2 cm from the PTV, lung V20, and chest wall V30 were evaluated. Five expert SBRT dosimetrists from 5 institutions evaluated field deliverability, with or without the guidance of the clearance map.</p></div><div><h3>Results</h3><p>In the dosimetry evaluation, a clear trend in increasing dosimetric compactness and OAR sparing is observed with increasing plan noncoplanarity. R50, Dmax 2 cm, lung V20, and chest wall V30 decreased 41%, 39%, 43%, and 57%, respectively, from plan 1 (2 coplanar partial arcs) to plan 8 (19 noncoplanar IMRT beams). In the observer tests, the expert dosimetrists’ ability to accurately discern beam deliverability because of collision significantly increases with the clearance map. The errors in predicting colliding fields were eliminated using the whole-body surface and clearance map, and the user was able to select fields based on plan quality and patient comfort instead of being overly conservative.</p></div><div><h3>Conclusion</h3><p>The study shows that incorporating a personalized, whole-body clearance map in the treatment planning workflow can facilitate the adoption of noncoplanar beams or arcs that benefit the SBRT plan dosimetry.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101570"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001337/pdfft?md5=72abedba7c03476b91252b0d8940b6fe&pid=1-s2.0-S2452109424001337-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18F-Flotufolastat Positron Emission Tomography in African American Patients With Suspected Prostate Cancer Recurrence: Findings From the Phase 3 SPOTLIGHT Study","authors":"Soroush Rais-Bahrami MD ,&nbsp;Mark Fleming MD ,&nbsp;Benjamin Gartrell MD ,&nbsp;William C. Lavely MD ,&nbsp;Albert Chau MSc ,&nbsp;Phillip Davis MD ,&nbsp;David M. Schuster MD","doi":"10.1016/j.adro.2024.101571","DOIUrl":"10.1016/j.adro.2024.101571","url":null,"abstract":"<div><h3>Purpose</h3><p>Although African American (AA) patients are disproportionately affected by prostate cancer, they are often underrepresented in oncology clinical trials. The SPOTLIGHT study (NCT04186845) assessed the novel diagnostic positron emission tomography radiopharmaceutical, ¹⁸F-flotufolastat (¹⁸F-rhPSMA-7.3), in patients with recurrent prostate cancer. The proportion of AA patients enrolled in SPOTLIGHT (17%) was greater than typically enrolled in oncology trials (8.5%) and was representative of the US population (14%). This post hoc analysis of SPOTLIGHT evaluates the diagnostic performance of ¹⁸F-flotufolastat in AA patients.</p></div><div><h3>Methods and Materials</h3><p>Patients underwent positron emission tomography/computed tomography 50 to 70 minutes after intravenous administration of 296 MBq ¹⁸F-flotufolastat. Three blinded readers evaluated all images, with the majority read (agreement of ≥2 readers) result reported here. Standard of truth (SoT) was established with histopathology or correlative imaging. Data from AA patients were evaluated to determine the ¹⁸F-flotufolastat overall detection rate (DR), positive predictive value (PPV), and verified DR (VDR). VDR (SoT-verified) is equivalent to DR × PPV.</p></div><div><h3>Results</h3><p>In total, 61 of 366 (17%) patients were AAs. Although baseline characteristics were broadly similar, fewer AA patients (56%) had undergone prostatectomy than non-AA patients (82%). The patient-level DR was 93% (57/61) in AA patients, increasing from 67% at prostate-specific antigen &lt;0.5 ng/mL to 100% at prostate-specific antigen ≥10 ng/mL. Patient-level DR was marginally lower in all other patients (87%, 264/305). However, when stratifying by prior treatment, DRs were similar across ethnic groups in postprostatectomy patients, but in patients with intact prostates, AA patients had higher prostate DR than non-AA patients. SoT-verification (predominantly with conventional imaging [79%]) gave a VDR of 64% and PPV of 68% in AA patients, versus 55% and 64%, respectively, in all other patients.</p></div><div><h3>Conclusions</h3><p>¹⁸F-Flotufolastat DRs were marginally higher in AA patients than in all other patients enrolled in SPOTLIGHT. High VDR and PPV were also achieved in AA patients from across all participating centers, indicating the broad applicability of newly US Food and Drug Administration–approved ¹⁸F-flotufolastat to the US population as a whole.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101571"},"PeriodicalIF":2.2,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001349/pdfft?md5=6326106769069cc5cc663bad23d491c8&pid=1-s2.0-S2452109424001349-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}