Advances in Radiation Oncology最新文献

{"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}

{"title":"Patient Perspectives on Virtual vs In-Person Posttreatment Care for Brain Metastases","authors":"Bardia Amanirad BSc ,&nbsp;Chinmay M. Potdar MSc ,&nbsp;Matthew Ramotar H.BSc,&nbsp;Anna T. Santiago MSc,&nbsp;Janet Papadakos PhD, Med ,&nbsp;David B. Shultz MD, PhD","doi":"10.1016/j.adro.2025.101907","DOIUrl":"10.1016/j.adro.2025.101907","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to explore perspectives of patients with brain metastasis on posttreatment care, comparing virtual and in-person visits, and identifying factors shaping those views.</div></div><div><h3>Methods and Materials</h3><div>A cross-sectional survey assessed patient perspectives on posttreatment care. We offered the survey to English-fluent patients with internet access who received posttreatment care at a Brain Metastases Clinic (n = =140). One hundred twenty-three participants returned the survey, and 112 completed at least 80% of it, a criterion for inclusion. Patients received posttreatment follow-up care either virtually, in-person, or both. Nonparametric data were analyzed using Mann-Whitney U and Chi-Square tests, with a modified linear regression model evaluating factors related to visit satisfaction. Our hypothesis was that virtual care would be rated higher based on doctor punctuality, but lower on personal connection, communication, and overall satisfaction.</div></div><div><h3>Results</h3><div>Participants who experienced both visit types rated in-person visits higher for personal connection (χ²(df = 1) = 19.703, <em>P</em> &lt; .0001), ability to demonstrate physical problems (χ²(df = 1) = 18.778, <em>P</em> &lt; .0001), and confidence in addressing health concerns (χ²(df = 1) = 16.941, <em>P</em> &lt; .0001). Overall satisfaction did not significantly differ between visit types (U = 3607.5, z = 1.613, <em>P</em> = .107). Doctor punctuality (<em>t</em> = –2.328, SE = 0.32, <em>P</em> = .025) and communication effectiveness (<em>t</em> = –3.166, SE = 0.608, <em>P</em> = .003) were significant correlates to visit satisfaction.</div></div><div><h3>Conclusions</h3><div>Similar levels of satisfaction with virtual and in-person visits suggest that virtual care is a viable alternative to in-person visits. Higher ratings of personal connection felt with the physician, ability to demonstrate physical problems, and having health concerns properly addressed, within in-person visits, underscore their importance within a health care setting. Additionally, a doctor punctuality and communication skills are the most significant factors affecting visit satisfaction in this population, highlighting key areas for improvement in health care delivery.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101907"},"PeriodicalIF":2.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359045","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":"Dosimetric Performance of Orthogonal Dual-Layer Multi-Leaf Collimator System on Locally Advanced Lung Cancer: Cardiac Substructures Sparing Plans","authors":"AiHui Feng MS ,&nbsp;YanHua Duan MS ,&nbsp;ZhangRu Yang MD ,&nbsp;Hao Wang PhD ,&nbsp;Hua Chen PhD ,&nbsp;HengLe Gu MS ,&nbsp;Ying Huang MS ,&nbsp;ZhenJiong Shen MS ,&nbsp;XuFei Wang PhD ,&nbsp;ZhiYong Xu PhD","doi":"10.1016/j.adro.2025.101891","DOIUrl":"10.1016/j.adro.2025.101891","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to reduce the risk of cardiovascular incidents and radiation pneumonia (RP) by improving the dose distribution to cardiac substructures through the use of a dual-layer multileaf collimator (MLC) accelerator- VenusX.</div></div><div><h3>Methods and Materials</h3><div>Eighteen patients with advanced-stage lung cancer were selected for this study. The total lung, spinal cord, whole heart, and specific cardiac substructures (including the left ventricle [LV], pulmonary artery, left anterior descending artery, left circumflex artery [LCX], and coronary artery) were delineated as organs at risk and incorporated into the optimization process of the avoidance plan. Single-layer MLC plans optimized for the whole heart, referred to as S-WH plans (where WH denotes whole heart), were developed alongside single-layer MLC plans specifically designed to avoid cardiac substructures, known as S-CS plans (where CS denotes cardiac substructures). Additionally, dual-layer MLC avoidance plans, designated as D-CS plans, were created for each patient. We evaluated the relative risk of coronary artery disease, chronic heart failure, acute cardiac events, and RP, as well as the effective dose to the immune system.</div></div><div><h3>Results</h3><div>D-CS plans significantly reduced the dose metrics of LV, pulmonary artery, left anterior descending artery, LCX, and the coronary, while maintaining target coverage and achieving comparable conformity index to the S-WH plans. Additionally, the D-CS plans significantly decreased the volume receiving 5 Gy (V_5Gy) for the LV and V_15Gy of LCX, with other substructures also experiencing a notable degree of dose reduction. Furthermore, the relative risk of coronary artery disease, chronic heart failure, acute cardiac event, and RP is ranked as follows: D-CS &lt; S-CS &lt; S-WH plans. Effective dose to the immune system of the D-CS plans indicated the lowest risk among the 3 plans.</div></div><div><h3>Conclusions</h3><div>The dual-layer MLC system demonstrated superior performance compared to the single-layer MLC system in CS-avoidance plans, providing new opportunities for subsequent immunotherapy in patients with locally advanced lung cancer.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101891"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Stereotactic Magnetic Resonance-Guided Adaptive Radiation Therapy (SMART) for Ultracentral Metastases in Non-Small Cell Lung Cancer","authors":"Elena Moreno-Olmedo MD ,&nbsp;Ben George PhD ,&nbsp;Kasia Owczarczyk MD ,&nbsp;David Woolf MD, PhD ,&nbsp;John Conibear MD ,&nbsp;Andy Gaya MD ,&nbsp;Joss Adams MD ,&nbsp;Luis Aznar-García PhD ,&nbsp;Timothy Sevitt MD ,&nbsp;Peter Dickinson MD ,&nbsp;Kevin Franks MD ,&nbsp;Alex Martin MD ,&nbsp;Veni Ezhil MD ,&nbsp;Philip Camilleri MD ,&nbsp;James Good MD, PhD ,&nbsp;Crispin Hiley MD, PhD","doi":"10.1016/j.adro.2025.101906","DOIUrl":"10.1016/j.adro.2025.101906","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic ablative radiation therapy (SABR) is a standard of care for early-stage lung cancer and thoracic oligometastatic or oligoprogressive disease. However, ultracentral lesions remain challenging because of their proximity to critical mediastinal structures and the associated risk of severe toxicity. Stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) allows for daily plan adaptation and real-time tracking in breath-hold, enhancing target coverage while improving sparing of adjacent organs compared to conventional SABR.</div></div><div><h3>Methods and Materials</h3><div>This retrospective study analyzed outcomes of SMART-based SABR for ultracentral metastatic lesions in patients with histologically confirmed non-small cell lung cancer (NSCLC). Ultracentral lesions were defined by planning target volume overlapping with the proximal bronchial tree, esophagus, or pulmonary vessels. Endpoints included grade ≥ 3 SMART-related toxicity, freedom from local progression, progression-free survival, and overall survival.</div></div><div><h3>Results</h3><div>Between 2020 and 2023, 11 patients with 18 ultracentral NSCLC lesions underwent SMART. All treatments were delivered in breath-hold. The median dose was 40 Gy (range, 30-60 Gy) in 5 to 8 fractions. Online plan adaptation was performed for 100% of the 78 delivered fractions. No grade ≥ 3 toxicities were observed. Rates of grade 1 to 2 acute and late toxicities were 54% and 18%, respectively. At a median follow-up of 28 months (range, 5-41 months), 66.7% of patients were alive. One-year freedom from local progression was 93%. Median progression-free survival was 5.8 months (range, 1-39 months), and median overall survival was 20 months (range, 5-41 months).</div></div><div><h3>Conclusions</h3><div>SMART with daily online adaptation achieved excellent local control and a favorable safety profile in ultracentral NSCLC, comparable to conventional non-adaptive SABR, but without severe toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101906"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359046","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":"Particle Therapy in the Multimodal Treatment for Locally Advanced Malignancies of the Nasal Cavity and Paranasal Sinus—Single Institute Experience","authors":"Fatima Frosan Sheikhzadeh MD ,&nbsp;Gertrud Schmich MD ,&nbsp;Niklas Recknagel MD ,&nbsp;Edgar Smalec ,&nbsp;Tasneim Abdelrahman Mohamed ,&nbsp;Vicky Soborun MD ,&nbsp;Kerem Tuna Tas ,&nbsp;Philipp Lishewski ,&nbsp;Klemens Zink PhD ,&nbsp;Khaled Elsayad MD, PhD ,&nbsp;Fabian Eberle MD, PhD ,&nbsp;Hilke Vorwerk MD, PhD ,&nbsp;Thomas Held MD, PhD ,&nbsp;Boris A. Stuck MD, PhD ,&nbsp;Sebastian Adeberg MD, PhD ,&nbsp;Ahmed Gawish MD, PhD","doi":"10.1016/j.adro.2025.101903","DOIUrl":"10.1016/j.adro.2025.101903","url":null,"abstract":"<div><h3>Purpose</h3><div>Particle therapy with protons or carbon ions is a promising method for treating locally advanced nasal cavity and paranasal sinus carcinomas (NPSC). This study evaluates the clinical outcomes and toxicities of patients treated with carbon ion radiation therapy with a boost (CIRT-B) at our institution.</div></div><div><h3>Methods and Materials</h3><div>Patients with NPSC who received combined treatment with CIRT-B and intensity modulated radiation therapy were considered. Local control (LC) and survival rates were estimated using Kaplan-Meier survival analysis and proportional hazards models.</div></div><div><h3>Results</h3><div>Between 2016 and 2023, a total of 66 patients were included in the analysis. Of these, 53 patients (80%) received primary radiation therapy as their first-line treatment, while 13 patients (20%) underwent salvage reirradiation for recurrent disease. The median total dose administered in the upfront radiation therapy group was 74 Gy (range, 70-78 Gy relative biological effectiveness), whereas the median total dose in the salvage radiation therapy group was 45 Gy (range, 39-51 Gy relative biological effectiveness). The median duration of LC was 21 months in both the upfront and salvage groups. The overall median LC across all patients was 14 months. The 2-year LC rate was 73% for the upfront radiation therapy group and 52% for the salvage radiation therapy group, with a statistically significant difference (<em>P</em> = .038). In terms of early toxicities, there were no grade 4 adverse events reported.</div></div><div><h3>Conclusions</h3><div>CIRT-B combined with photon radiation therapy is an effective and safe treatment for advanced NPSC in both primary and salvage settings.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101903"},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412562","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":"Image-Based Recurrence Patterns After Reirradiation in Prostate Cancer with Long-Term Follow-Up","authors":"Una Ryg MD ,&nbsp;Wolfgang Lilleby MD, PhD ,&nbsp;Line Brennhaug Nilsen PhD ,&nbsp;Taran Paulsen Hellebust PhD, MSc ,&nbsp;Therese Seierstad PhD, MSc ,&nbsp;Knut Håkon Hole MD, PhD","doi":"10.1016/j.adro.2025.101900","DOIUrl":"10.1016/j.adro.2025.101900","url":null,"abstract":"<div><h3>Purpose</h3><div>Local failure of prostate cancer after definitive radiation therapy is associated with poor prognosis. Studies on reirradiation have primarily focused on toxicity and oncologic outcome and only partially reported recurrence patterns. Investigating the recurrence pattern may help guide future therapy decisions.</div></div><div><h3>Methods and Materials</h3><div>Thirty-three men with local recurrence of prostate cancer after primary definitive radiation therapy were enrolled between 2012 and 2018 (median age 69.8 years [IQR: 6.8], median prostate-specific antigen 4.1 ng/mL [IQR: 3.8]). Twenty-three patients received reirradiation with focal high dose-rate brachytherapy, and 10 received stereotactic body radiation therapy to the prostate with (8/10) or without (2/10) a simultaneous integrated boost to the recurrent tumor. The sites of recurrences were examined with multiparametric magnetic resonance imaging and compared with the dose distribution maps.</div></div><div><h3>Results</h3><div>During the median 99 months (IQR: 56) follow-up, 25 patients had biochemical rerecurrence. Twenty had adequate imaging. Five patients had rerecurrences solely inside the high-dose region, and 7 had both inside and outside the high-dose region. Two patients with a prostatic recurrence received whole-gland stereotactic body radiation therapy without a boost to the tumor. Four had a combination of rerecurrence within the prostate as well as regional lymph node metastases. One patient had a prostatic rerecurrence and a single bone metastasis. One patient had prostatic rerecurrence, lymph node metastases, and bone metastases. No patients had only regional or distant metastases.</div></div><div><h3>Conclusions</h3><div>After reirradiation of prostate cancer, the tumor frequently recurred within the prostate, both inside and outside the high-dose region. About 1 in 3 patients also had regional or distant metastatic disease at rerecurrence.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101900"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412669","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":"Dose Intensification to the Dominant Intraprostatic Lesion During Prostate Stereotactic Body Radiation Therapy Delivered on a Magnetic Resonance Imaging Linear Accelerator: Feasibility and Early Clinical Outcomes","authors":"Michael J. Zelefsky MD,&nbsp;David Byun MD,&nbsp;Matthew Long BS,&nbsp;Gabriel Fuligni BS,&nbsp;Hesheng Wang PhD,&nbsp;Siming Lu PhD,&nbsp;Ting Chen PhD,&nbsp;David Barbee PhD","doi":"10.1016/j.adro.2025.101905","DOIUrl":"10.1016/j.adro.2025.101905","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the feasibility of delivering escalated doses to the dominant intraprostatic lesion (DIL) as noted on T2-weighted magnetic resonance imaging and diffusion-weighted imaging while maintaining dose to the surrounding normal tissue structures within dose-volume constraints.</div></div><div><h3>Methods and Materials</h3><div>A total of 50 consecutive patients were treated with prostate stereotactic body radiation therapy (SBRT), via a simultaneous integrated boost to the DIL, on a 1.5-Tesla magnetic resonance imaging linear accelerator platform. These patients were treated with SBRT to 40 Gy in 5 fractions every other day, and the DIL was simultaneously boosted to 45 Gy in 5 fractions. No patient was treated with androgen deprivation therapy. The normal tissue structures and the prostate and DIL were recontoured, and a postfraction plan was generated to retrospectively generate the doses delivered to the prostate and the DIL boost target for each of these 250 therapy sessions.</div></div><div><h3>Results</h3><div>On postfraction dosimetric analysis, the median dose to 95% (D95) of the DIL was 45.3 Gy (initial plan: 45.9 Gy; <em>P</em> &lt; .05), and 44 Gy or more was delivered to the DIL in 84% of the treated fractions. The median D95 to the prostate was 40.4 Gy (initial plan: 40.7 Gy; <em>P</em> &lt; .05). Despite excellent target coverage, the rectum, urethra, and bladder dose constraints were generally maintained. At 6 months from completion of therapy, the median prostate-specific antigen result was 1.1 ng/mL (range, 0-5.6 ng/mL) compared to the median pre-SBRT prostate-specific antigen of 6.8 ng/mL (range, 3.45-31 ng/mL). No patient developed late grade 3 or higher urinary or rectal toxicities at median follow-up of 10.8 months (range, 6.4-15.7 months).</div></div><div><h3>Conclusions</h3><div>With real-time adaptive planning on a magnetic resonance imaging linear accelerator, dose escalation was achieved in most cases with the intended doses without significantly compromising the dose-volume constraints of the surrounding normal tissue structures. These dosimetric findings were associated with an excellent tolerance profile at 12 months and a low incidence of urinary or rectal toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101905"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Precise Reirradiation Supporting Tool Initiative (PRISTIN) for Prescribing Absorbed Dose and Number of Fractions in Reirradiation","authors":"Mayu Hagiwara MS ,&nbsp;Ryusuke Suzuki PhD ,&nbsp;Seishin Takao PhD ,&nbsp;Rumiko Kinoshita MD, PhD ,&nbsp;Shizusa Yamazaki MS ,&nbsp;Keiji Nakazato MS ,&nbsp;Hideki Kojima MP ,&nbsp;Takayuki Hashimoto MD, PhD ,&nbsp;Keiji Kobashi PhD ,&nbsp;Yasuhiro Onodera PhD ,&nbsp;Hisanori Fukunaga MD, PhD ,&nbsp;Hidefumi Aoyama MD, PhD ,&nbsp;Michael F Gensheimer MD ,&nbsp;Masahiro Mizuta PhD ,&nbsp;Hiroki Shirato MD, PhD","doi":"10.1016/j.adro.2025.101904","DOIUrl":"10.1016/j.adro.2025.101904","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to develop a supporting tool to calculate the most appropriate prescribing absorbed dose and number of fractions for precise reirradiation.</div></div><div><h3>Methods and Materials</h3><div>After deformable image registration of the initial computed tomography to the computed tomography at reirradiation, an initial biological effective dose (BED) taking into account the recovery from the initial irradiation is calculated voxel-by-voxel for each organ at risk (OAR). Using a commercial radiation therapy planning system, the clinical target volume for reirradiation (CTV2) is made. Keeping the BED_{tumor’s α/β} to CTV2, cumulative BED_{OAR’s α/β}(CBED_{OAR’s α/β}) in each voxel of critical OARs is calculated by changing the number of fractions in a stepwise process. The most appropriate prescribing absorbed dose to the target and the number of fractions in reirradiation is determined by using CBED_{OAR’s α/β}-volume histogram for critical OARs. The function of the tool was validated in silico using 3 scenarios in 2 patients: a patient with a lung cancer at the peripheral lung parenchyma and at the hilar lymphatic region at different times, and in a patient with a metastatic internal mammary lymph node relapsed after postoperative radiation therapy for breast cancer.</div></div><div><h3>Results</h3><div>In scenario 1, giving 57 Gy in 22 fractions (57 Gy/22 Fr) to the CTV2 at the right hilum, the maximum CBED_α/β=2 was 124.078 Gy, and the mean CBED_α/β=2 of the whole lung parenchyma excluding gross tumor volume was 18.332 Gy. In scenario 2, 44.152 Gy/7 Fr to the target was suggested to be most appropriate. In scenario 3, 71.675 Gy/30 Fr proton therapy to the target was recommended in which the maximum CBED_α/β=2 in the aorta near the recurrence site was 145.796 Gy, and the volume of CBED_α/β=2 ≥ 100 Gy was 0.800 cm³, both are within the constraints.</div></div><div><h3>Conclusions</h3><div>The tool was suggested to be useful to find the most appropriate prescribing absorbed dose to the target as well as the number of fractions for precise reirradiation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101904"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145263498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective First-In-Human Pilot Study 18F-DCFPyL Prostate-Specific Membrane Antigen Imaging on the RefleXion X1 Positron Emission Tomography-Computed Tomograpghy Subsystem in Patients with Prostate Cancer","authors":"Bo Liu PhD ,&nbsp;Savita Dandapani MD, PhD ,&nbsp;Yun Li MD, PhD ,&nbsp;Scott Glaser MD ,&nbsp;Helen Chen MD ,&nbsp;Tanya Dorff MD ,&nbsp;Dave Yamauchi MD ,&nbsp;Quan Chen PhD ,&nbsp;Kun Qing PhD ,&nbsp;Chengyu Shi PhD ,&nbsp;Angela J. Da Silva PhD ,&nbsp;Karine A. Al Feghali MD ,&nbsp;An Liu PhD ,&nbsp;Terence Williams MD, PhD ,&nbsp;Jeffrey Y.C. Wong MD","doi":"10.1016/j.adro.2025.101902","DOIUrl":"10.1016/j.adro.2025.101902","url":null,"abstract":"<div><h3>Purpose</h3><div>The RefleXion X1 Medical Radiotherapy System (RefleXion Medical) is a novel radiation therapy (RT) device capable of delivering real-time positron emission tomography (PET) scan-guided or biology-guided RT (BgRT). The purpose of this pilot study was to evaluate the performance of its PET imaging subsystem to detect 2-(3-{1-carboxy-5-[(6-[(18)F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (¹⁸F-DCFPyl) prostate-specific membrane antigen [PSMA] PET scan signal as the foundation for BgRT in patients with prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>Patients underwent a standard diagnostic ¹⁸F-DCFPyl PSMA PET scan. If at least 1 PET-scan-avid tumor was identified, the patient was then scanned on the RefleXion X1 unit. The target volume, activity concentration, and normalized target signal were determined, and BgRT planning was performed.</div></div><div><h3>Results</h3><div>In 20 patients, at least 1 PSMA PET-scan-avid tumor was identified for BgRT planning (5 lymph node metastases, 7 bone metastases, 7 prostate glands, and 1 prostate bed). In 18 patients, the PET-scan-avid tumor was visualized on the RefleXion X1 PET scan, whereas in 2 patients, the tumor was too close to the PET scan activity in the bladder to be clearly visualized. BgRT planning was feasible and met stereotactic body RT organ dose constraints in 8 (40%) patients (3 prostate glands, 3 bones, and 2 lymph nodes). BgRT was not feasible in 12 (60%) patients because of low target activity concentration (&lt;5 kBq/mL), low normalized target signal intensity (&lt;2.7), or proximity of the PET-scan-avid tumor to the bladder.</div></div><div><h3>Conclusions</h3><div>This is the first study to demonstrate the feasibility of using ¹⁸F-DCFPyl scan imaging for BgRT planning on the RefleXion X1 system in patients with prostate cancer. BgRT using targeted PET scan radiopharmaceuticals to guide RT represents a promising new dimension in radiation oncology and warrants further investigation.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101902"},"PeriodicalIF":2.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359044","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":"Leveraging High-Fidelity Mode for Improved Online Adaptive Stereotactic Accelerated Partial Breast Treatment Efficiency","authors":"Joel A. Pogue PhD ,&nbsp;Jingwei Duan PhD ,&nbsp;Joseph Harms PhD ,&nbsp;Sean Sullivan BS ,&nbsp;Courtney Stanley DMP ,&nbsp;Richard A. Popple PhD ,&nbsp;Natalie Viscariello PhD ,&nbsp;Dennis N. Stanley PhD ,&nbsp;Drexel Hunter Boggs MD ,&nbsp;Carlos E. Cardenas PhD","doi":"10.1016/j.adro.2025.101901","DOIUrl":"10.1016/j.adro.2025.101901","url":null,"abstract":"<div><h3>Purpose</h3><div>Cone beam computed tomography guided online adaptive radiation therapy (OART) for stereotactic accelerated partial breast irradiation (APBI) can help mitigate the effects of interfraction lumpectomy bed variation. However, OART leads to a prolonged treatment time due to daily reoptimization of the treatment plan, potentially increasing patient discomfort and intrafraction variation. Here, we investigate the feasibility of using a stereotactic radiation therapy optimization feature, high-fidelity (HF) mode, through an in silico analysis of the entire APBI OART session.</div></div><div><h3>Methods and Materials</h3><div>This retrospective in silico institutional review board–approved study included 25 patient data sets; 10 training patients allowed for iterative tuning of an HF planning strategy aiming to reduce optimization time with comparable plan quality to our previous non-HF planning strategy. Five OART treatment fractions were emulated for the remaining 15 patients in a virtual treatment planning and delivery system using both templates (with/without HF), resulting in the analysis of 330 validation cohort plans, including reference/nonadaptive/adaptive plans (initial plan/recalculated initial plan/reoptimized plan). Dose-volume-histogram metrics, optimization times, and patient-specific quality assurance results were compared with/without HF via the Wilcoxon paired test.</div></div><div><h3>Results</h3><div>HF adaptive planning resulted in improved per-fraction breast V100%/50% (0.2%/3.3%), Ribs D0.01cc (0.2 Gy), and Paddick conformity/gradient indices (0.01/0.17), but led to marginally inferior planning target volume V100% (0.2%) and lung V30% (0.2%) compared to non-HF (<em>P</em> &lt; .005). HF planning reduced the median online optimization time by 54% (5.4 minutes) per fraction, significantly improving treatment efficiency. There were no statistically significant differences in patient-specific quality assurance delivery accuracy, as indicated by the gamma passing rate (<em>P</em> ≥ .29), with both HF and non-HF plans achieving &gt;97% at 3%/3 mm.</div></div><div><h3>Conclusions</h3><div>This work demonstrates that leveraging Ethos v2.0 HF mode may significantly improve stereotactic OART treatment efficiency for volumetric modulated arc therapy APBI, with &gt;50% reduction in optimization time observed while maintaining plan quality on a nonclinical system, potentially leading to reduced patient discomfort and mitigated intrafraction variations.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101901"},"PeriodicalIF":2.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412670","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}