Advances in Radiation Oncology最新文献

{"title":"The Empty Bladder is Preferred in Some Cases of Radiation Therapy for Rectal Cancer","authors":"Inna Ospovat MD, Albert Schlocker MSc, Natan Shtraus MSc, Ravit Geva MD, Shani Hazan BSc, Tatyana Shevchuk MSc, Alexander Barenboim MD, Ido Wolf MD, Orit Gutfeld MD, Viacheslav Soyfer MD","doi":"10.1016/j.adro.2025.101872","DOIUrl":"10.1016/j.adro.2025.101872","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101872"},"PeriodicalIF":2.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217867","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":"Novel Molecular Subtyping Predicts Locoregional Recurrence in Triple-negative Breast Cancer","authors":"Shali Shao MS ,&nbsp;Wei Shi PhD ,&nbsp;Li Zhang PhD ,&nbsp;Qixian Zhang PhD ,&nbsp;Jin Meng PhD ,&nbsp;Zhaozhi Yang PhD ,&nbsp;Miao Mo PhD ,&nbsp;Zhen Zhang PhD ,&nbsp;Xiaomao Guo PhD ,&nbsp;Xiaoli Yu PhD","doi":"10.1016/j.adro.2025.101909","DOIUrl":"10.1016/j.adro.2025.101909","url":null,"abstract":"<div><h3>Purpose</h3><div>Immunohistochemistry (IHC)-based molecular subtyping provides a comprehensive profile of triple-negative breast cancer (TNBC). We aimed to elucidate patterns of locoregional recurrence (LRR) in different subtypes of TNBC.</div></div><div><h3>Methods and Materials</h3><div>In this study, 352 patients with breast cancer treated with mastectomy and postmastectomy radiation therapy from November 2019 to March 2022 were retrospectively analyzed. Based on IHC, these patients were classified into the basal-like immune-suppressed (BLIS) and non-BLIS groups. We compared LRR as the first event, disease-free survival, and overall survival (OS) between the 2 groups. Univariate and multivariate analysis was performed.</div></div><div><h3>Results</h3><div>The median follow-up time was 44.6 months. Twenty-six LRR (including 9 isolated LRR) and 70 distant metastases (DMs) were observed. The cumulative incidence of LRR was significantly different between the 2 groups, with an LRR rate of 5.8% in the non-BLIS group and 14.9% in the BLIS group (<em>P</em> = .005). The difference in OS was also significant (91.9% vs 83.0%, <em>P</em> = .01). However, there was no significant difference in disease-free survival between the non-BLIS and BLIS groups (80.2% vs 74.5%, <em>P</em> = .35). Multivariate analysis demonstrated that IHC-based molecular subtyping was an independently prognostic factor for LRR and OS (<em>P</em> = .03; <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that the BLIS subtype appears to be at a higher risk of developing LRR, and IHC-based molecular subtyping might be used as prognostic biomarkers to guide postmastectomy radiation therapy in patients with TNBC. New strategies that improve locoregional control rates in patients with BLIS are warranted.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101909"},"PeriodicalIF":2.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576306","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":"It Takes a Village: Building Multidisciplinary Partnerships in Palliative Radiation Therapy","authors":"Katherine Delposo-Lee MSN, NP-PHC ,&nbsp;Joanna Javor MS ,&nbsp;Amiya Agrawal MD ,&nbsp;Chiaojung Jillian Tsai MD, PhD","doi":"10.1016/j.adro.2025.101851","DOIUrl":"10.1016/j.adro.2025.101851","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101851"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319941","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":"Impact of an Advanced Practice Provider Directed Palliative Bone Metastasis Radiation Therapy Clinic on Patient Care","authors":"Michelle A. Wear MSN, APRN,&nbsp;Bradford S. Hoppe MD, MPH,&nbsp;Michael S. Rutenberg MD, PhD,&nbsp;Kathryn C. Moreno MSN, MBA, RN,&nbsp;Anna C. Harrell MPH,&nbsp;Adam L. Holtzman MD,&nbsp;Oluwadamilola T. Oladeru MD, MBA,&nbsp;Jennifer L. Peterson MD,&nbsp;Daniel M. Trifiletti MD,&nbsp;Albert N. Attia MD,&nbsp;Gene M. Logvinov RTT,&nbsp;Terry L. McKenzie RTT,&nbsp;Bryon C. May MD,&nbsp;Laura A. Vallow MD","doi":"10.1016/j.adro.2024.101712","DOIUrl":"10.1016/j.adro.2024.101712","url":null,"abstract":"<div><div>Patients commonly present to a radiation oncologist (RO) with bone metastases requiring palliative radiation therapy (RT). The standard referral workflow can be inefficient, causing delays in time to RO evaluation and treatment. We created an advanced practice provider (APP)-led rapid access palliative RT clinic (PRC) to manage bone metastases and address these care barriers. Following institutional review board approval, all outpatients receiving palliative RT for bone metastases from June 2021 to June 2023 were retrospectively reviewed. Patients treated in the 12 months after the creation of the PRC represented the PRC cohort. A comparison cohort (“pre-PRC”) included patients treated in the 6 months before the creation of the PRC using a typical RO workflow. Critical analysis assessed the impact of the PRC in reducing the time from referral to evaluation by RO (TTE) and time from referral to treatment (TTT) for patients receiving palliative RT. An independent <em>t</em> test was used to analyze TTE and TTT between the PRC and pre-PRC cohorts. Seventy-nine and 148 patients were treated in the pre-PRC and PRC periods, respectively. The median RT dose delivered was 8 Gy in 1 fraction for both cohorts. The mean TTE was 10.4 days (SD, 10.2) for the pre-PRC cohort versus 6.4 days (SD, 7.8) (<em>P</em> = .005) for the PRC cohort. The mean TTT was 20.7 days (SD, 17.5) in the pre-PRC cohort versus 16.0 days (SD, 13.7) in the PRC cohort (<em>P</em> = .01). The APP-led PRC significantly decreases TTE and TTT in patients requiring palliative RT for bone metastases. Additional analyses are underway to evaluate the impact of the APP-led PRC on patient and physician satisfaction and the effect of the PRC on bone metastasis-related emergency room visits and hospitalizations.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101712"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319940","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":"ASTRO’s Advances in Radiation Oncology Outstanding Reviewers for 2024","authors":"Rachel B. Jimenez MD","doi":"10.1016/j.adro.2025.101892","DOIUrl":"10.1016/j.adro.2025.101892","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101892"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319939","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":"Carbon Ion Versus Photon-based Stereotactic Ablative Radiation Therapy for Patients with Choroidal Melanoma","authors":"Jina Kim MD ,&nbsp;Masaru Wakatsuki MD, PhD ,&nbsp;Shuri Aoki MD, PhD ,&nbsp;Jong Won Park MD, PhD ,&nbsp;Nao Kobayashi MD, PhD ,&nbsp;Ki Chang Keum MD, PhD ,&nbsp;Hirokazu Makishima MD, PhD ,&nbsp;Christopher Seungkyu Lee MD, PhD ,&nbsp;Hitoshi Ishikawa MD, PhD ,&nbsp;Kyung Hwan Kim MD, PhD","doi":"10.1016/j.adro.2025.101915","DOIUrl":"10.1016/j.adro.2025.101915","url":null,"abstract":"<div><h3>Purpose</h3><div>To our knowledge, no study has compared the treatment outcomes of carbon ion radiation therapy (CIRT) and photon-based stereotactic ablative radiation therapy (SABR) in patients with choroidal melanoma. This study aimed to evaluate the treatment outcomes of patients with choroidal melanoma treated with CIRT or photon-based SABR.</div></div><div><h3>Methods and Materials</h3><div>This study included 346 patients with localized choroidal melanoma who received CIRT or photon-based SABR between April 2001 and November 2021. Patients in the CIRT group received a median of 70 Gy delivered in a median dosage of 14 Gy per fraction, and patients in the SABR group received a median of 60 Gy delivered in a median dosage of 15 Gy per fraction. Propensity score matching (PSM) was performed to account for differences between the 2 groups. The main outcome was progression-free survival (PFS) in the PSM cohort, and secondary endpoints included overall survival, cumulative incidence of local and distant failures, and enucleation.</div></div><div><h3>Results</h3><div>In all, 282 and 64 patients were included in the CIRT and SABR groups. After PSM, the 5-year PFS was significantly superior in the CIRT group to that in the SABR group (69.0% vs 56.5%, <em>P</em> = .024). The CIRT group also showed significantly reduced risks of local failure (5-year local failure rate 5.6% vs 13.4%, <em>P</em> = .025) and enucleation (5-year enucleation rate 8.5% vs 24.2%, <em>P</em> &lt; .001). Moreover, CIRT was superior in terms of visual acuity preservation: the proportion of patients with visual acuity of ≥20/200 decreased from 64.7% initially to 23.7% at last follow-up in the CIRT group and from 64.1% to 6.3% in the SABR group (<em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>CIRT was found to be superior to SABR in patients with choroidal melanoma in terms of PFS, local control, and preservation of vision and eye.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101915"},"PeriodicalIF":2.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412560","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":"Reduced-Dose Hypofractionated Radiation Therapy (3 Gy × 3 Fractions) for Indolent Non-Hodgkin’s lymphoma (POSEIDON): A Multisite Phase 2 Randomized Trial Protocol","authors":"Omran Saifi ,&nbsp;Scott C. Lester ,&nbsp;William G. Rule ,&nbsp;William Breen ,&nbsp;Randa Tao ,&nbsp;Jason R. Young ,&nbsp;Liuyan Jiang ,&nbsp;Han W. Tun ,&nbsp;Emily Liu ,&nbsp;Lauren E. Haydu ,&nbsp;Allison Rosenthal ,&nbsp;Javier Munoz ,&nbsp;Jose Caetano Villasboas ,&nbsp;Yucai Wang ,&nbsp;Muhamad Alhaj Moustafa ,&nbsp;Madiha Iqbal ,&nbsp;Anna C. Harrell ,&nbsp;Jennifer L. Peterson ,&nbsp;Bradford S. Hoppe MD, MPH","doi":"10.1016/j.adro.2025.101908","DOIUrl":"10.1016/j.adro.2025.101908","url":null,"abstract":"<div><div>Indolent non-Hodgkin’s lymphoma, including follicular and marginal zone lymphoma, is highly radiosensitive, with radiation therapy (RT) serving as an effective treatment. Although standard RT doses (24 Gy in 12 fractions) provide excellent disease control, they are associated with toxicity. Emerging evidence suggests that lower RT doses may maintain efficacy while reducing toxicity; however, prior prospective randomized attempts to reduce the dose to 4 Gy in 2 fractions have demonstrated inferior disease control. This phase 2 randomized trial aims to determine whether reduced-dose hypofractionated RT can achieve comparable disease control while minimizing toxicity and treatment burden. Patients will be randomized 1:1 to receive experimental arm treatment with 8 to 10 Gy in 2 to 5 fractions or standard of care treatment with 24 Gy in 12 fractions. The primary endpoint is acute toxicity (grade ≥ 2). Secondary endpoints include patient-reported quality of life (FACIT-Fatigue scale), response rate at 3 months posttreatment (Lugano criteria), local control, relapse-free survival, and overall survival. Exploratory analyses will evaluate financial toxicity (COST-FACIT questionnaire), health care expenditure, late toxicity, and the prognostic value of preradiation metabolic imaging parameters, including metabolic tumor volume, total lesion glycolysis, and maximum standardized uptake value, as well as molecular biomarkers such as <em>TP53, MYC</em>, and Ki-67.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"11 1","pages":"Article 101908"},"PeriodicalIF":2.7,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145615559","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":"Rural cancer financial toxicity screening","authors":"Yash Deshmukh ,&nbsp;Melanie L. Rose MD ,&nbsp;Renata W. Yen PhD, MPH ,&nbsp;Sybil T. Jones MD ,&nbsp;Nirav S. Kapadia MD, MS","doi":"10.1016/j.adro.2025.101910","DOIUrl":"10.1016/j.adro.2025.101910","url":null,"abstract":"<div><h3>Purpose</h3><div>Cancer treatment expenses can lead to financial toxicity (FT), which reduces treatment compliance and impairs outcomes. Little is known regarding the FT among rural cancer populations, where added barriers impair accrual of survey data. To increase our understanding of FT experienced by these patients, we piloted a validated survey instrument and reported on the feasibility of administration.</div></div><div><h3>Methods and Materials</h3><div>Institutional approval was obtained to prospectively survey rural oncology patients undergoing radiation treatment. Baseline surveys were provided at simulation appointments; weekly surveys were captured during on-treatment visits. Respondents reported on demographics (including self-reported gender, race, education, income, insurance, employment) at baseline and on expenses, the COmprehensive Score for financial Toxicity (range, 0-44, modified such that higher score indicates worse toxicity), perception of providers’ financial empathy, and the minimum financially impactful amount of money at weekly visits. Completion rates and associations between demographic characteristics and FT were assessed with Mann–Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>Twenty-six participants were enrolled. Patients were elderly (mean 68.3 years old, SD 10.7), male (25 of 26), White (25 of 26). Forty-two percent were low-income (annual income &lt; $48,000) and 50% had high school or less education. Most (n = 19, 73%) were insured through Medicare. Eighty-five percent of surveys were fully complete. The mean COmprehensive Score for financial Toxicity score at baseline was 14.0 (SD, 11.5; range, 0-38). The mean amount of money that would make a meaningful difference was $211 at baseline (interquartile range, $87.50-$350) and rose to $329 toward the end of the survey period (week 7).</div></div><div><h3>Conclusions</h3><div>FT screening of rural radiation oncology populations with a range of education is feasible with high fidelity of data collection. Future steps will identify patterns and predictors of severe FT and develop targeted interventions based on this feasibility study.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101910"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576308","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":"HyperArc Automated Stereotactic Radiosurgery Planning Enables Accurate a Priori Fractionation Scheme Selection via Adherence to HyTEC Toxicity Thresholds","authors":"Joel A. Pogue PhD ,&nbsp;John Fiveash MD ,&nbsp;Rex Cardan PhD ,&nbsp;Christopher Willey MD, PhD ,&nbsp;Natalie Viscariello PhD ,&nbsp;Rodney Sullivan PhD ,&nbsp;Samuel Marcrom MD ,&nbsp;Luke Moradi MD ,&nbsp;Philip Schmalz MD ,&nbsp;James Markert MD, MPH ,&nbsp;Richard Popple PhD","doi":"10.1016/j.adro.2025.101893","DOIUrl":"10.1016/j.adro.2025.101893","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiosurgery plan safety is commonly estimated by volumes receiving specific doses (ie, 12 Gy/1 fraction [fx]), which are evaluated postplan generation. However, automated treatment planning can produce highly consistent and thus predictable plans. Thus, we hypothesized that HyperArc (HA) automated stereotactic radiosurgery (SRS) planning enables clinical decision-making prior to plan generation, such as selecting the appropriate SRS fractionation scheme.</div></div><div><h3>Methods and Materials</h3><div>All previously treated single-isocenter HA plans at our institution were queried, totaling 3361 marginless targets without bridging at the 50% isodose level (1495 plans), making this the largest single-institutional SRS dosimetry study to the authors’ knowledge. Eight isodose volumes (IDVs; 50.00%-97.60%) were calculated for all HA targets, each corresponding to the ratio of a High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic (HyTEC) brain toxicity dose level and a common prescription dose (eg, 50.00% = 12 Gy/24 Gy). Power law relationships of IDV and target volume (<span><math><mrow><mi>I</mi><mi>D</mi><mi>V</mi><mo>=</mo><mi>a</mi><msup><mrow><msub><mi>V</mi><mrow><mi>t</mi><mi>a</mi><mi>r</mi><mi>g</mi><mi>e</mi><mi>t</mi></mrow></msub></mrow><mi>b</mi></msup></mrow></math></span>) were generated from a training data set of 361 targets (10.7%) and validated on the remaining 3000 targets (89.3%), allowing grade 1 to 3 brain toxicity rates to be predicted from target volume.</div></div><div><h3>Results</h3><div>Models resulted in high R² values when applied to the validation cohort (≥0.982), allowing targets to be classified as either above or below the HyTEC thresholds (IDV = 5 cm³, 10 cm³, and 20 cm³) with high accuracy (≥97.6%) and precision (≥99.3%). As an example, the 50.0% IDV model predicted that target volumes/diameters of 1.00 cm³/1.24 cm, 2.34 cm³/1.65 cm, and 5.51 cm³/2.19 cm correlate with 3.6%, 4.8%, and 8.6% grade 1 to 3 brain toxicity rates, respectively, when prescribing 24 Gy/1 fx.</div></div><div><h3>Conclusion</h3><div>The resulting models enabled accurate and precise prediction of target volumes/diameters, resulting in 3.6%, 4.8%, and 8.6% brain grade 1 to 3 toxicity rates, according to HyTEC toxicity estimates. Leveraging relative IDVs rather than prescription doses enabled all 3361 targets to be used for modeling 9 common SRS prescriptions (1 fx: 24 Gy, 20 Gy, 18 Gy, 16 Gy, and 15 Gy; 3 fx: 27 Gy and 24 Gy; 5 fx: 30 Gy and 25 Gy), enabling clinicians to estimate brain toxicity a priori via an open-source calculator.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101893"},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119616","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":"Risk Factors of Cardiotoxicity After Breast Cancer Radiation Therapy","authors":"Felicia B. Guo BA ,&nbsp;Hyunsoo Joshua No MD, CMD ,&nbsp;Natalie J. Park BA ,&nbsp;Santino Butler MD ,&nbsp;Scott Jackson MS ,&nbsp;June-Wha Rhee MD ,&nbsp;Daniel Eugene Clark MD, MPH ,&nbsp;Carol Marquez MD ,&nbsp;Kathleen Claire Horst MD ,&nbsp;Michael Sargent Binkley MD, MS","doi":"10.1016/j.adro.2025.101911","DOIUrl":"10.1016/j.adro.2025.101911","url":null,"abstract":"<div><h3>Purpose</h3><div>Concern for cardiotoxicity after the treatment of breast cancer necessitates a better understanding of factors that may increase the risk of significant (grade ≥3) cardiac events. We investigated clinical factors, coronary artery calcium (CAC), and radiation therapy dose to cardiac structures as predictive post-radiation therapy cardiotoxicity risk factors.</div></div><div><h3>Methods and Materials</h3><div>We retrospectively analyzed a cohort of serial patients treated with neoadjuvant chemotherapy for stage I to III breast cancer from 2005 through 2014. We measured the incidence of cardiac events after treatment, adjusting for the competing risk of death.</div></div><div><h3>Results</h3><div>We identified 174 patients with a median follow-up of 117 months and a median age of 47 years. The 10-year incidence of grade ≥3 cardiac events was 8.5% (95% CI, 4.7%-13.6%) with 13 events observed. 78.9% of the 166 patients with available imaging had no measurable CAC. Patients with nodal positivity (N <em>=</em> 75) were 3 times more likely to develop cardiac toxicity (HR=3.30) and were more likely to receive anthracyclines, hormonal therapy, and regional nodal irradiation during treatment (<em>P &lt;</em> 0.05). After multivariable adjustment for age and smoking status, nodal positive disease remained associated with increased risk of significant cardiac events <em>(P</em> &lt; .05)<em>.</em></div></div><div><h3>Conclusions</h3><div>In a cohort of patients with breast cancer with low CAC burden and overall low doses of radiation, we observed low rates of cardiotoxicity. However, our findings identify patients with nodal positive disease as a particularly high-risk group, suggesting that close follow-up and optimization of therapies for this subgroup is needed.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101911"},"PeriodicalIF":2.7,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576304","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}