Advances in Radiation Oncology最新文献_第9页

Inflammatory Markers Associated With Radiation-Induced Lung Injury, Metastasis and Mortality After Breast Cancer Treatment 乳腺癌治疗后与放射性肺损伤、转移和死亡率相关的炎症标志物

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-01 Epub Date: 2025-08-28 DOI: 10.1016/j.adro.2025.101894

Jarle Karlsen MD , Guro Giskeødegård MSc, PhD , Torgrim Tandstad MD, PhD , Øyvind Salvesen MSc, PhD , Torgeir Wethal MD, PhD , Randi Johansen Reidunsdatter MSc, PhD

Purpose

Breast cancer (BC) radiation therapy (RT) prevents local recurrence and improves survival. However, it can induce acute and late effects on organs at risk, such as the lung. In some patients, radiation activates inflammatory markers, which promote inflammation in the lung leading to radiation pneumonitis and fibrosis (RF). Moreover, inflammatory markers may be associated with metastatic disease and survival. This study examines the relationships between inflammatory markers and clinical radiation pneumonitis and RF and explores their potential to predict BC metastasis or overall survival.

Methods and Materials

Patients prescribed postoperative BC RT were included in this prospective longitudinal cohort study with assessments before RT (baseline) and after 3, 6, and 12 months and at a long-term follow-up 7 to 12 years after RT. Inflammatory markers from each assessment were analyzed. BC metastasis and overall survival were registered up to 16 years after RT.

Results

Monocyte chemoattractant protein 1 at 3 months emerged as a predictor for clinical RF at 12 months. Tumor necrosis factor alpha at baseline and the change in fibroblast growth factor basic, neutrophil lymphocyte ratio, C-reactive protein, and interleukin (IL) 1b (IL-1b) from baseline to 3 months predicted BC metastasis. IL-6 at 3 and 12 months, IL-8 at 12 months, and an increase in fibroblast growth factor basic and IL-6 from baseline to 3 months were associated with all-cause mortality.

Conclusions

We found monocyte chemoattractant protein 1 linked to radiation-induced lung injury. Inflammatory markers before and after RT were associated with BC metastasis and all-cause mortality. Our findings indicate that prolonged inflammation following RT may be linked with BC metastasis and overall survival. However, further research is needed to understand their signaling pathways and their role in predicting BC outcomes.

目的乳腺癌（BC）放射治疗（RT）预防局部复发，提高生存率。然而，它会对有危险的器官（如肺）产生急性和晚期影响。在一些患者中，辐射激活炎症标志物，从而促进肺部炎症，导致放射性肺炎和纤维化（RF）。此外，炎症标志物可能与转移性疾病和生存有关。本研究探讨了炎症标志物与临床放射性肺炎和RF之间的关系，并探讨了它们预测BC转移或总生存的潜力。方法和材料在这项前瞻性纵向队列研究中纳入了接受术后BC RT治疗的患者，在RT前（基线）、3个月、6个月和12个月以及RT后7至12年的长期随访中进行评估。结果3个月时单核细胞趋化蛋白1可以作为12个月时临床RF的预测因子。基线时肿瘤坏死因子α和成纤维细胞生长因子碱性、中性粒细胞淋巴细胞比率、c反应蛋白和白细胞介素（IL） 1b （IL-1b）从基线到3个月的变化预测BC转移。3个月和12个月时的IL-6, 12个月时的IL-8，以及从基线到3个月时成纤维细胞生长因子基础和IL-6的增加与全因死亡率相关。结论单核细胞趋化蛋白1与放射性肺损伤有关。放疗前后的炎症标志物与BC转移和全因死亡率相关。我们的研究结果表明，RT后炎症的延长可能与BC转移和总生存率有关。然而，需要进一步的研究来了解它们的信号通路及其在预测BC预后中的作用。

{"title":"Inflammatory Markers Associated With Radiation-Induced Lung Injury, Metastasis and Mortality After Breast Cancer Treatment","authors":"Jarle Karlsen MD , Guro Giskeødegård MSc, PhD , Torgrim Tandstad MD, PhD , Øyvind Salvesen MSc, PhD , Torgeir Wethal MD, PhD , Randi Johansen Reidunsdatter MSc, PhD","doi":"10.1016/j.adro.2025.101894","DOIUrl":"10.1016/j.adro.2025.101894","url":null,"abstract":"<div><h3>Purpose</h3><div>Breast cancer (BC) radiation therapy (RT) prevents local recurrence and improves survival. However, it can induce acute and late effects on organs at risk, such as the lung. In some patients, radiation activates inflammatory markers, which promote inflammation in the lung leading to radiation pneumonitis and fibrosis (RF). Moreover, inflammatory markers may be associated with metastatic disease and survival. This study examines the relationships between inflammatory markers and clinical radiation pneumonitis and RF and explores their potential to predict BC metastasis or overall survival.</div></div><div><h3>Methods and Materials</h3><div>Patients prescribed postoperative BC RT were included in this prospective longitudinal cohort study with assessments before RT (baseline) and after 3, 6, and 12 months and at a long-term follow-up 7 to 12 years after RT. Inflammatory markers from each assessment were analyzed. BC metastasis and overall survival were registered up to 16 years after RT.</div></div><div><h3>Results</h3><div>Monocyte chemoattractant protein 1 at 3 months emerged as a predictor for clinical RF at 12 months. Tumor necrosis factor alpha at baseline and the change in fibroblast growth factor basic, neutrophil lymphocyte ratio, C-reactive protein, and interleukin (IL) 1b (IL-1b) from baseline to 3 months predicted BC metastasis. IL-6 at 3 and 12 months, IL-8 at 12 months, and an increase in fibroblast growth factor basic and IL-6 from baseline to 3 months were associated with all-cause mortality.</div></div><div><h3>Conclusions</h3><div>We found monocyte chemoattractant protein 1 linked to radiation-induced lung injury. Inflammatory markers before and after RT were associated with BC metastasis and all-cause mortality. Our findings indicate that prolonged inflammation following RT may be linked with BC metastasis and overall survival. However, further research is needed to understand their signaling pathways and their role in predicting BC outcomes.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101894"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576305","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

Carbon Ion Versus Photon-based Stereotactic Ablative Radiation Therapy for Patients with Choroidal Melanoma 碳离子与光子立体定向放射治疗脉络膜黑色素瘤的比较

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-01 Epub Date: 2025-09-29 DOI: 10.1016/j.adro.2025.101915

Jina Kim MD , Masaru Wakatsuki MD, PhD , Shuri Aoki MD, PhD , Jong Won Park MD, PhD , Nao Kobayashi MD, PhD , Ki Chang Keum MD, PhD , Hirokazu Makishima MD, PhD , Christopher Seungkyu Lee MD, PhD , Hitoshi Ishikawa MD, PhD , Kyung Hwan Kim MD, PhD

Purpose

To our knowledge, no study has compared the treatment outcomes of carbon ion radiation therapy (CIRT) and photon-based stereotactic ablative radiation therapy (SABR) in patients with choroidal melanoma. This study aimed to evaluate the treatment outcomes of patients with choroidal melanoma treated with CIRT or photon-based SABR.

Methods and Materials

This study included 346 patients with localized choroidal melanoma who received CIRT or photon-based SABR between April 2001 and November 2021. Patients in the CIRT group received a median of 70 Gy delivered in a median dosage of 14 Gy per fraction, and patients in the SABR group received a median of 60 Gy delivered in a median dosage of 15 Gy per fraction. Propensity score matching (PSM) was performed to account for differences between the 2 groups. The main outcome was progression-free survival (PFS) in the PSM cohort, and secondary endpoints included overall survival, cumulative incidence of local and distant failures, and enucleation.

Results

In all, 282 and 64 patients were included in the CIRT and SABR groups. After PSM, the 5-year PFS was significantly superior in the CIRT group to that in the SABR group (69.0% vs 56.5%, P = .024). The CIRT group also showed significantly reduced risks of local failure (5-year local failure rate 5.6% vs 13.4%, P = .025) and enucleation (5-year enucleation rate 8.5% vs 24.2%, P < .001). Moreover, CIRT was superior in terms of visual acuity preservation: the proportion of patients with visual acuity of ≥20/200 decreased from 64.7% initially to 23.7% at last follow-up in the CIRT group and from 64.1% to 6.3% in the SABR group (P = .005).

Conclusions

CIRT was found to be superior to SABR in patients with choroidal melanoma in terms of PFS, local control, and preservation of vision and eye.

目的据我们所知，目前还没有研究比较碳离子放射治疗（CIRT）和光子立体定向消融放射治疗（SABR）在脉络膜黑色素瘤患者中的治疗效果。本研究旨在评估使用CIRT或光子SABR治疗脉络膜黑色素瘤患者的治疗结果。方法和材料本研究纳入了346例局限性脉络膜黑色素瘤患者，这些患者在2001年4月至2021年11月期间接受了CIRT或光子SABR。CIRT组患者接受的中位放射量为70 Gy，中位剂量为14 Gy /次；SABR组患者接受的中位放射量为60 Gy，中位剂量为15 Gy /次。采用倾向评分匹配（PSM）来解释两组之间的差异。主要终点是PSM队列中的无进展生存期（PFS），次要终点包括总生存期、局部和远处失败的累积发生率以及去核。结果CIRT组282例，SABR组64例。PSM后，CIRT组的5年PFS显著优于SABR组（69.0% vs 56.5%, P = 0.024）。CIRT组局部失败（5年局部失败率5.6% vs 13.4%, P = 0.025）和去核（5年去核率8.5% vs 24.2%, P < 0.001）的风险也显著降低。此外，CIRT在视力保护方面更有优势：CIRT组视力≥20/200的患者比例从最初的64.7%下降到最后随访时的23.7%，SABR组从64.1%下降到6.3% （P = 0.005）。结论scirt在脉络膜黑色素瘤患者的PFS、局部控制、视力和眼睛保护方面优于SABR。

{"title":"Carbon Ion Versus Photon-based Stereotactic Ablative Radiation Therapy for Patients with Choroidal Melanoma","authors":"Jina Kim MD , Masaru Wakatsuki MD, PhD , Shuri Aoki MD, PhD , Jong Won Park MD, PhD , Nao Kobayashi MD, PhD , Ki Chang Keum MD, PhD , Hirokazu Makishima MD, PhD , Christopher Seungkyu Lee MD, PhD , Hitoshi Ishikawa MD, PhD , Kyung Hwan Kim MD, PhD","doi":"10.1016/j.adro.2025.101915","DOIUrl":"10.1016/j.adro.2025.101915","url":null,"abstract":"<div><h3>Purpose</h3><div>To our knowledge, no study has compared the treatment outcomes of carbon ion radiation therapy (CIRT) and photon-based stereotactic ablative radiation therapy (SABR) in patients with choroidal melanoma. This study aimed to evaluate the treatment outcomes of patients with choroidal melanoma treated with CIRT or photon-based SABR.</div></div><div><h3>Methods and Materials</h3><div>This study included 346 patients with localized choroidal melanoma who received CIRT or photon-based SABR between April 2001 and November 2021. Patients in the CIRT group received a median of 70 Gy delivered in a median dosage of 14 Gy per fraction, and patients in the SABR group received a median of 60 Gy delivered in a median dosage of 15 Gy per fraction. Propensity score matching (PSM) was performed to account for differences between the 2 groups. The main outcome was progression-free survival (PFS) in the PSM cohort, and secondary endpoints included overall survival, cumulative incidence of local and distant failures, and enucleation.</div></div><div><h3>Results</h3><div>In all, 282 and 64 patients were included in the CIRT and SABR groups. After PSM, the 5-year PFS was significantly superior in the CIRT group to that in the SABR group (69.0% vs 56.5%, <em>P</em> = .024). The CIRT group also showed significantly reduced risks of local failure (5-year local failure rate 5.6% vs 13.4%, <em>P</em> = .025) and enucleation (5-year enucleation rate 8.5% vs 24.2%, <em>P</em> < .001). Moreover, CIRT was superior in terms of visual acuity preservation: the proportion of patients with visual acuity of ≥20/200 decreased from 64.7% initially to 23.7% at last follow-up in the CIRT group and from 64.1% to 6.3% in the SABR group (<em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>CIRT was found to be superior to SABR in patients with choroidal melanoma in terms of PFS, local control, and preservation of vision and eye.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101915"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Physician Body-Site Expertise and Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy Rounds Review 医师身体部位专业知识和立体定向放射外科/立体定向放射治疗查房综述

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-01 Epub Date: 2025-08-20 DOI: 10.1016/j.adro.2025.101880

Elizabeth Covington PhD , Krithika Suresh PhD , Aleksandar Dragovic MD , Mary Feng MD , Jason Hearn MD , Reshma Jagsi MD, DPhil , Theodore Lawrence MD, PhD , Dawn Owen , Daniel Spratt MD , Kyle Cuneo MD , Scott W. Hadley PhD

Purpose

Contouring targets for stereotactic body radiation therapy (SBRT) requires expertise for each body site. Likewise, peer reviewers require sufficient expertise to provide an adequate review. In this work, we investigate physician self-reported expertise for performing peer review by body site and how the quality of SBRT peer review is impacted by the expertise of the reviewer.

Methods and Materials

The results of 7 years of SBRT rounds, which included information on body site, attending and reviewing physicians, changes to targets, prescriptions, and planning target volume, were analyzed. We surveyed physicians on their expertise for reviewing each body site and defined them as being an expert by body site if they indicated a moderate or high level of competence. Multivariable logistic regression models were used to assess the association between reviewing physician expertise and planning data changes, and whether this varied by body site or by presenting physician expertise. Models were adjusted for physician and case characteristics, and generalized estimating equations were used to account for the correlation of cases reviewed by the same physician.

Results

The survey response rate was 95% (20/21) with 4103 cases for analysis. Reviewing physician experts were more likely to make any change, gross target volume, and prescription compared with reviewing physicians who were nonexperts. Controlling for physician expertise and case characteristics, brain, liver, spine, and stereotactic radiosurgery cases have an increased odds of any change being made when compared to lung cases, with odds ratios of 2.42 (95% CI, 1.78-3.30), 1.55 (95% CI, 1.19-2.01), 1.7 (95% CI, 1.31-2.20), and 2.18 (95% CI, 1.73-2.77), respectively.

Conclusions

The extent to which changes are made during contour review is associated with both peer reviewer disease-site expertise and disease site. In larger radiation oncology departments relying on a general coverage model, rather than review by disease-site experts, peer review results in variations in the outcome of the preplanning review.

目的：立体定向全身放射治疗（SBRT）的二次巡诊目标需要每个身体部位的专业知识。同样，同行评审人员需要足够的专业知识来提供充分的评审。在这项工作中，我们调查了医生自我报告的同行评议的专业知识，以及评议者的专业知识如何影响SBRT同行评议的质量。方法与材料对7年SBRT轮次的结果进行分析，包括身体部位、就诊和复查医生、目标变更、处方和计划目标量等信息。我们调查了医生的专业知识，以审查每个身体部位，并将他们定义为身体部位的专家，如果他们表示中等或高水平的能力。使用多变量逻辑回归模型来评估回顾医生专业知识和计划数据变化之间的关系，以及这种关系是否因身体部位或医生专业知识而变化。根据医生和病例特征调整模型，并使用广义估计方程来解释由同一医生审查的病例的相关性。结果调查回复率为95%(20/21)，共分析4103例。与非专家医师相比，评估医师专家更有可能做出任何改变、总目标量和处方。在控制医生专业知识和病例特征的情况下，脑、肝、脊柱和立体定向放射手术病例与肺病例相比，发生任何改变的几率更高，比值比分别为2.42 （95% CI, 1.78-3.30）、1.55 （95% CI, 1.19-2.01）、1.7 （95% CI, 1.31-2.20）和2.18 （95% CI, 1.73-2.77）。结论轮廓线审评过程中改变的程度与审稿人疾病现场专业知识和疾病现场有关。在依靠一般覆盖模式的较大的放射肿瘤学部门，而不是由疾病现场专家进行审查，同行审查导致预先计划审查结果的变化。

{"title":"Physician Body-Site Expertise and Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy Rounds Review","authors":"Elizabeth Covington PhD , Krithika Suresh PhD , Aleksandar Dragovic MD , Mary Feng MD , Jason Hearn MD , Reshma Jagsi MD, DPhil , Theodore Lawrence MD, PhD , Dawn Owen , Daniel Spratt MD , Kyle Cuneo MD , Scott W. Hadley PhD","doi":"10.1016/j.adro.2025.101880","DOIUrl":"10.1016/j.adro.2025.101880","url":null,"abstract":"<div><h3>Purpose</h3><div>Contouring targets for stereotactic body radiation therapy (SBRT) requires expertise for each body site. Likewise, peer reviewers require sufficient expertise to provide an adequate review. In this work, we investigate physician self-reported expertise for performing peer review by body site and how the quality of SBRT peer review is impacted by the expertise of the reviewer.</div></div><div><h3>Methods and Materials</h3><div>The results of 7 years of SBRT rounds, which included information on body site, attending and reviewing physicians, changes to targets, prescriptions, and planning target volume, were analyzed. We surveyed physicians on their expertise for reviewing each body site and defined them as being an expert by body site if they indicated a moderate or high level of competence. Multivariable logistic regression models were used to assess the association between reviewing physician expertise and planning data changes, and whether this varied by body site or by presenting physician expertise. Models were adjusted for physician and case characteristics, and generalized estimating equations were used to account for the correlation of cases reviewed by the same physician.</div></div><div><h3>Results</h3><div>The survey response rate was 95% (20/21) with 4103 cases for analysis. Reviewing physician experts were more likely to make any change, gross target volume, and prescription compared with reviewing physicians who were nonexperts. Controlling for physician expertise and case characteristics, brain, liver, spine, and stereotactic radiosurgery cases have an increased odds of any change being made when compared to lung cases, with odds ratios of 2.42 (95% CI, 1.78-3.30), 1.55 (95% CI, 1.19-2.01), 1.7 (95% CI, 1.31-2.20), and 2.18 (95% CI, 1.73-2.77), respectively.</div></div><div><h3>Conclusions</h3><div>The extent to which changes are made during contour review is associated with both peer reviewer disease-site expertise and disease site. In larger radiation oncology departments relying on a general coverage model, rather than review by disease-site experts, peer review results in variations in the outcome of the preplanning review.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101880"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145412559","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

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 磁共振成像直线加速器对前列腺立体定向放射治疗中优势前列腺内病变的剂量增强：可行性和早期临床结果

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-01 Epub Date: 2025-09-16 DOI: 10.1016/j.adro.2025.101905

Michael J. Zelefsky MD, David Byun MD, Matthew Long BS, Gabriel Fuligni BS, Hesheng Wang PhD, Siming Lu PhD, Ting Chen PhD, David Barbee PhD

Purpose

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.

Methods and Materials

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.

Results

On postfraction dosimetric analysis, the median dose to 95% (D95) of the DIL was 45.3 Gy (initial plan: 45.9 Gy; P < .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; P < .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).

Conclusions

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.

目的本研究旨在评估在t2加权磁共振成像和弥散加权成像上显示的前列腺内病变（DIL）上递增剂量的可行性，同时在剂量-体积限制下保持对周围正常组织结构的剂量。方法和材料总共50例连续患者在1.5特斯拉磁共振成像直线加速器平台上接受前列腺立体定向全身放射治疗（SBRT），通过同时集成DIL提升。这些患者每隔一天接受5次SBRT治疗至40 Gy，同时将DIL分5次提高至45 Gy。没有患者接受雄激素剥夺治疗。重新绘制正常组织结构、前列腺和DIL的轮廓，并生成一个后分割计划，以回顾性地生成在这250个治疗过程中每次给予前列腺和DIL增强目标的剂量。结果经分级后剂量学分析，95% DIL的中位剂量（D95）为45.3 Gy（初始计划为45.9 Gy; P < 0.05）， 84%的治疗组DIL的中位剂量≥44 Gy。前列腺的中位D95为40.4 Gy（初始计划为40.7 Gy; P < 0.05）。尽管靶覆盖范围很好，但直肠、尿道和膀胱的剂量限制通常保持不变。在治疗结束后6个月，中位前列腺特异性抗原结果为1.1 ng/mL（范围0-5.6 ng/mL），而sbrt前的中位前列腺特异性抗原为6.8 ng/mL（范围3.45-31 ng/mL）。在中位随访10.8个月（6.4-15.7个月）期间，没有患者出现晚期3级或更高级别的泌尿或直肠毒性。结论利用磁共振成像直线加速器的实时自适应规划，在大多数情况下可以实现剂量递增，而不会明显影响周围正常组织结构的剂量-体积限制。这些剂量学结果与12个月时良好的耐受性和低尿或直肠毒性发生率相关。

{"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, David Byun MD, Matthew Long BS, Gabriel Fuligni BS, Hesheng Wang PhD, Siming Lu PhD, Ting Chen PhD, 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> < .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> < .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":"2025-12-01","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}

引用次数: 0

Risk Factors of Cardiotoxicity After Breast Cancer Radiation Therapy 乳腺癌放射治疗后心脏毒性的危险因素

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-01 Epub Date: 2025-09-21 DOI: 10.1016/j.adro.2025.101911

Felicia B. Guo BA , Hyunsoo Joshua No MD, CMD , Natalie J. Park BA , Santino Butler MD , Scott Jackson MS , June-Wha Rhee MD , Daniel Eugene Clark MD, MPH , Carol Marquez MD , Kathleen Claire Horst MD , Michael Sargent Binkley MD, MS

Purpose

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.

Methods and Materials

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.

Results

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 = 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 (P < 0.05). After multivariable adjustment for age and smoking status, nodal positive disease remained associated with increased risk of significant cardiac events (P < .05).

Conclusions

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.

目的关注乳腺癌治疗后的心脏毒性，需要更好地了解可能增加重大（≥3级）心脏事件风险的因素。我们研究了临床因素、冠状动脉钙（CAC）和放射治疗剂量对心脏结构的影响作为预测放射治疗后心脏毒性的危险因素。方法和材料我们回顾性分析了2005年至2014年接受新辅助化疗的I至III期乳腺癌患者的队列。我们测量了治疗后心脏事件的发生率，调整了死亡的竞争风险。结果174例患者，中位随访117个月，中位年龄47岁。≥3级心脏事件的10年发生率为8.5% (95% CI, 4.7%-13.6%)，观察到13个事件。166例有显像的患者中，78.9%没有可测量的CAC。淋巴结阳性患者（N = 75）发生心脏毒性的可能性是其他患者的3倍（HR=3.30），治疗期间接受蒽环类药物、激素治疗和局部淋巴结照射的可能性更高（P < 0.05）。在对年龄和吸烟状况进行多变量调整后，淋巴结阳性疾病仍与显著心脏事件风险增加相关（P < 0.05）。结论在低CAC负荷和总体低剂量辐射的乳腺癌患者队列中，我们观察到低的心脏毒性率。然而，我们的研究结果将淋巴结阳性疾病患者确定为一个特别的高风险群体，这表明需要对该亚组进行密切的随访和优化治疗。

{"title":"Risk Factors of Cardiotoxicity After Breast Cancer Radiation Therapy","authors":"Felicia B. Guo BA , Hyunsoo Joshua No MD, CMD , Natalie J. Park BA , Santino Butler MD , Scott Jackson MS , June-Wha Rhee MD , Daniel Eugene Clark MD, MPH , Carol Marquez MD , Kathleen Claire Horst MD , 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 <</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> < .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":"2025-12-01","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}

引用次数: 0

Radiation Dose Overlay Improves Radiologists' Interpretation of Post-therapy Computed Tomography Imaging for Thoracic Malignancies 放射剂量叠加改善放射科医生对胸部恶性肿瘤治疗后计算机断层成像的解释

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-12-01 Epub Date: 2025-09-13 DOI: 10.1016/j.adro.2025.101899

Kira R. Newell BA , Zoe O. Ferguson-Steele BA , David Shin BA , Min Gyu Noh MD , Sudhakar Pipavath MD , Joseph Tsai MD, PhD , Kristi Hendrickson PhD , Tyler Gutschenritter MD , John Kang MD, PhD

Purpose

Radiation therapy dose visualizations created by radiation oncologists are not accessible to diagnostic radiologists; however, access may improve interpretation accuracy and confidence when applied to surveillance imaging of patients with radiation therapy-treated thoracic malignancies.

Methods and Materials

In a prospective analysis of retrospectively acquired data, 32 imaging series of patients treated with radiation therapy for thoracic malignancies (14 men, 18 women; mean age, 71 years ± SD 10.35 years) were interpreted. One cardiothoracic radiology attending and 1 radiology resident interpreted pretreatment, treatment planning, and posttreatment computed tomography (CT) images in anonymized software sessions first without, then—after a 1 month “washout period”—with access to radiation therapy dose overlays. Readers then labeled treated lesion(s) and treatment effect(s) and recorded their confidence using a Likert scale (1-5) and agreement with yes/no statements. Binary data were analyzed with McNemar’s and Fisher’s tests, whereas Likert scale data were analyzed with paired 2-sided t tests.

Results

With the addition of radiation dose visualization, the identification of all treated lesions increased from 61% to 81% of CT series (P < .001). This was most pronounced in CT series with multiple treated lesions (15%-54% of CT series, P = .004). Confidence in identification ability also increased from a rating of 4.1 to 4.8 on a scale of 1 to 5 (P < .001), and the desire to access the chart for additional patient information decreased from 3.63 to 3.28 (P = .005).

Conclusions

Access to radiation dose visualization was associated with increased correct identification rate of irradiated lesions and treatment effects, as well as radiologists' confidence in said identifications.

目的放射肿瘤学家制作的放射治疗剂量可视化对诊断放射科医生来说是不可用的；然而，当应用于放射治疗的胸部恶性肿瘤患者的监测成像时，可提高解释的准确性和信心。方法和材料回顾性分析32例胸部恶性肿瘤放射治疗患者的影像学资料（男性14例，女性18例，平均年龄71岁±SD 10.35岁）。一名心胸放射科主治医师和一名放射科住院医师在匿名软件会议中解释了预处理、治疗计划和治疗后的计算机断层扫描（CT）图像，首先没有，然后经过一个月的“洗脱期”，可以获得放射治疗剂量叠加。然后，读者标记治疗的病变和治疗效果，并使用李克特量表（1-5）记录他们的信心和对是/否陈述的同意度。二元数据采用McNemar 's和Fisher 's检验，李克特量表数据采用配对双侧t检验。结果随着放射剂量显示的增加，所有病灶的CT序列识别率从61%提高到81% （P < .001）。这在多发病灶的CT系列中最为明显（占CT系列的15%-54%，P = 0.004）。在1到5的范围内，对识别能力的信心也从4.1等级增加到4.8等级（P < 0.001），并且访问图表以获取额外患者信息的愿望从3.63下降到3.28 （P = 0.005）。结论放射剂量可视化可提高放射病灶的正确识别率和治疗效果，提高放射科医师对放射病灶识别的信心。

{"title":"Radiation Dose Overlay Improves Radiologists' Interpretation of Post-therapy Computed Tomography Imaging for Thoracic Malignancies","authors":"Kira R. Newell BA , Zoe O. Ferguson-Steele BA , David Shin BA , Min Gyu Noh MD , Sudhakar Pipavath MD , Joseph Tsai MD, PhD , Kristi Hendrickson PhD , Tyler Gutschenritter MD , John Kang MD, PhD","doi":"10.1016/j.adro.2025.101899","DOIUrl":"10.1016/j.adro.2025.101899","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation therapy dose visualizations created by radiation oncologists are not accessible to diagnostic radiologists; however, access may improve interpretation accuracy and confidence when applied to surveillance imaging of patients with radiation therapy-treated thoracic malignancies.</div></div><div><h3>Methods and Materials</h3><div>In a prospective analysis of retrospectively acquired data, 32 imaging series of patients treated with radiation therapy for thoracic malignancies (14 men, 18 women; mean age, 71 years ± SD 10.35 years) were interpreted. One cardiothoracic radiology attending and 1 radiology resident interpreted pretreatment, treatment planning, and posttreatment computed tomography (CT) images in anonymized software sessions first without, then—after a 1 month “washout period”—with access to radiation therapy dose overlays. Readers then labeled treated lesion(s) and treatment effect(s) and recorded their confidence using a Likert scale (1-5) and agreement with yes/no statements. Binary data were analyzed with McNemar’s and Fisher’s tests, whereas Likert scale data were analyzed with paired 2-sided <em>t</em> tests.</div></div><div><h3>Results</h3><div>With the addition of radiation dose visualization, the identification of all treated lesions increased from 61% to 81% of CT series (<em>P</em> < .001). This was most pronounced in CT series with multiple treated lesions (15%-54% of CT series, <em>P</em> = .004). Confidence in identification ability also increased from a rating of 4.1 to 4.8 on a scale of 1 to 5 (<em>P</em> < .001), and the desire to access the chart for additional patient information decreased from 3.63 to 3.28 (<em>P</em> = .005).</div></div><div><h3>Conclusions</h3><div>Access to radiation dose visualization was associated with increased correct identification rate of irradiated lesions and treatment effects, as well as radiologists' confidence in said identifications.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 12","pages":"Article 101899"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576307","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

In Regard to McClure et al 关于麦克卢尔等人

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-01 Epub Date: 2025-08-27 DOI: 10.1016/j.adro.2025.101884

Phillip M. Devlin MD, FASTRO , Anna Likhacheva MD , Gerald White MS

引用次数: 0

Dosimetric Performance of Orthogonal Dual-Layer Multi-Leaf Collimator System on Locally Advanced Lung Cancer: Cardiac Substructures Sparing Plans 正交双层多叶准直系统在局部晚期肺癌中的剂量学性能：心脏亚结构保留计划

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-01 Epub Date: 2025-09-19 DOI: 10.1016/j.adro.2025.101891

AiHui Feng MS , YanHua Duan MS , ZhangRu Yang MD , Hao Wang PhD , Hua Chen PhD , HengLe Gu MS , Ying Huang MS , ZhenJiong Shen MS , XuFei Wang PhD , ZhiYong Xu PhD

Purpose

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.

Methods and Materials

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.

Results

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 < S-CS < S-WH plans. Effective dose to the immune system of the D-CS plans indicated the lowest risk among the 3 plans.

Conclusions

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.

目的本研究旨在通过使用双层多叶准直器（MLC）加速器- VenusX改善心脏亚结构的剂量分布，从而降低心血管事件和放射性肺炎（RP）的风险。方法与材料选择18例晚期肺癌患者作为研究对象。将全肺、脊髓、全心和特定的心脏亚结构（包括左心室[LV]、肺动脉、左前降支、左旋动脉[LCX]和冠状动脉）划分为危险器官，并纳入回避方案的优化过程。针对全心脏优化的单层MLC计划称为S-WH计划（WH表示全心脏），与专门设计避免心脏亚结构的单层MLC计划称为S-CS计划（CS表示心脏亚结构）一起开发。此外，为每位患者创建双层MLC避免计划，称为D-CS计划。我们评估了冠状动脉疾病、慢性心力衰竭、急性心脏事件和RP的相对风险，以及对免疫系统的有效剂量。结果d - cs方案显著降低左室、肺动脉、左前降支、LCX和冠状动脉的剂量指标，同时保持目标覆盖率，符合指标与S-WH方案相当。此外，D-CS方案显著降低lvx接受5gy （V5Gy）和V15Gy的体积，其他亚结构也经历了显著程度的剂量减少。此外，冠状动脉疾病、慢性心力衰竭、急性心脏事件和RP的相对危险度排序如下：D-CS <； S-CS <； S-WH计划。3种方案中，D-CS方案对免疫系统的有效剂量风险最低。结论双层MLC系统与单层MLC系统相比，在CS-avoidance方案中表现出更好的效果，为局部晚期肺癌患者的后续免疫治疗提供了新的机会。

{"title":"Dosimetric Performance of Orthogonal Dual-Layer Multi-Leaf Collimator System on Locally Advanced Lung Cancer: Cardiac Substructures Sparing Plans","authors":"AiHui Feng MS , YanHua Duan MS , ZhangRu Yang MD , Hao Wang PhD , Hua Chen PhD , HengLe Gu MS , Ying Huang MS , ZhenJiong Shen MS , XuFei Wang PhD , 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<sub>5Gy</sub>) for the LV and V<sub>15Gy</sub> 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 < S-CS < 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":"2025-11-01","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}

引用次数: 0

The Estimated Difference in Biologically Effective Dose Between Two-Opposing-Fields-Per-Day and One-Alternating-Field-Per-Day Carbon Ion Radiation Therapy for Prostate Cancer 前列腺癌每日两个相对场与每日一个交替场碳离子放射治疗生物有效剂量的估计差异

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-01 Epub Date: 2025-07-21 DOI: 10.1016/j.adro.2025.101863

Chi-Chuan Chiou MD , Yu-Ming Liu PhD , Keng-Li Lan PhD , Yuan-Hung Wu PhD , Tzu-Yu Lai PhD , Yu-Mei Kang MD , Jui-Pin Chen MSc , Yu-Wen Hu PhD

Purpose

This study aims to determine whether two-opposing-fields-per-day (2-fields-per-day) carbon ion radiation therapy for prostate cancer provides a significant advantage in terms of biologically effective dose (BED) for normal tissue compared to the one-alternating-field-per-day (1-field-per-day) approach.

Methods and Materials

The prescribed dose for carbon ion radiation therapy is 54 Gy (relative biological effectiveness [RBE]) in 12 fractions, and 10 patients were randomly selected for analysis. BED was calculated using 3 methods: the linear-quadratic model, modified microdosimetric kinetic model (mMKM) with a fixed clinical RBE of 2.41 (adopted in most treatment planning systems), and the mMKM without rescaling, using domain radius (

r_{d}

) values of 0.28, 0.38, and 0.45 µm with

α / β

ratios of 3, 5, and 10 Gy. Organs at risk (OARs) were contoured following standard guidelines. The dosimetric and dose-volume histogram differences, based on BEDs estimated using various methods, were compared between the 2-fields-per-day and 1-field-per-day approaches. Statistical analyses were performed using the Wilcoxon signed rank test with P < .05 considered statistically significant.

Results

The 2-fields-per-day approach resulted in significantly lower BED for noncentrally located OARs, particularly the femoral head, skin, and bone marrow. Among these, the femoral head showed the largest relative mean BED difference, with approximately 17% using the linear-quadratic model (

α / β

= 3 Gy), 7% with the mMKM model using a fixed clinical RBE, and 9% with the mMKM model (

r_{d}

= 0.38 µm,

α / β

= 3 Gy), with all P values <.01. In contrast, the differences observed for the obturator muscles and other centrally located OARs, including the urethra, bladder, and rectum, were minimal, with relative BED differences remaining below 3%.

Conclusions

Compared to the 1-field-per-day approach, the 2-fields-per-day approach results in lower BED for noncentrally located OARs, though significant variation is observed between the different methods used to estimate BED. The reduction in BED requires further investigation to evaluate its clinical significance and impact on toxicity.

目的：本研究旨在确定每天两个相对场（2场/天）的前列腺癌碳离子放射治疗是否比每天一个交替场（1场/天）的方法在正常组织的生物有效剂量（BED）方面具有显著优势。方法与材料碳离子放射治疗的处方剂量为54 Gy（相对生物有效性[RBE]），分12个部分，随机选择10例患者进行分析。BED采用3种方法计算：线性二次模型，修正微剂量动力学模型（mMKM），固定临床RBE为2.41（大多数治疗计划系统采用），以及未重新缩放的mMKM，使用域半径（rd）值为0.28,0.38和0.45µm， α/β比为3,5和10 Gy。危险器官（OARs）按照标准指南进行轮廓。基于使用各种方法估计的床，比较了每天2场和每天1场方法之间的剂量学和剂量-体积直方图差异。采用Wilcoxon符号秩检验进行统计分析，P <； 0.05认为有统计学意义。结果：对于非中心位置的OARs，特别是股骨头、皮肤和骨髓，每天2场的方法显著降低了BED。其中，股骨头表现出最大的相对平均BED差异，线性二次模型（α/β= 3 Gy）约为17%，使用固定临床RBE的mMKM模型约为7%，mMKM模型约为9% (rd = 0.38µm, α/β= 3 Gy)， P值均为<； 01。相比之下，闭孔肌和其他位于中心位置的桨，包括尿道、膀胱和直肠，观察到的差异很小，相对BED差异保持在3%以下。与每天1个油田的方法相比，每天2个油田的方法对非中心位置的桨叶的BED较低，尽管使用不同方法来估计BED之间存在显著差异。BED的减少需要进一步的研究来评估其临床意义和对毒性的影响。

{"title":"The Estimated Difference in Biologically Effective Dose Between Two-Opposing-Fields-Per-Day and One-Alternating-Field-Per-Day Carbon Ion Radiation Therapy for Prostate Cancer","authors":"Chi-Chuan Chiou MD , Yu-Ming Liu PhD , Keng-Li Lan PhD , Yuan-Hung Wu PhD , Tzu-Yu Lai PhD , Yu-Mei Kang MD , Jui-Pin Chen MSc , Yu-Wen Hu PhD","doi":"10.1016/j.adro.2025.101863","DOIUrl":"10.1016/j.adro.2025.101863","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to determine whether two-opposing-fields-per-day (2-fields-per-day) carbon ion radiation therapy for prostate cancer provides a significant advantage in terms of biologically effective dose (BED) for normal tissue compared to the one-alternating-field-per-day (1-field-per-day) approach.</div></div><div><h3>Methods and Materials</h3><div>The prescribed dose for carbon ion radiation therapy is 54 Gy (relative biological effectiveness [RBE]) in 12 fractions, and 10 patients were randomly selected for analysis. BED was calculated using 3 methods: the linear-quadratic model, modified microdosimetric kinetic model (mMKM) with a fixed clinical RBE of 2.41 (adopted in most treatment planning systems), and the mMKM without rescaling, using domain radius (<span><math><msub><mi>r</mi><mi>d</mi></msub></math></span>) values of 0.28, 0.38, and 0.45 µm with <span><math><mrow><mi>α</mi><mo>/</mo><mi>β</mi></mrow></math></span> ratios of 3, 5, and 10 Gy. Organs at risk (OARs) were contoured following standard guidelines. The dosimetric and dose-volume histogram differences, based on BEDs estimated using various methods, were compared between the 2-fields-per-day and 1-field-per-day approaches. Statistical analyses were performed using the Wilcoxon signed rank test with <em>P</em> < .05 considered statistically significant.</div></div><div><h3>Results</h3><div>The 2-fields-per-day approach resulted in significantly lower BED for noncentrally located OARs, particularly the femoral head, skin, and bone marrow. Among these, the femoral head showed the largest relative mean BED difference, with approximately 17% using the linear-quadratic model (<span><math><mrow><mi>α</mi><mo>/</mo><mi>β</mi></mrow></math></span>= 3 Gy), 7% with the mMKM model using a fixed clinical RBE, and 9% with the mMKM model (<span><math><msub><mi>r</mi><mi>d</mi></msub></math></span> = 0.38 µm, <span><math><mrow><mi>α</mi><mo>/</mo><mi>β</mi><mspace></mspace></mrow></math></span>= 3 Gy), with all <em>P</em> values <.01. In contrast, the differences observed for the obturator muscles and other centrally located OARs, including the urethra, bladder, and rectum, were minimal, with relative BED differences remaining below 3%.</div></div><div><h3>Conclusions</h3><div>Compared to the 1-field-per-day approach, the 2-fields-per-day approach results in lower BED for noncentrally located OARs, though significant variation is observed between the different methods used to estimate BED. The reduction in BED requires further investigation to evaluate its clinical significance and impact on toxicity.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"10 11","pages":"Article 101863"},"PeriodicalIF":2.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156161","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

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 基于动态增强磁共振成像的新型图像生物标志物的功能剂量-体积分析预测肝癌患者立体定向放射治疗后肝功能保存

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology

Pub Date : 2025-11-01 Epub Date: 2025-08-19 DOI: 10.1016/j.adro.2025.101883

Yimin Ni MSc , Ho-Fun Victor Lee MD , Chi-leung Chiang MD , Lai-Yin Andy Cheung PhD , Zhengxing Huang PhD , Xinzhi Teng PhD , Jiang Zhang PhD , Ge Ren PhD , Jing Cai PhD , Tian Li PhD

Purpose

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.

Methods and Materials

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.

Results

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 (P > .005), while D300cc, D400cc, and V10Gy(cc) of the HFV were significantly higher in patients with LFD than in the non-LFD group (P < .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.

Conclusions

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.

目的本研究的目的是确定基于动态对比增强磁共振成像（DCE-MRI）获得的图像生物标志物的功能剂量-体积参数，用于预测肝细胞癌患者立体定向放射治疗（SBRT）后肝功能恶化（LFD）。方法与材料回顾性分析48例接受SBRT治疗的患者。所有患者治疗前均行加多赛特增强DCE-MRI检查。计算等效均匀剂量、绝对剂量-体积参数Dxcc、VxGy(cc) 3个肝体积：解剖体积（AV）、基于DCE-MRI衍生功能图定义的高功能体积（HFV）、低功能体积（LFV = AV - HFV）。本研究的主要终点是sbrt后1个月时，以∆白蛋白-胆红素≥0.5表示的LFD。比较LFD患者和非LFD患者的剂量-体积参数。建立单变量逻辑回归模型来评估剂量-体积参数区分LFD和非LFD病例的能力。结果48例患者中，12例（25%）发生LFD（∆白蛋白-胆红素≥0.5）。肝功能不全组与无肝功能不全组间房颤、低房颤的剂量-体积参数差异无统计学意义（P < 0.005），肝功能不全组间房颤D300cc、D400cc、V10Gy（cc）显著高于无肝功能不全组（P < 0.005）。为了区分LFD和非LFD病例，AV、LFV和HFV的D300cc的平均曲线下面积（aus）分别为0.60、0.50和0.78。AV、LFV和HFV D400cc的平均auc分别为0.62、0.50和0.78。AV、LFV和HFV V10Gy的平均auc分别为0.63、0.48和0.77。结论HFV衍生的剂量-体积参数与sbrt后LFD的风险相关。这些基于DCE-MRI的功能参数可用于指导更个性化的SBRT计划以保护肝功能。

{"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 , Ho-Fun Victor Lee MD , Chi-leung Chiang MD , Lai-Yin Andy Cheung PhD , Zhengxing Huang PhD , Xinzhi Teng PhD , Jiang Zhang PhD , Ge Ren PhD , Jing Cai PhD , 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> > .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> < .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":"2025-11-01","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}

引用次数: 0