Advances in Radiation Oncology最新文献_第7页

Magnetic Resonance Imaging Radiomic Analysis of Radiation-Induced Morphea of the Breast: A Proof-of-Concept Study 磁共振成像放射学分析辐射引起的乳房睡眠：一项概念验证研究

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-08-17 DOI: 10.1016/j.adro.2025.101881

Jieying Wu MD , Joseph Bae MS , Chao Chen PhD , Samuel Ryu MD , Daniel Lozeau MD , Alexander Stessin MD, PhD , Prateek Prasanna PhD

Purpose

Radiation-induced morphea (RIM) is a very rare but devastating side effect of breast radiation therapy, characterized by progressive skin induration, pain, and discoloration, with no effective treatments currently available. This is a proof-of-concept study that aims to identify radiomic features from pretreatment magnetic resonance imaging (MRI) scans associated with the development of RIM in patients with breast cancer undergoing radiation therapy.

Methods and Materials

This is a retrospective analysis of a single institutional registry of patients who received diagnosis of RIM following breast radiation therapy from 2008 to 2022. Clinical and histopathological data were reviewed. Pretreatment MRI scans of these patients and matched controls were analyzed. Radiomic features were extracted from whole breast and fibroglandular tissue regions of interest. A total of 528 radiomic features were compared between patients who developed RIM and those who did not, using the Wilcoxon rank-sum test to identify statistically significant differences.

Results

We evaluated 10 patients who received clinical diagnosis of RIM, with a mean age of 63 years (range, 44-75 years). Among these, 7 patients had biopsy-proven RIM. Both clinical and histologic findings were correlated with radiomic analyses. Forty percent of the patients had a history of autoimmune disorders, including hypothyroidism, Graves’ disease, systemic sclerosis, and systemic lupus erythematosus. Radiomic analysis identified 11 significant features, primarily related to tissue structure and texture. Nine of these features were from the contralateral breast, and 2 were from the ipsilateral breast.

Conclusions

This is a pilot study on a small sample that demonstrates that radiomic features extracted from pretreatment MRI scans can serve as potential predictors for the development of RIM in patients with breast cancer. The integration of clinical and histopathological data with radiomic analysis highlights the distinct changes in breast tissue architecture that precede RIM onset. These findings pave the way for the early identification of patients at risk, allowing for more personalized surveillance and management strategies.

目的：放射诱导的皮肤坏死（RIM）是乳房放射治疗中一种非常罕见但具有破坏性的副作用，其特征是进行性皮肤硬化、疼痛和变色，目前尚无有效的治疗方法。这是一项概念验证性研究，旨在确定预处理磁共振成像（MRI）扫描与接受放射治疗的乳腺癌患者RIM发展相关的放射学特征。方法和材料本研究是对2008年至2022年接受乳房放射治疗后诊断为RIM的单一机构登记患者的回顾性分析。回顾了临床和组织病理学资料。分析了这些患者和匹配对照的预处理MRI扫描结果。从整个乳房和感兴趣的纤维腺组织区域提取放射学特征。采用Wilcoxon秩和检验，对发生RIM的患者和未发生RIM的患者进行了528项放射学特征的比较，以确定具有统计学意义的差异。结果我们评估了10例临床诊断为RIM的患者，平均年龄63岁（44-75岁）。其中7例经活检证实为RIM。临床和组织学结果均与放射组学分析相关。40%的患者有自身免疫性疾病史，包括甲状腺功能减退、格雷夫斯病、系统性硬化症和系统性红斑狼疮。放射组学分析确定了11个重要特征，主要与组织结构和质地有关。其中9例来自对侧乳房，2例来自同侧乳房。结论：这是一项小样本的试点研究，表明从预处理MRI扫描中提取的放射学特征可以作为乳腺癌患者RIM发展的潜在预测因素。临床和组织病理学数据与放射组学分析的整合突出了RIM发病前乳腺组织结构的明显变化。这些发现为早期识别有风险的患者铺平了道路，允许更个性化的监测和管理策略。

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引用次数: 0

Are There High-Risk Prognostic Factors for Isolated Locoregional Recurrence in Patients With Early-Stage Breast Cancer Treated With Mastectomy Without Adjuvant Radiation Therapy? 早期乳腺癌行乳房切除术而不进行辅助放疗的患者孤立性局部复发是否存在高危预后因素？

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-08-16 DOI: 10.1016/j.adro.2025.101877

Giuseppe Facondo MD , Chiara Reverberi MD , Agnese Prisco MD , Tino Ceschia MD , Gianluca Vullo MD , Giuseppe Aprile MD , Alessandro Marco Minisini MD , Luca Seriau MD , Serena Bertozzi MD , Carla Cedolini MD , Marco Trovò MD

Purpose

This study aims to investigate whether there are subgroups of patients with early-stage breast cancer (BC) treated with radical mastectomy that are at high risk of locoregional recurrence (LRR) and could benefit from postmastectomy radiation therapy (PMRT).

Methods and Materials

We retrospectively reviewed patients with early-stage BC treated with mastectomy at our institution between December 2009 and December 2018. Tumors were classified according to molecular subtype and known prognostic factors. Outcomes were estimated using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test, while Cox proportional hazards regression was applied to estimate hazard ratios for evaluating associations between prognostic factors and survival. A P value of <.05 was considered statistically significant.

Results

A total of 670 patients who met the selection criteria were identified. Median age was 59.4 years (IQR, 48-72), and the median follow-up was 107.1 months (IQR, 80.3-138.6). Among the cohort, 257 patients (38.3%) had T2 tumors, 249 (37.1%) were pN1, 186 (27.8%) had grade 3 tumors, 134 (20%) presented with lymphovascular invasion (LVI), 116 (17.3%) were HER2-positive, and 55 (8.2%) had triple-negative disease. LRR rates at 2, 5, and 8 years were 1.4%, 2.9%, and 3.5%, respectively. On univariate analysis, the presence of LVI, G3, tumor size (T), nodal involvement (pN1), estrogen receptor-negative status, triple-negative phenotype, and Ki-67 expression were significantly associated with an increased risk of LRR. Notably, LVI-positive patients had significantly higher locoregional and regional recurrence rates at 8 years (9.5% and 9.4%, respectively) compared to LVI-negative patients (1% and 1.1%). Multivariate analysis confirmed LVI as a strong and independent predictor of recurrence across all models.

Conclusions

This study confirms the prognostic relevance of several pathologic factors in predicting LRR, with particular emphasis on the independent role of LVI, in patients with early-stage BC treated with mastectomy and not receiving PMRT. In patients with early-stage BC with T1-T2 tumors and 1-3 positive axillary lymph nodes with the presence of LVI, PMRT should be considered.

目的本研究旨在探讨乳腺癌根治术患者中是否存在局部复发（LRR）风险高的亚组，这些亚组可以从乳房切除术后放射治疗（PMRT）中获益。方法和材料我们回顾性分析了2009年12月至2018年12月在我院接受乳房切除术治疗的早期乳腺癌患者。根据分子亚型和已知预后因素对肿瘤进行分类。使用Kaplan-Meier方法估计结果。采用log-rank检验进行单因素分析，采用Cox比例风险回归估计风险比，评估预后因素与生存率之间的相关性。P值为<； 0.05认为有统计学意义。结果共筛选出670例符合入选标准的患者。中位年龄59.4岁（IQR, 48 ~ 72），中位随访107.1个月（IQR, 80.3 ~ 138.6）。在队列中，T2肿瘤257例（38.3%），pN1 249例（37.1%），3级肿瘤186例（27.8%），淋巴血管侵袭（LVI） 134例（20%），her2阳性116例（17.3%），三阴性55例（8.2%）。2年、5年和8年的LRR利率分别为1.4%、2.9%和3.5%。在单因素分析中，LVI、G3、肿瘤大小(T)、淋巴结累及（pN1）、雌激素受体阴性状态、三阴性表型和Ki-67表达的存在与LRR风险增加显著相关。值得注意的是，lvi阳性患者在8年的局部和区域复发率（分别为9.5%和9.4%）明显高于lvi阴性患者（1%和1.1%）。多变量分析证实LVI是所有模型中复发的强大且独立的预测因子。结论：本研究证实了几个病理因素在预测LRR方面的预后相关性，特别强调了LVI在早期乳腺癌切除术且未接受PMRT患者中的独立作用。早期BC伴T1-T2肿瘤及1-3个腋窝淋巴结阳性伴LVI的患者，应考虑PMRT。

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引用次数: 0

Interim Analysis of Pro-Grid: A Phase 1 Proton Spatially Fractionated Radiation Therapy Trial Pro-Grid的中期分析：一期质子空间分割放射治疗试验

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-08-06 DOI: 10.1016/j.adro.2025.101857

Khadija Sheikh PhD , Anh Tran MSc , Heng Li PhD , Anna W. LaVigne MD , Jean L. Wright MD , Aditya Halthore MD

Purpose

Spatial fractionation (SFRT) is a radiation therapy technique that targets bulky tumors by delivering alternating high and low doses within the tumor. Here, we report an interim analysis of a phase 1 trial examining the feasibility and safety of a novel proton SFRT approach.

Methods and Materials

Ten patients with unresectable tumors of varying histopathology measuring at least 7 cm in the palliative setting were enrolled in a prospective phase 1 trial. Robust pencil-beam scanning proton SFRT plans were created using cylindrical (grid) targets within gross tumor treated to a prescription dose of 18 Gy in a single fraction. Quality assurance computed tomography imaging (qCT) was performed before treatment delivery.

Results

Four patients had breast primaries, 3 patients had lung primaries, and 3 patients had pelvic primaries. Five patients had prior photon treatment to a different site. Eight patients received additional planned normofractionated radiation therapy totaling an average dose of 30 Gy. Median time from SFRT treatment to last follow-up was 25 weeks (range, 4-60 weeks). Gross tumor volume ranged from 151 cm³ to 1638 cm³. All qCTs maintained robustness, with no re-planning needed. At last follow-up, 40% showed partial response, 20% had stable disease, and 40% experienced disease progression, with half progressing in the treated area. One patient with pelvic treatment developed grade 3 small bowel obstruction, followed by late grade 2 obstructions. No other patients had grade 3 or higher acute or late toxicities attributable to the proton SFRT.

Conclusions

Spatial fractionation using a novel pencil-beam scanning SFRT technique was technically feasible to deliver and reliable on robust evaluation of qCT in this small prospective cohort of patients with difficult-to-manage bulky tumors. Proton SFRT appears safe even when additional normofractionated radiation therapy is delivered. Some bulky tumors exhibited significant response to proton SFRT; thus, further work elucidating which patients most benefit from this technique is warranted.

空间分割（SFRT）是一种通过在肿瘤内交替输送高、低剂量来靶向大体积肿瘤的放射治疗技术。在这里，我们报告了一项1期试验的中期分析，该试验检验了一种新型质子SFRT方法的可行性和安全性。方法和材料：在姑息治疗环境下，不可切除的不同组织病理学肿瘤至少为7厘米的患者被纳入前瞻性1期试验。稳健的铅笔束扫描质子SFRT计划是使用圆柱形（网格）靶标在总体肿瘤内治疗到处方剂量为18 Gy的单个部分。质量保证在治疗交付前进行计算机断层成像（qCT）。结果乳腺原发4例，肺原发3例，盆腔原发3例。5例患者先前接受过不同部位的光子治疗。8名患者接受了额外的计划放射治疗，平均剂量为30 Gy。从SFRT治疗到最后一次随访的中位时间为25周（范围4-60周）。大体肿瘤体积为151 ~ 1638 cm³。所有的qct都保持了健壮性，不需要重新规划。在最后一次随访中，40%表现出部分缓解，20%病情稳定，40%出现疾病进展，其中一半在治疗区域进展。1例接受盆腔治疗的患者出现3级小肠梗阻，随后出现2级晚期梗阻。没有其他患者有3级或更高级别的急性或晚期毒性归因于质子SFRT。结论：使用新型铅笔束扫描SFRT技术进行空间分割在技术上是可行的，并且在难以处理的大体积肿瘤患者的小前瞻性队列中可靠地进行了qCT的稳健评估。质子SFRT是安全的，即使在额外的正放射治疗的情况下。一些体积较大的肿瘤对质子SFRT有明显的反应；因此，进一步阐明哪些患者最受益于这项技术是有必要的。

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引用次数: 0

Erratum to ‘Integrating Radiosensitivity Index and Radiation Resistance Related Index Improves Prostate Cancer Outcome Prediction’ [Advances in Radiation Oncology (2025) 10, 101713] “整合放射敏感性指数和放射耐药相关指数提高前列腺癌预后预测”的勘误[放射肿瘤学进展（2025）10,101713]

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-08-01 DOI: 10.1016/j.adro.2025.101830

Qi-Qiao Wu MD , Zhao-Sheng Yin MD , Yi Zhang MD , Yu-Fu Lin MD , Jun-Rong Jiang BS , Ruo-Yan Zheng BS , Tao Jiang MD , Dong-Xu Lin MD , Peng Lai MD , Fan Chao PhD , Xin-Yue Wang MD , Bu-Fu Tang PhD , Shi-Suo Du PhD , Jing Sun MD , Ping Yang MD , Zhao-Chong Zeng PhD

引用次数: 0

Case Volume and Experience in Stereotactic Radiation: Analysis of a Prospective Peer Review Program 立体定向放射的病例量和经验：一个前瞻性同行评议项目的分析

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-07-31 DOI: 10.1016/j.adro.2025.101875

Luke Peng MD , Kee-Young Shin MS , Tara Kosak MEd , Ayal A. Aizer MD , John G. Phillips MD, MPH , Itai M. Pashtan MD

Purpose

Stereotactic radiation therapy (SRT) is highly effective but carries the risk of significant toxicity. We identified factors associated with SRT plans that require revision in a comprehensive, prospective peer review program conducted across a network of affiliated radiation oncology centers.

Methods and Materials

Weekly peer review rounds were conducted to review SRT cases prior to the start of radiation. Revision recommendations were tracked. Univariate and multivariable logistic regression was performed to identify factors associated with case revision.

Results

From 2019 to 2024, 1172 SRT cases were reviewed at weekly rounds, including 313 brain stereotactic radiosurgery (SRS), 190 brain multi-fractionated SRS, and 669 stereotactic body radiation therapy. The yearly revision rate ranged from 19% in 2020 to 31% in 2024. There were 16 individual treating physicians with a median of 6 years of experience (range, 1-19 years), measured at the time of each SRT case review. Factors assessed for significance included SRT case volume in the 3 months preceding review (dichotomized as low- or high-volume), physician experience (≤2, 3-9, or ≥10 years), SRT technique (SRS, multi-fractionated SRS, or stereotactic body radiation therapy, and disease site. On multivariable logistic regression, revisions were less likely for high-volume physicians (odds ratio [OR], 0.58; 95% CI, 0.43-0.77), those with 3-9 years of experience (OR, 0.65; 95% CI, 0.44-0.96), and SRS technique (OR, 0.59; 95% CI, 0.41-0.84).

Conclusions

These data imply high value to prospective peer review for physicians with low SRT case volume and in their early career. Adequate case volume may be a critical factor for high quality SRT, analogous to the surgical literature. Annual revision rates in the program remained substantial over time, demonstrating the ongoing importance of an effective prospective peer review program for SRT.

目的立体定向放射治疗（SRT）是一种非常有效的放射治疗方法，但具有明显的毒性风险。我们确定了与SRT计划相关的因素，这些因素需要在一个综合的、前瞻性的同行评审项目中进行修订，该项目在附属放射肿瘤学中心网络中进行。方法和材料每周进行同行评议，在放疗开始前对SRT病例进行评议。对修订建议进行了跟踪。采用单变量和多变量逻辑回归来确定与病例修订相关的因素。结果2019年至2024年，每周回顾1172例SRT病例，其中脑立体定向放射外科（SRS） 313例，脑多分割SRS 190例，体立体定向放射治疗669例。年修正率从2020年的19%到2024年的31%不等。在每个SRT病例回顾时，有16位治疗医生，平均经验为6年（范围1-19年）。评估显著性的因素包括回顾前3个月的SRT病例量（分为低量或高量）、医生经验（≤2年、3-9年或≥10年）、SRT技术（SRS、多分步SRS或立体定向体放射治疗）和疾病部位。在多变量logistic回归中，大容量医生（优势比[OR]， 0.58; 95% CI, 0.43-0.77）、具有3-9年经验的医生（OR, 0.65; 95% CI, 0.44-0.96）和SRS技术（OR, 0.59; 95% CI, 0.41-0.84）的修订可能性较小。结论这些数据对低SRT病例量和职业生涯早期的医生的前瞻性同行评议具有很高的价值。足够的病例量可能是高质量SRT的关键因素，类似于外科文献。随着时间的推移，该项目的年度修订率保持了可观的水平，这表明了一个有效的前瞻性同行评审项目对SRT的持续重要性。

{"title":"Case Volume and Experience in Stereotactic Radiation: Analysis of a Prospective Peer Review Program","authors":"Luke Peng MD , Kee-Young Shin MS , Tara Kosak MEd , Ayal A. Aizer MD , John G. Phillips MD, MPH , Itai M. Pashtan MD","doi":"10.1016/j.adro.2025.101875","DOIUrl":"10.1016/j.adro.2025.101875","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic radiation therapy (SRT) is highly effective but carries the risk of significant toxicity. We identified factors associated with SRT plans that require revision in a comprehensive, prospective peer review program conducted across a network of affiliated radiation oncology centers.</div></div><div><h3>Methods and Materials</h3><div>Weekly peer review rounds were conducted to review SRT cases prior to the start of radiation. Revision recommendations were tracked. Univariate and multivariable logistic regression was performed to identify factors associated with case revision.</div></div><div><h3>Results</h3><div>From 2019 to 2024, 1172 SRT cases were reviewed at weekly rounds, including 313 brain stereotactic radiosurgery (SRS), 190 brain multi-fractionated SRS, and 669 stereotactic body radiation therapy. The yearly revision rate ranged from 19% in 2020 to 31% in 2024. There were 16 individual treating physicians with a median of 6 years of experience (range, 1-19 years), measured at the time of each SRT case review. Factors assessed for significance included SRT case volume in the 3 months preceding review (dichotomized as low- or high-volume), physician experience (≤2, 3-9, or ≥10 years), SRT technique (SRS, multi-fractionated SRS, or stereotactic body radiation therapy, and disease site. On multivariable logistic regression, revisions were less likely for high-volume physicians (odds ratio [OR], 0.58; 95% CI, 0.43-0.77), those with 3-9 years of experience (OR, 0.65; 95% CI, 0.44-0.96), and SRS technique (OR, 0.59; 95% CI, 0.41-0.84).</div></div><div><h3>Conclusions</h3><div>These data imply high value to prospective peer review for physicians with low SRT case volume and in their early career. Adequate case volume may be a critical factor for high quality SRT, analogous to the surgical literature. Annual revision rates in the program remained substantial over time, demonstrating the ongoing importance of an effective prospective peer review program for SRT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101875"},"PeriodicalIF":2.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144921740","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}

引用次数: 0

Comparative Analysis of Atlas and Neural Network Autosegmentation Methods for Pediatric Craniospinal Irradiation With the Development of a Knowledge-Based Quality Assurance Tool 基于知识质量保证工具的儿童颅脊柱辐照图谱与神经网络自分割方法的比较分析

IF 2.2 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-07-28 DOI: 10.1016/j.adro.2025.101847

Ozgur Ates , James Man Git Tsui , Zachary Wooten , Sydney Hutcheson , Rico Zhang , Jared Becksfort , Thomas E. Merchant , Chia-ho Hua

Purpose

This study aims to evaluate the performance of Atlas and neural network autosegmentation methods and develop a knowledge-based quality assurance (QA) tool for pediatric craniospinal irradiation (CSI).

Methods and Materials

Autosegmentation was performed on 63 CSI patients using 3 methods: Atlas, commercial artificial intelligence (AI), and in-house AI. The performance of these methods was analyzed using 13 quantitative metrics, comprising 6 overlap and 7 distance metrics, across 13 critical organs and a linear mixed-effect model analysis was performed. Additionally, a knowledge-based QA tool was developed by leveraging distinctive computed tomography number distributions from 100 CSI patients for each organ, using the kernel density estimation (KDE) method to ensure robust error detection and validation. The QA tool was tested on 50 CSI cases by comparing baseline KDEs from 100 CSI patients.

Results

The linear mixed-effect analysis showed that the in-house AI outperformed both the Atlas and commercial AI methods in overlap and distance metrics. The in-house AI outperformed the commercial AI with a higher average overlap of 0.01 ± 0.01 and surpassed the Atlas method by 0.02 ± 0.01. In terms of distance metrics, the in-house AI matched the commercial AI (–0.31 ± 0.72 mm) and exceeded the Atlas method by 3.10 ± 0.68 mm. Paired t-tests showed the in-house AI was superior to the Atlas in 13.0% of cases, while the Atlas outperformed the in-house method in 8.9% of comparisons. Similarly, the in-house AI was better than the commercial AI in 35.3% of tests, with the commercial AI outperforming in 32.7%. The QA tool results demonstrated that 100% agreement with baseline KDEs occurred in 46.4% of tests for Atlas, 46.5% for the commercial AI, and 60.7% for the in-house AI.

Conclusions

The in-house AI excelled over the Atlas and commercial AI methods in autosegmentation accuracy for pediatric CSI patients. Furthermore, a knowledge-based QA tool enables clinicians to detect and correct gross errors in autosegmentation.

目的评估Atlas和神经网络自动分割方法的性能，开发基于知识的儿童颅脊髓照射（CSI）质量保证（QA）工具。方法和材料采用Atlas、商业人工智能（AI）和内部人工智能（AI） 3种方法对63例CSI患者进行自动分割。使用13个定量指标（包括6个重叠指标和7个距离指标）对13个关键器官的这些方法的性能进行了分析，并进行了线性混合效应模型分析。此外，通过利用来自100名CSI患者的每个器官的不同计算机断层扫描数量分布，使用核密度估计（KDE）方法开发了基于知识的QA工具，以确保稳健的错误检测和验证。通过比较100名CSI患者的基线kde，在50例CSI病例中测试了QA工具。结果线性混合效应分析表明，内部人工智能在重叠和距离指标上优于Atlas和商业人工智能方法。内部人工智能的平均重叠度为0.01±0.01，优于商业人工智能，超过Atlas方法0.02±0.01。在距离度量方面，内部人工智能与商用人工智能（-0.31±0.72 mm）相当，比Atlas方法高出3.10±0.68 mm。配对t检验显示，在13.0%的情况下，内部人工智能优于Atlas，而Atlas在8.9%的比较中优于内部方法。同样，内部人工智能在35.3%的测试中优于商业人工智能，商业人工智能在32.7%的测试中优于商业人工智能。QA工具结果表明，46.4%的Atlas测试、46.5%的商业AI测试和60.7%的内部AI测试与基线kde 100%一致。结论室内人工智能在儿童CSI患者的自动分割精度上优于Atlas和商业人工智能方法。此外，基于知识的QA工具使临床医生能够检测和纠正自动分割中的严重错误。

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引用次数: 0

Optimizing Workflow for Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy Toward Reduced Physician Involvement 优化基于锥形束计算机断层成像的在线适应性放射治疗的工作流程，以减少医生的介入

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-07-25 DOI: 10.1016/j.adro.2025.101874

Goda Kalinauskaite MD , Luise A. Künzel PhD , Anne Kluge PhD , Kerstin Rubarth PhD , Jakob Dannehl , Celina Höhne , Marcus Beck MD , Daniel Zips MD , Carolin Senger MD

Purpose

To evaluate the impact of an optimized online adaptive radiation therapy workflow on physician involvement.

Methods and Materials

Data from a prospective phase 2 trial involving 34 prostate cancer patients treated with cone beam computed tomography (CBCT)-based online adaptive radiation therapy (62 Gy in 20 fractions) were analyzed. Manual interventions were required for 2 steps in the workflow: radiation therapy technologist review and adjustment of automatically segmented organs, guiding target segmentation, so-called “influencer,” while physicians reviewed and refined the targets. Three different workflows were compared: 2-influencer (rectum and bladder), 3-influencer (+prostate), and 5-influencer (+seminal vesicles and bowel). Time for workflow steps, extent of manual corrections, and target volume changes were compared.

Results

A total of 613 fractions were analyzed. The 5-influencer workflow reduced manual target corrections to 11% of fractions compared with 51% for the 3-influencer workflow and 61% for the 2-influencer workflow (P < .001). Median session duration across workflows was 24.0 minutes (IQR, 22.0-28.0). Median target review times were shortest with the 5-influencer workflow at 2.5 minutes compared with 5.0 minutes for the 3-influencer workflow (P < .001) and 5.6 minutes for the 2-influencer workflow (P = .002). Most patients (84%) found the treatment time well tolerable.

Conclusions

This study of prostate cancer patients suggests that optimized workflow reduces the need for physician involvement in online CBCT guided adaptive radiation therapy. Optimized workflows may facilitate a more radiation therapy technologist-driven approach similar to standard image guided radiation therapy. Further studies in other cancers, also focusing on clinical endpoints, are needed to further improve CBCT guided online adaptive radiation therapy.

目的评价优化的在线适应性放射治疗工作流程对医师参与的影响。方法和材料对一项前瞻性2期试验的数据进行分析，该试验涉及34名前列腺癌患者，他们接受了基于锥束计算机断层扫描（CBCT）的在线适应性放射治疗（62 Gy，分20个部分）。工作流程中的2个步骤需要人工干预：放射治疗技术专家审查和调整自动分割的器官，指导目标分割，所谓的“影响者”，而医生审查和完善目标。比较了三种不同的工作流程：2影响者（直肠和膀胱）、3影响者（+前列腺）和5影响者（+精囊和肠道）。比较了工作流程步骤的时间、手动更正的范围和目标量更改。结果共分析了613个组分。5个影响者工作流将人工目标修正率降低到11%，而3个影响者工作流为51%，2个影响者工作流为61% （P < .001）。跨工作流的中位会话持续时间为24.0分钟（IQR, 22.0-28.0）。5位影响者工作流程的目标审查时间中位数最短，为2.5分钟，而3位影响者工作流程为5.0分钟（P < .001）， 2位影响者工作流程为5.6分钟（P = .002）。大多数患者（84%）认为治疗时间可耐受。结论：这项针对前列腺癌患者的研究表明，优化的工作流程减少了医生参与在线CBCT引导的适应性放射治疗的需要。优化的工作流程可以促进更多的放射治疗技术驱动的方法，类似于标准的图像引导放射治疗。其他癌症的进一步研究，也关注临床终点，需要进一步改进CBCT引导的在线适应性放射治疗。

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引用次数: 0

Osteoradionecrosis of the Hyoid Bone: A Systematic Review 舌骨放射性骨坏死：系统综述

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-07-24 DOI: 10.1016/j.adro.2025.101873

Quentin H. Drane BS , Andrea Ziegler MD , Eric J. Thorpe MD

Purpose

Osteoradionecrosis (ORN) is a serious complication following radiation therapy (RT) for head and neck cancers, commonly affecting the mandible, but is less understood when involving the hyoid bone.

Methods and Materials

A literature review through PubMed and Scopus identified 16 relevant articles. Patient characteristics, presentation, imaging findings, management, and outcomes are highlighted.

Results

The review found 40 cases of hyoid bone ORN, with an average patient age of 60.0 years. Most patients were male (87.5%) and had oropharyngeal tumors (77.5%). The average RT dose was 66.2 Gy, and ORN typically developed 27.6 months after RT. Patients receiving concurrent radiation and chemotherapy were more likely to need surgery compared with those treated with RT alone (80% vs 30%, P = .0042).

Conclusions

While rare, hyoid bone ORN may become more common with increasing rates of oropharyngeal cancers. Clinicians should be aware of presenting symptoms and possible complications and be familiar with a thorough work-up and treatment.

目的：骨放射性坏死（ORN）是头颈癌放疗后的严重并发症，通常影响下颌骨，但对舌骨的影响知之甚少。方法和材料通过PubMed和Scopus进行文献综述，确定了16篇相关文章。强调了患者的特征、表现、影像学表现、管理和结果。结果本组共发现舌骨ORN 40例，平均年龄60.0岁。男性居多（87.5%），口咽肿瘤居多（77.5%）。平均放疗剂量为66.2 Gy，通常在放疗后27.6个月发生ORN。与仅接受放疗的患者相比，同时接受放疗和化疗的患者更有可能需要手术（80% vs 30%, P = 0.0042）。结论舌骨ORN虽然罕见，但随着口咽癌发病率的增加，可能会变得越来越常见。临床医生应该意识到出现的症状和可能的并发症，并熟悉彻底的检查和治疗。

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引用次数: 0

Predicting Radionecrosis After Stereotactic Radiation Therapy for Solitary Brain Metastases: External Validation of a Univariable Model and Development of a Multivariable Model 预测单发脑转移瘤立体定向放疗后放射性坏死：单变量模型的外部验证和多变量模型的发展

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-07-24 DOI: 10.1016/j.adro.2025.101871

Elise E.M.W. van Schaik MSc , Jeroen A. Crouzen MSc , Mirjam E. Mast PhD , Marike L.D. Broekman MD, PhD , Martijn P. Hakstege BSc , Bart J.A. Mertens PhD , Mandy Kiderlen PhD , Noëlle C.M.G. van der Voort van Zyp PhD , Anna L. Petoukhova PhD , Jaap D. Zindler PhD

Purpose

Stereotactic radiation therapy (SRT) is a frequently used and effective treatment for patients who received diagnosis for brain metastases (BMs). Radionecrosis (RN) is a severe complication of SRT which may cause neurologic symptoms. A normal tissue complication probability (NTCP) model has previously been established to predict the risk of RN based on the volume of healthy brain receiving ≥12 Gy. The aim of this study is to externally validate this prediction model.

Methods and Materials

A total of 162 patients treated with SRT for solitary BMs were retrospectively included. The NTCP models for all (asymptomatic and symptomatic) RN and symptomatic RN cases were evaluated using discrimination (C-statistic) and calibration (Brier scores). Overall survival was determined using the Kaplan-Meier method.

Results

Median overall survival was 10 months. Asymptomatic or symptomatic RN was found in 44 (27%) of patients. Of these, 26 (16%) RN cases were symptomatic, with actuarial rates of 11% and 22% after 6 and 12 months, respectively. The C-statistics of the “any RN” and the “symptomatic RN” models were identical (0.61). Brier scores were 0.201 and 0.217, respectively. Univariable logistic regression analysis showed a significant correlation between both tumor volume and volume of healthy brain receiving ≥12 Gy with symptomatic RN. These effects did not hold up in the multivariable analysis. A nomogram was established and internally validated.

Conclusions

The accuracy of the tested NTCP models in assessing the risk of RN in patients with BM after SRT was insufficient for clinical practice. A novel multifactorial nomogram was developed to predict symptomatic RN. This model needs to be externally validated.

目的立体定向放射治疗（SRT）是脑转移瘤（BMs）患者常用且有效的治疗方法。放射性坏死（RN）是SRT的严重并发症，可引起神经系统症状。先前已经建立了正常组织并发症概率（NTCP）模型，以健康脑接受≥12 Gy的体积为基础预测RN的风险。本研究的目的是对该预测模型进行外部验证。方法与材料回顾性分析采用SRT治疗孤立性脑转移的162例患者。采用判别（c -统计）和校正（Brier评分）对所有（无症状和有症状）RN和有症状RN病例的NTCP模型进行评估。采用Kaplan-Meier法测定总生存期。结果中位总生存期为10个月。44例（27%）患者出现无症状或有症状的RN。其中，26例（16%）RN病例出现症状，6个月和12个月后的精算率分别为11%和22%。“任意型RN”与“症状型RN”模型的c统计量相同（0.61）。Brier评分分别为0.201和0.217。单变量logistic回归分析显示，≥12 Gy的健康脑肿瘤体积与有症状的RN存在显著相关。这些效应在多变量分析中并不成立。建立了nomogram并进行了内部验证。结论所测试的NTCP模型在评估SRT后BM患者RN风险方面的准确性不足，无法用于临床实践。我们开发了一种新的多因子nomogram来预测症状性RN。该模型需要外部验证。

{"title":"Predicting Radionecrosis After Stereotactic Radiation Therapy for Solitary Brain Metastases: External Validation of a Univariable Model and Development of a Multivariable Model","authors":"Elise E.M.W. van Schaik MSc , Jeroen A. Crouzen MSc , Mirjam E. Mast PhD , Marike L.D. Broekman MD, PhD , Martijn P. Hakstege BSc , Bart J.A. Mertens PhD , Mandy Kiderlen PhD , Noëlle C.M.G. van der Voort van Zyp PhD , Anna L. Petoukhova PhD , Jaap D. Zindler PhD","doi":"10.1016/j.adro.2025.101871","DOIUrl":"10.1016/j.adro.2025.101871","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic radiation therapy (SRT) is a frequently used and effective treatment for patients who received diagnosis for brain metastases (BMs). Radionecrosis (RN) is a severe complication of SRT which may cause neurologic symptoms. A normal tissue complication probability (NTCP) model has previously been established to predict the risk of RN based on the volume of healthy brain receiving ≥12 Gy. The aim of this study is to externally validate this prediction model.</div></div><div><h3>Methods and Materials</h3><div>A total of 162 patients treated with SRT for solitary BMs were retrospectively included. The NTCP models for all (asymptomatic and symptomatic) RN and symptomatic RN cases were evaluated using discrimination (C-statistic) and calibration (Brier scores). Overall survival was determined using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Median overall survival was 10 months. Asymptomatic or symptomatic RN was found in 44 (27%) of patients. Of these, 26 (16%) RN cases were symptomatic, with actuarial rates of 11% and 22% after 6 and 12 months, respectively. The C-statistics of the “any RN” and the “symptomatic RN” models were identical (0.61). Brier scores were 0.201 and 0.217, respectively. Univariable logistic regression analysis showed a significant correlation between both tumor volume and volume of healthy brain receiving ≥12 Gy with symptomatic RN. These effects did not hold up in the multivariable analysis. A nomogram was established and internally validated.</div></div><div><h3>Conclusions</h3><div>The accuracy of the tested NTCP models in assessing the risk of RN in patients with BM after SRT was insufficient for clinical practice. A novel multifactorial nomogram was developed to predict symptomatic RN. This model needs to be externally validated.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101871"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095615","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}

引用次数: 0

Extracranial Palliative Radiation Therapy for Renal Cell Carcinoma 肾细胞癌的颅外姑息性放射治疗

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-07-24 DOI: 10.1016/j.adro.2025.101870

Young Suk Kwon MD, MPH , Eric Hsu MD, PhD , Maggie Stein BSPH , Alana Christie MS , Aurelie Garant MD , Neil B. Desai MD , Andrew Wang MD , Daniel X. Yang MD , Allen Yen MD , Mihailo Miljanic MD , Kevin D. Courtney MD, PhD , Hans Hammers MD, PhD , Tian Zhang MD , Waddah Arafat MD , Qian Qin MD , Suzanne Cole MD , James Brugarolas MD, PhD , Robert Timmerman MD , Raquibul Hannan MD, PhD

Purpose

Symptom management is an integral component of care for patients with renal cell carcinoma (RCC). We evaluated the efficacy of radiation therapy (RT) and factors influencing symptom in an ethnically diverse patient population.

Methods and Materials

An institutional review board-approved retrospective review was conducted of patients with symptomatic extracranial RCC metastases treated with RT between 2011 and 2022 at a tertiary referral center. Symptoms were categorized as pain, neurologic (paresthesia or weakness), respiratory (dyspnea, hemoptysis, or cough) and gastrointestinal/genitourinary (GI/GU) bleeding. Time to symptom alleviation was measured from the start of RT and assessed during-treatment and follow-up visits. Descriptive and survival analyses were performed. Associations between symptom relief and treatment parameters were evaluated by generalized estimating equations

Results

We identified 240 symptomatic RCC patients who received RT to 581 metastases including 93.0% for pain, 4.0% for neurologic, 4.1% for respiratory, and 1.6% for GI/GU bleeding. Symptom improvement was observed in 84.0% of patients overall at 6 months (95% confidence interval [CI], 80.4-87.2%). Among symptom categories, pain improved in 84.6% (95% CI, 81.0-87.9%) at 6 months, respiratory symptoms in 69.9% (49.3-88.0%) at 6 months, neurologic symptoms in 88.6% (69.6-98.1%) at 6 months, and GI/GU bleeding in 37.5% (13.9-77.1%) at 1 month. The median times to overall and pain alleviation were 1.6 months (range, 1.4-1.9) and 1.6 months (range, 1.4-1.9), respectively. Although the odds of achieving pain palliation were similar between stereotactic and conventional RT, unexpectedly, symptom relief occurred more quickly with conventional RT (P < .001).

Conclusions

Stereotactic and conventional RT are effective for symptom palliation for patients with metastatic RCC.

目的：症状管理是肾细胞癌（RCC）患者护理的一个组成部分。我们在不同种族的患者群体中评估放射治疗（RT）的疗效和影响症状的因素。方法和材料对2011年至2022年在三级转诊中心接受RT治疗的症状性颅外RCC转移患者进行了一项机构审查委员会批准的回顾性审查。症状分为疼痛、神经系统（感觉异常或无力）、呼吸系统（呼吸困难、咯血或咳嗽）和胃肠道/泌尿生殖系统（GI/GU）出血。从RT开始测量症状缓解的时间，并在治疗和随访期间进行评估。进行描述性和生存分析。结果240例有症状的RCC患者接受了RT治疗，其中93.0%为疼痛，4.0%为神经系统，4.1%为呼吸系统，1.6%为GI/GU出血。6个月时，84.0%的患者症状改善（95%可信区间[CI]， 80.4-87.2%）。在症状类别中，6个月时疼痛改善率为84.6% (95% CI, 81.0-87.9%)， 6个月时呼吸系统症状改善率为69.9%(49.3-88.0%)，6个月时神经系统症状改善率为88.6%(69.6-98.1%)，1个月时GI/GU出血改善率为37.5%（13.9-77.1%）。总体缓解和疼痛缓解的中位时间分别为1.6个月（范围，1.4-1.9）和1.6个月（范围，1.4-1.9）。尽管立体定向放疗和常规放疗获得疼痛缓解的几率相似，但出乎意料的是，常规放疗的症状缓解更快（P < .001）。结论立体定向放射治疗和常规放射治疗对转移性肾细胞癌患者的症状均有缓解作用。

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引用次数: 0