Advances in Radiation Oncology最新文献

{"title":"Functional Dose-Volume Analysis Based on a Novel Image Biomarker Derived From Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Predicting Poststereotactic Body Radiation Therapy Liver Function Preservation in Patients With Hepatocellular Carcinoma","authors":"Yimin Ni MSc ,&nbsp;Ho-Fun Victor Lee MD ,&nbsp;Chi-leung Chiang MD ,&nbsp;Lai-Yin Andy Cheung PhD ,&nbsp;Zhengxing Huang PhD ,&nbsp;Xinzhi Teng PhD ,&nbsp;Jiang Zhang PhD ,&nbsp;Ge Ren PhD ,&nbsp;Jing Cai PhD ,&nbsp;Tian Li PhD","doi":"10.1016/j.adro.2025.101883","DOIUrl":"10.1016/j.adro.2025.101883","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study is to identify functional dose-volume parameters based on image biomarker derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for predicting poststereotactic body radiation therapy (SBRT) liver function deterioration (LFD) in patients with hepatocellular carcinoma.</div></div><div><h3>Methods and Materials</h3><div>Forty-eight patients treated with SBRT were retrospectively included. All patients underwent gadoxetate-enhanced DCE-MRI before treatment. Equivalent uniform dose, absolute dose-volume parameters including Dxcc and VxGy(cc) were calculated in 3 liver volumes: the anatomic volume (AV), the high-functional volumes (HFV) defined based on DCE-MRI derived function map, and the low-functional volume (LFV = AV – HFV). The primary endpoint of this study was the LFD as indicated by ∆albumin-bilirubin ≥ 0.5 at 1-month post-SBRT. Dose-volume parameters in patients with and without LFD were compared. Univariate logistic regression models were built to assess the ability of dose-volume parameters to distinguish between LFD and non-LFD cases.</div></div><div><h3>Results</h3><div>Of the 48 patients, 12 (25%) had LFD (∆albumin-bilirubin ≥ 0.5). The dose-volume parameters in the AV and LFV were not statistically different in patients with and without LFD (<em>P</em> &gt; .005), while D300cc, D400cc, and V10Gy(cc) of the HFV were significantly higher in patients with LFD than in the non-LFD group (<em>P</em> &lt; .005). For distinguishing LFD and non-LFD cases, the mean area under curves (AUCs) for D300cc of AV, LFV, and HFV are 0.60, 0.50, and 0.78, respectively. The mean AUCs for D400cc of AV, LFV, and HFV are 0.62, 0.50, and 0.78, respectively. The mean AUCs for V10Gy of AV, LFV, and HFV are 0.63, 0.48, and 0.77, respectively.</div></div><div><h3>Conclusions</h3><div>The dose-volume parameters derived from HFV were linked to the risk of post-SBRT LFD. These functional parameters derived based on DCE-MRI could be useful to guide more personalized SBRT planning to protect liver function.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101883"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324503","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":"Clinical Efficacy of Hydrogen Therapy on Acute Radiation Enteritis and Inflammatory Response in Patients with Cervical Cancer Undergoing Concurrent Chemoradiation Therapy","authors":"Bo Liu PhD ,&nbsp;Yao Bao MD ,&nbsp;Jinan Ma PhD ,&nbsp;Xiaodong Wang PhD ,&nbsp;Yeqian Feng PhD","doi":"10.1016/j.adro.2025.101879","DOIUrl":"10.1016/j.adro.2025.101879","url":null,"abstract":"<div><h3>Purpose</h3><div>Acute radiation enteritis (ARE) is a common toxic inflammatory reaction in patients with cervical cancer undergoing concurrent chemoradiation therapy (CCRT). Molecular hydrogen, as a novel antioxidant and anti-inflammatory agent, may alleviate treatment-related toxicity. This study aimed to evaluate the efficacy of inhaled hydrogen in preventing ARE and modulating systemic inflammation.</div></div><div><h3>Methods</h3><div>Eligible patients with cervical cancer undergoing CCRT were prospectively enrolled and randomized into an experimental group (n = 28) or a control group (n = 30). The experimental group received inhalation therapy with a hydrogen-oxygen gas mixture (66.6% hydrogen, 33.3% oxygen; 3 L/min, 2 h/d) on each radiation therapy day. Inflammatory biomarkers—including C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and interleukin 6—as well as hemogram parameters, fecal occult blood, Late Effects Normal Tissue Task Force—Subjective, Objective, Management, and Analytic scores; Patient-Generated Subjective Global Assessment scores; and Radiation Therapy Oncology Group enteritis grades were monitored during treatment and Response Evaluation Criteria in Solid Tumors scores.</div></div><div><h3>Results</h3><div>Baseline characteristics (age, tumor stage, pathology, and surgical history) were balanced between groups (<em>P</em> &gt; .05). Compared with the control group, the experimental group showed significantly lower levels of C-reactive protein, neutrophil-to-lymphocyte ratio, interleukin 6, and fecal occult blood positivity rates (<em>P</em> &lt; .05). Clinical assessments also indicated lower Late Effects Normal Tissue Task Force–Subjective, Objective, Management, and Analytic and Patient-Generated Subjective Global Assessment scores and milder Radiation Therapy Oncology Group enteritis grading in the hydrogen group (<em>P</em> &lt; .05). Importantly, no significant difference in tumor response was observed between groups based on the Response Evaluation Criteria in Solid Tumors, suggesting that hydrogen therapy did not interfere with the antitumor efficacy of CCRT. No adverse events related to hydrogen inhalation were reported.</div></div><div><h3>Conclusion</h3><div>Hydrogen inhalation is a safe and effective adjunctive therapy that significantly alleviates inflammation and mitigates clinical symptoms of ARE in patients with cervical cancer who are undergoing CCRT, without compromising antitumor treatment outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101879"},"PeriodicalIF":2.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145107380","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":"Magnetic Resonance Imaging Radiomic Analysis of Radiation-Induced Morphea of the Breast: A Proof-of-Concept Study","authors":"Jieying Wu MD ,&nbsp;Joseph Bae MS ,&nbsp;Chao Chen PhD ,&nbsp;Samuel Ryu MD ,&nbsp;Daniel Lozeau MD ,&nbsp;Alexander Stessin MD, PhD ,&nbsp;Prateek Prasanna PhD","doi":"10.1016/j.adro.2025.101881","DOIUrl":"10.1016/j.adro.2025.101881","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101881"},"PeriodicalIF":2.7,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119617","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":"Are There High-Risk Prognostic Factors for Isolated Locoregional Recurrence in Patients With Early-Stage Breast Cancer Treated With Mastectomy Without Adjuvant Radiation Therapy?","authors":"Giuseppe Facondo MD ,&nbsp;Chiara Reverberi MD ,&nbsp;Agnese Prisco MD ,&nbsp;Tino Ceschia MD ,&nbsp;Gianluca Vullo MD ,&nbsp;Giuseppe Aprile MD ,&nbsp;Alessandro Marco Minisini MD ,&nbsp;Luca Seriau MD ,&nbsp;Serena Bertozzi MD ,&nbsp;Carla Cedolini MD ,&nbsp;Marco Trovò MD","doi":"10.1016/j.adro.2025.101877","DOIUrl":"10.1016/j.adro.2025.101877","url":null,"abstract":"<div><h3>Purpose</h3><div>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).</div></div><div><h3>Methods and Materials</h3><div>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 <em>P</em> value of &lt;.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101877"},"PeriodicalIF":2.7,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145262942","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":"Interim Analysis of Pro-Grid: A Phase 1 Proton Spatially Fractionated Radiation Therapy Trial","authors":"Khadija Sheikh PhD ,&nbsp;Anh Tran MSc ,&nbsp;Heng Li PhD ,&nbsp;Anna W. LaVigne MD ,&nbsp;Jean L. Wright MD ,&nbsp;Aditya Halthore MD","doi":"10.1016/j.adro.2025.101857","DOIUrl":"10.1016/j.adro.2025.101857","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101857"},"PeriodicalIF":2.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781500","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":"Erratum to ‘Integrating Radiosensitivity Index and Radiation Resistance Related Index Improves Prostate Cancer Outcome Prediction’ [Advances in Radiation Oncology (2025) 10, 101713]","authors":"Qi-Qiao Wu MD ,&nbsp;Zhao-Sheng Yin MD ,&nbsp;Yi Zhang MD ,&nbsp;Yu-Fu Lin MD ,&nbsp;Jun-Rong Jiang BS ,&nbsp;Ruo-Yan Zheng BS ,&nbsp;Tao Jiang MD ,&nbsp;Dong-Xu Lin MD ,&nbsp;Peng Lai MD ,&nbsp;Fan Chao PhD ,&nbsp;Xin-Yue Wang MD ,&nbsp;Bu-Fu Tang PhD ,&nbsp;Shi-Suo Du PhD ,&nbsp;Jing Sun MD ,&nbsp;Ping Yang MD ,&nbsp;Zhao-Chong Zeng PhD","doi":"10.1016/j.adro.2025.101830","DOIUrl":"10.1016/j.adro.2025.101830","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 8","pages":"Article 101830"},"PeriodicalIF":2.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831579","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":"Case Volume and Experience in Stereotactic Radiation: Analysis of a Prospective Peer Review Program","authors":"Luke Peng MD ,&nbsp;Kee-Young Shin MS ,&nbsp;Tara Kosak MEd ,&nbsp;Ayal A. Aizer MD ,&nbsp;John G. Phillips MD, MPH ,&nbsp;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}

{"title":"Comparative Analysis of Atlas and Neural Network Autosegmentation Methods for Pediatric Craniospinal Irradiation With the Development of a Knowledge-Based Quality Assurance Tool","authors":"Ozgur Ates ,&nbsp;James Man Git Tsui ,&nbsp;Zachary Wooten ,&nbsp;Sydney Hutcheson ,&nbsp;Rico Zhang ,&nbsp;Jared Becksfort ,&nbsp;Thomas E. Merchant ,&nbsp;Chia-ho Hua","doi":"10.1016/j.adro.2025.101847","DOIUrl":"10.1016/j.adro.2025.101847","url":null,"abstract":"<div><h3>Purpose</h3><div>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).</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 9","pages":"Article 101847"},"PeriodicalIF":2.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144712950","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":"Optimizing Workflow for Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy Toward Reduced Physician Involvement","authors":"Goda Kalinauskaite MD ,&nbsp;Luise A. Künzel PhD ,&nbsp;Anne Kluge PhD ,&nbsp;Kerstin Rubarth PhD ,&nbsp;Jakob Dannehl ,&nbsp;Celina Höhne ,&nbsp;Marcus Beck MD ,&nbsp;Daniel Zips MD ,&nbsp;Carolin Senger MD","doi":"10.1016/j.adro.2025.101874","DOIUrl":"10.1016/j.adro.2025.101874","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of an optimized online adaptive radiation therapy workflow on physician involvement.</div></div><div><h3>Methods and Materials</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> &lt; .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 (<em>P</em> &lt; .001) and 5.6 minutes for the 2-influencer workflow (<em>P</em> = .002). Most patients (84%) found the treatment time well tolerable.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101874"},"PeriodicalIF":2.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912305","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":"Osteoradionecrosis of the Hyoid Bone: A Systematic Review","authors":"Quentin H. Drane BS ,&nbsp;Andrea Ziegler MD ,&nbsp;Eric J. Thorpe MD","doi":"10.1016/j.adro.2025.101873","DOIUrl":"10.1016/j.adro.2025.101873","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>A literature review through PubMed and Scopus identified 16 relevant articles. Patient characteristics, presentation, imaging findings, management, and outcomes are highlighted.</div></div><div><h3>Results</h3><div>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%, <em>P</em> = .0042).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 10","pages":"Article 101873"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888678","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}