Advances in Radiation Oncology最新文献

{"title":"Impact of Clinical Factors on 18F-Flotufolastat Detection Rates in Men With Recurrent Prostate Cancer: Exploratory Analysis of the Phase 3 SPOTLIGHT Study","authors":"","doi":"10.1016/j.adro.2024.101532","DOIUrl":"10.1016/j.adro.2024.101532","url":null,"abstract":"<div><h3>Purpose</h3><p>¹⁸F-Flotufolastat (¹⁸F-rhPSMA-7.3) is a newly approved prostate-specific membrane antigen targeting radiopharmaceutical for diagnostic imaging of prostate cancer (PCa). SPOTLIGHT (National Clinical Trials 04186845) evaluated ¹⁸F-flotufolastat in men with suspected PCa recurrence. Here, we present results of predefined exploratory endpoints from SPOTLIGHT to evaluate the impact of clinical factors on ¹⁸F-flotufolastat detection rates (DR).</p></div><div><h3>Methods and Materials</h3><p>The impact of baseline prostate-specific antigen (PSA), PSA doubling time (PSAdt), and International Society of Urologic Pathology Grade Group (GG) on ¹⁸F-flotufolastat DR was evaluated among all SPOTLIGHT patients with an evaluable scan, with DR stratified according to the patients’ prior treatment (radical prostatectomy ± radiation therapy [RP] or radiation therapy only [RT]). The patients underwent positron emission tomography 50 to 70 minutes after receiving ¹⁸F-flotufolastat (296 MBq IV), and scans were read by 3 blinded central readers, with the majority read representing agreement between ≥2 readers.</p></div><div><h3>Results</h3><p>In total, 389 men (median PSA: 1.10 ng/mL) were evaluable. By majority read, ¹⁸F-flotufolastat identified distant lesions in 39% and 43% of patients treated with prior RP or RT, respectively. The overall DR broadly increased with increasing PSA (&lt;0.2 ng/mL: 33%; ≥10 ng/mL: 100%). Among patients with PSA &lt;1 ng/mL, 68% had positive scans, and 27% had extrapelvic findings. PSAdt was available for 145/389 (37%) patients. PSAdt did not appear to influence ¹⁸F-flotufolastat DR (77%-90% across all PSAdt categories). Among patients with prior RP, DR ranged from 70% to 83% across PSAdt categories, and 100% DR was reported for all post-RT patients. In total, 362/389 (93%) patients had baseline GG data. Overall DRs were uniformly high (75%‒95%) across all GG. When stratified by prior treatment, DRs across all GG were 69% to 89% in patients with prior RP and ≥96% in patients with prior RT.</p></div><div><h3>Conclusions</h3><p>¹⁸F-Flotufolastat-positron emission tomography enabled the accurate detection of recurrent PCa lesions across a wide range of PSA, PSAdt, and International Society of Urologic Pathology GG, thus supporting its clinical utility for a broad range of patients with recurrent PCa.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101532"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000952/pdfft?md5=52d6d6627ce3ef308d040e3c629b718c&pid=1-s2.0-S2452109424000952-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Planning Methods for Dose Painting by Numbers Treatment in Gamma Knife Radiosurgery","authors":"","doi":"10.1016/j.adro.2024.101534","DOIUrl":"10.1016/j.adro.2024.101534","url":null,"abstract":"<div><h3>Purpose</h3><p>Dose painting radiation therapy delivers a nonuniform dose to tumors to account for heterogeneous radiosensitivity. With recent and ongoing development of Gamma Knife machines making large-volume brain tumor treatments more practical, it is increasingly feasible to deliver dose painting treatments. The increased prescription complexity means automated treatment planning is greatly beneficial, and the impact of dose painting on stereotactic radiosurgery (SRS) plan quality has not yet been studied. This research investigates the plan quality achievable for Gamma Knife SRS dose painting treatments when using optimization techniques and automated isocenter placement in treatment planning.</p></div><div><h3>Methods and Materials</h3><p>Dose painting prescription functions with varying parameters were applied to convert voxel image intensities to prescriptions for 10 sample cases. To study achievable plan quality and optimization, clinically placed isocenters were used with each dose painting prescription and optimized using a semi-infinite linear programming formulation. To study automated isocenter placement, a grassfire sphere-packing algorithm and a clinically available Leksell gamma plan isocenter fill algorithm were used. Plan quality for each optimized treatment plan was measured with dose painting SRS metrics.</p></div><div><h3>Results</h3><p>Optimization can be used to find high quality dose painting plans, and plan quality is affected by the dose painting prescription method. Polynomial function prescriptions show more achievable plan quality than sigmoid function prescriptions even with high mean dose boost. Automated isocenter placement is shown as a feasible method for dose painting SRS treatment, and increasing the number of isocenters improves plan quality. The computational solve time for optimization is within 5 minutes in most cases, which is suitable for clinical planning.</p></div><div><h3>Conclusions</h3><p>The impact of dose painting prescription method on achievable plan quality is quantified in this study. Optimization and automated isocenter placement are shown as possible treatment planning methods to obtain high quality plans.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101534"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000976/pdfft?md5=608466e3ee613eecd6026e214a108272&pid=1-s2.0-S2452109424000976-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141024365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Visualization and Radiation Treatment Plan Quality Scoring Method for Triage in a Population-Based Context","authors":"Alexandra O. Leone MBS ,&nbsp;Abdallah S.R. Mohamed MD, PhD ,&nbsp;Clifton D. Fuller MD, PhD ,&nbsp;Christine B. Peterson PhD ,&nbsp;Adam S. Garden MD ,&nbsp;Anna Lee MD, MPH ,&nbsp;Lauren L. Mayo MD ,&nbsp;Amy C. Moreno MD ,&nbsp;Jay P. Reddy MD, PhD ,&nbsp;Karen Hoffman MD ,&nbsp;Joshua S. Niedzielski PhD ,&nbsp;Laurence E. Court PhD ,&nbsp;Thomas J. Whitaker PhD","doi":"10.1016/j.adro.2024.101533","DOIUrl":"10.1016/j.adro.2024.101533","url":null,"abstract":"<div><h3>Purpose</h3><p>Our purpose was to develop a clinically intuitive and easily understandable scoring method using statistical metrics to visually determine the quality of a radiation treatment plan.</p></div><div><h3>Methods and Materials</h3><p>Data from 111 patients with head and neck cancer were used to establish a percentile-based scoring system for treatment plan quality evaluation on both a plan-by-plan and objective-by-objective basis. The percentile scores for each clinical objective and the overall treatment plan score were then visualized using a daisy plot. To validate our scoring method, 6 physicians were recruited to assess 60 plans, each using a scoring table consisting of a 5-point Likert scale (with scores ≥3 considered passing). Spearman correlation analysis was conducted to assess the association between increasing treatment plan percentile rank and physician rating, with Likert scores of 1 and 2 representing clinically unacceptable plans, scores of 3 and 4 representing plans needing minor edits, and a score of 5 representing clinically acceptable plans. Receiver operating characteristic curve analysis was used to assess the scoring system's ability to quantify plan quality.</p></div><div><h3>Results</h3><p>Of the 60 plans scored by the physicians, 8 were deemed as clinically acceptable; these plans had an 89.0th ± 14.5 percentile value using our scoring system. The plans needing minor edits or deemed unacceptable had more variation, with scores falling in the 62.6nd ± 25.1 percentile and 35.6th ± 25.7 percentile, respectively. The estimated Spearman correlation coefficient between the physician score and treatment plan percentile was 0.53 (<em>P</em> &lt; .001), indicating a moderate but statistically significant correlation. Receiver operating characteristic curve analysis demonstrated discernment between acceptable and unacceptable plan quality, with an area under the curve of 0.76.</p></div><div><h3>Conclusions</h3><p>Our scoring system correlates with physician ratings while providing intuitive visual feedback for identifying good treatment plan quality, thereby indicating its utility in the quality assurance process.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101533"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000964/pdfft?md5=1ec273f3ec0b3ebf2b0a60ff2373317f&pid=1-s2.0-S2452109424000964-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Surface-guided Radiation Therapy for Upper and Lower Limb Sarcomas: An Analysis of Setup Errors and Clinical Target Volume-To-Planning Target Volume Margins","authors":"Yan-Xin Zhang MS ,&nbsp;Fu-Kui Huan MB ,&nbsp;Bao Wan MB,&nbsp;Zhao-Hui Li BS,&nbsp;Wei Li BS,&nbsp;Geng-Qiang Zhu BS,&nbsp;Zhi-Wei Wang BS,&nbsp;Huan Chen BS,&nbsp;Lu Hou MB,&nbsp;Hao Jing MD,&nbsp;Shu-Lian Wang MD,&nbsp;Ning-Ning Lu MD","doi":"10.1016/j.adro.2024.101526","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101526","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the clinical benefits of surface-guided radiation therapy (SGRT) in terms of setup error, positioning time, and clinical target volume-to-planning target volume (CTV-PTV) margin in extremity soft tissue sarcoma (STS).</p></div><div><h3>Methods and Materials</h3><p>Fifty consecutive patients treated with radiation therapy were selected retrospectively. Treatment setup was performed with either laser-based imaging only (control group), or with laser-based and daily optical surface-based imaging (SGRT group). Pretreatment cone beam computed tomography images were acquired daily for the first 3 to 5 fractions and weekly thereafter, with the frequency adjusted as necessary. Translational and rotational errors were collected. CTV-PTV margin was calculated using the formula, 2.5Σ + 0.7σ.</p></div><div><h3>Results</h3><p>Each group consisted of 10 and 15 upper and lower limb STSs, respectively. For patients with upper limb sarcomas, the translation errors were 1.64 ± 1.34 mm, 1.10 ± 1.50 mm, and 1.24 ± 1.45 mm in the SGRT group, and 1.48 ± 3.16 mm, 2.84 ± 2.85 mm, and 3.14 ± 3.29 mm in control group in the left-right, supero-inferior, and antero-posterior directions, respectively. Correspondingly, for patients with lower limb sarcomas, the translation errors were 1.21 ± 1.65 mm, 1.39 ± 1.71 mm, and 1.48 ± 2.10 mm in the SGRT group, and 1.81 ± 2.60 mm, 2.93 ± 3.28 mm, and 3.53 ± 3.75 mm in control group, respectively. The calculated CTV-PTV margins of the SGRT group and control group were 5.0, 3.8, 4.1 versus 5.9, 9.1, 10.1 mm for upper limb sarcomas; and 4.2, 4.7, 5.2 mm versus 6.3, 9.6, and 11.4 mm for lower limb sarcomas in the left-right, supero-inferior, and antero-posterior directions, respectively.</p></div><div><h3>Conclusions</h3><p>Daily optical surface guidance can effectively improve the setup accuracy of extremity STS patients, and safely reduce the required CTV-PTV margins.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101526"},"PeriodicalIF":2.2,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000897/pdfft?md5=107e7ba8a24a5700b72242013256c9c7&pid=1-s2.0-S2452109424000897-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141484495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrahypofractionated Radiation Therapy for Prostate Cancer Including Seminal Vesicles in the Target Volume: A Treatment-planning Study Based on the HYPO-RT-PC Fractionation Schedule","authors":"Elinore Wieslander PhD ,&nbsp;Vilberg Jóhannesson PhD ,&nbsp;Per Nilsson PhD ,&nbsp;Elisabeth Kjellén MD, PhD ,&nbsp;Adalsteinn Gunnlaugsson MD, PhD","doi":"10.1016/j.adro.2024.101531","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101531","url":null,"abstract":"<div><h3>Purpose</h3><p>Ultrahypofractionated (UHF) radiation therapy (RT) has become a treatment alternative for patients with localized prostate cancer. In more advanced cases, seminal vesicles (SVs) are routinely included in the target volume. The Scandinavian HYPO-RT-PC trial, which compared 42.7 Gy in 7 fractions (fr) to conventional fractionation (CF), did not include SVs in the clinical target volume. The primary objective of the present work was to implement a ultrahypofractionated-simultaneous integrated boost (UHF-SIB) for prostate cancer RT, incorporating SVs into the target volume based on this fractionation schedule. A secondary objective was to analyze the unintentional dose coverage of SVs from state-of-the-art volumetric modulated arc therapy treatments to the prostate gland only.</p></div><div><h3>Methods and Materials</h3><p>Two different equieffective UHF-SIB treatment schedules to SVs were derived based on the CF clinical schedule (50.0 Gy/25 fr to elective SVs and 70.0 Gy/35 fr to verified SV-invasion (SVI)) using the linear quadric model with α/β = 2 Gy and 3 Gy. The dose to the prostate was 42.7 Gy/7 fr in both schedules, with 31.2 Gy/37.8 Gy (α/β = 2 Gy) and 32.7 Gy/40.1 Gy (α/β = 3 Gy) to elective SV/verified SVI. Volumetric modulated arc therapy plans to the proximal 10 mm and 20 mm were optimized, and dose-volume metrics for target volumes and organs at risk were evaluated.</p></div><div><h3>Results</h3><p>Dose metrics were overall lower for UHF-SIB compared with CF. QUANTEC-based volume criteria were 2% to 7% lower for the rectum and 2% to 4% lower for the bladder in the UHF-SIB. The D_98% to elective SV was 7 to 12 Gy₃ lower with UHF-SIB, and the corresponding data for verified SVI were approximately 2 to 3 Gy₃. The SV(10 mm) V_{90%/(29.5 Gy)} for prostate-only treatments (42.7 Gy) were as follows: median (IQR), 99% (87-100) and 78% (58-99) for the clinical target volume and planning target volume, respectively.</p></div><div><h3>Conclusions</h3><p>UHF RT based on the HYPO-RT-PC fractionation schedule, with a SIB technique, to the prostate and the base of the SV can be planned with lower doses (EQD2) to organs at risk, compared with CF. The unintentional dose to the proximal parts of SVs in prostate-only treatment can be substantial.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 7","pages":"Article 101531"},"PeriodicalIF":2.3,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000940/pdfft?md5=9a1c0706c9ed6d6e8792a782f49ca6b0&pid=1-s2.0-S2452109424000940-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141241390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exacerbated Inflammatory Gene Expression After Impaired G2/M-Checkpoint Arrest in Fibroblasts Derived From a Patient Exhibiting Severe Adverse Effects","authors":"Takahiro Oike ,&nbsp;Ken Okuda ,&nbsp;Shunji Haruna ,&nbsp;Akiko Shibata ,&nbsp;Ryota Hayashi ,&nbsp;Mayu Isono ,&nbsp;Kohei Tateno ,&nbsp;Nobuteru Kubo ,&nbsp;Akihiko Uchiyama ,&nbsp;Sei-Ichiro Motegi ,&nbsp;Tatsuya Ohno ,&nbsp;Yuki Uchihara ,&nbsp;Yu Kato ,&nbsp;Atsushi Shibata","doi":"10.1016/j.adro.2024.101530","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101530","url":null,"abstract":"<div><h3>Purpose</h3><p>Recent radiation therapy (RT), such as intensity modulated radiation therapy and particle RT, has improved the concentration of the radiation field targeting tumors. However, severe adverse effects still occur, possibly due to genetic factors in patients. We aimed to investigate the mechanism of exacerbated inflammation during RT.</p></div><div><h3>Methods and Materials</h3><p>Dermal fibroblasts derived from a patient with severe inflammatory adverse effects during RT were compared with 2 normal human dermal fibroblasts. Micronuclei formation, G2/M-checkpoint arrest, DNA damage signaling and repair, and inflammatory gene expression were comprehensively examined.</p></div><div><h3>Results</h3><p>We found greater micronuclei formation in radiation-sensitive fibroblasts (RS-Fs) after ionizing radiation (IR). RS-Fs exhibited premature G2/M-checkpoint release after IR, which triggers micronuclei formation because RS-Fs undergo mitosis with unrepaired DNA double-strand breaks (DSBs). Additionally, we found that DSB end-resection and activation of the ATR-Chk1 pathway were impaired in RS-Fs after IR. Consistent with the increase in the formation of micronuclei, which can deliver cytosolic nucleic acids resulting in an innate immune response, the expression of genes associated with inflammatory responses was highly upregulated in RS-Fs after IR.</p></div><div><h3>Conclusions</h3><p>Although this is a single case of RT-dependent adverse effect, our findings suggest that impaired G2/M-checkpoint arrest due to the lack of DSB end-resection and activation of the ATR-Chk1 pathway causes exacerbated inflammation during RT; therefore, genes involved in G2/M-checkpoint arrest may be a predictive marker for unexpected inflammatory responses in RT.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101530"},"PeriodicalIF":2.3,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000939/pdfft?md5=81ab3126a13885d4171e487f32898eaa&pid=1-s2.0-S2452109424000939-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141423925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Olaparib and Radiation Therapy for BRCA2-Mutated Breast Cancer","authors":"Danny Lavigne MD ,&nbsp;Lucas Sideris MD ,&nbsp;Lara de Guerke MD ,&nbsp;Eve-Lyne Marchand MD ,&nbsp;Suzanne Fortin MD ,&nbsp;Pierre Dubé MD ,&nbsp;Peter Vavassis MD ,&nbsp;Marie-Hélène Auclair MD ,&nbsp;Michael Yassa MD","doi":"10.1016/j.adro.2024.101528","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101528","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 7","pages":"Article 101528"},"PeriodicalIF":2.3,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000915/pdfft?md5=7b6f57227eb9cc7b18148a12a923b56d&pid=1-s2.0-S2452109424000915-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining Obinutuzumab With Radiation for Refractory DLBCL: Retrospective Safety and Efficacy Analysis","authors":"Brett A. Morris MD, PhD ,&nbsp;Emily C. Merfeld MD ,&nbsp;Adam R. Burr MD, PhD ,&nbsp;Kristin A. Bradley MD ,&nbsp;Christopher D. Fletcher MD","doi":"10.1016/j.adro.2024.101524","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101524","url":null,"abstract":"<div><h3>Purpose</h3><p>Approximately 30% of patients with diffuse large B cell lymphoma (DLBCL) will develop relapsed or treatment-refractory disease after primary chemotherapy. Patients unable to undergo aggressive chemotherapy and stem cell transplant or chimeric antigen receptor T-cell (CAR T-cell) therapy have limited treatment options. Here, we investigated the safety and efficacy of combining obinutuzumab with cytoreductive radiation to all areas of disease in patients with relapsed DLBCL.</p></div><div><h3>Methods and Materials</h3><p>A retrospective review of patients with treatment refractory DLBCL was performed. All patients were treated with external beam radiation to all sites of refractory disease with concurrent and adjuvant obinutuzumab. Toxicities were evaluated based on Common Terminology Criteria for Adverse Events v5.0 criteria. Kaplan-Meier analysis was used to calculate progression-free survival and overall survival.</p></div><div><h3>Results</h3><p>Between 2016 and 2022, 7 patients with refractory DLBCL were treated with concurrent radiation and obinutuzumab. No grade 3 or greater treatment-related toxicity was observed. Four of the 7 patients had a complete response at the radiated site on first postradiation imaging. The median progression-free survival and overall survival were 30 months.</p></div><div><h3>Conclusions</h3><p>In this small cohort of treatment-refractory patients with DLBCL, the combination of radiation and obinutuzumab was well tolerated without excessive treatment-related toxicity. The combination resulted in durable disease control with a prolonged overall survival without additional treatment in a subset of patients.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 7","pages":"Article 101524"},"PeriodicalIF":2.3,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000873/pdfft?md5=20cda2a4f3814dcc6d7394bf3875bef4&pid=1-s2.0-S2452109424000873-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141067655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motion-Inclusive Treatment Planning to Assess Normal Tissue Dose for Central Lung Stereotactic Body Radiation Therapy","authors":"David Cooper MD ,&nbsp;Laura Padilla PhD ,&nbsp;Amy Watson CMD ,&nbsp;Keith Neiderer CMD ,&nbsp;Benjamin Smith CMD ,&nbsp;Elisabeth Weiss MD","doi":"10.1016/j.adro.2024.101525","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101525","url":null,"abstract":"<div><h3>Purpose</h3><p>For lung stereotactic body radiation therapy, 4-dimensional computed tomography is often used to delineate target volumes, whereas organs at risk (OARs) are typically outlined on either average intensity projection (AIP) or midventilation (MidV = 30% phase) images. AIP has been widely adopted as it represents a true average, but image blurring often precludes accurate contouring of critical structures such as central airways. Here, we compare AIP versus MidV planning for centrally located tumors via respiratory motion-inclusive (RMI) plans to better evaluate dose delivered throughout the breathing cycle.</p></div><div><h3>Methods and Materials</h3><p>Independently contoured and optimized AIP and MidV plans were created for 16 treatments and rigidly copied to each of the 10 breathing phase-specific computed tomography image sets. Resulting dose distributions were deformably registered back to the MidV image set (used as reference because of clearer depiction of anatomy compared with motion-blurred AIP) and averaged to create RMI plans. Doses to central OARs were compared between plans.</p></div><div><h3>Results</h3><p>Mean absolute dose differences were low for all comparisons (range, 0.01-2.87 Gy); however, individual plans exhibited differences &gt;20 Gy. Dose differences &gt;5 Gy were observed most often for plan comparisons involving AIP-based plans (MidV vs AIP 23, AIP RMI vs AIP 12, MidV RMI vs AIP RMI 7, and MidV RMI vs MidV 8 times). Inclusion of respiratory motion reduced large dose differences. Standard OAR thresholds were exceeded up to 5 times for each plan comparison scenario and always involved proximal bronchial tree D4 cc tolerance dose. AIP-based contours were larger by, on average, 3% to 15%.</p></div><div><h3>Conclusions</h3><p>Large dose differences were observed when plans with AIP-based contours were compared with MidV-based contours, indicating that observed dose differences were likely due to contoured volume differences rather than the effect of motion. Because of blurring with AIP images, MidV RMI-based planning may offer a more accurate method to determine dose to critical OARs in the presence of respiratory motion.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 7","pages":"Article 101525"},"PeriodicalIF":2.3,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000885/pdfft?md5=2eba7bed77a69f4551986c6e697a0c3d&pid=1-s2.0-S2452109424000885-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric Advantage of Combined IMRT for Whole Lung and Abdomen Irradiation for Wilms Tumor","authors":"Basil H. Chaballout BA ,&nbsp;Kyra N. McComas MD ,&nbsp;Mohamed Khattab MD ,&nbsp;Gabrielle P. Seymore MS, DABR ,&nbsp;Stephen K. Martinez PhD ,&nbsp;Guozhen Luo MS ,&nbsp;Austin Kirschner MD, PhD ,&nbsp;Leo Y. Luo MD","doi":"10.1016/j.adro.2024.101527","DOIUrl":"https://doi.org/10.1016/j.adro.2024.101527","url":null,"abstract":"<div><h3>Purpose</h3><p>In patients with Wilms tumor with lung metastases, a cardiac-sparing intensity modulated radiation therapy (CS-IMRT) technique is increasingly being adopted for whole lung irradiation. However, the standard technique for flank and whole abdomen radiation remains 2-dimensional anterioposterior (AP), and overlap at the junction between the whole lung CS-IMRT and abdominal AP fields can result in overdose to normal organs. Here, we compared the dosimetry of patients who received whole lung irradiation and flank or abdominal radiation therapy with CS-IMRT with AP abdominal field (IMRT-AP) versus CS-IMRT with IMRT abdominal field (combined IMRT).</p></div><div><h3>Methods and Materials</h3><p>We retrospectively reviewed the radiation plans of 2 patients with Wilms tumor who received CS-IMRT and flank or whole abdomen irradiation with a combined IMRT approach. Comparison IMRT-AP plans were generated with equivalent target coverage of 95% receiving the prescribed dose. Maximum doses to normal organs were compared at the junctional overlap.</p></div><div><h3>Results</h3><p>Overlap at the junction between CS-IMRT and abdominal fields resulted in a significantly lower dose with combined IMRT plans compared with IMRT-AP plan. Differences in maximum doses (in cGy) to normal organs between combined IMRT versus IMRT-AP plans were most significant in the vertebral body (patient 1 = 1277 vs 2065; patient 2 = 1334 vs 2287), lungs (patient 1 = 1298 vs 2081; patient 2 = 1234 vs 1820), spinal cord (patient 1 = 1235 vs 1975; patient 2 = 1345 vs 2253), stomach (patient 1 = 1264 vs 1977; patient 2 = 1118 vs 2062), and liver (patient 1 = 1297 vs 1889; patient 2 = 1334 vs 2237).</p></div><div><h3>Conclusions</h3><p>The combined IMRT approach for Wilms patients who require whole lung and abdomen irradiation can provide more uniform dose distribution in the junction area and significantly lower doses to normal organs at the junctional overlap.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 8","pages":"Article 101527"},"PeriodicalIF":2.3,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424000903/pdfft?md5=573984a7ab83d6b2b2cf567c336fd4b0&pid=1-s2.0-S2452109424000903-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141324941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}