Cancer Radiotherapie最新文献

Electron radiation therapy: Back to the future? 电子放射治疗：回到未来？

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.013

Electron radiotherapy has long been preferred to photons for the treatment of superficial lesions because of its physical characteristics (high dose at the surface, rapid decrease in depth). Other characteristics (penumbra, heterogeneity on an oblique or irregular surface) make them difficult to use. In most indications (skin cancers, head and neck, medulloblastoma), with technical progress, in some cases they have been replaced by intensity-modulated conformal radiotherapy, brachytherapy and contact therapy. Other indications (drainage of mesotheliomas or irradiation of benign lesions) have disappeared. The low frequency of use leads to problems of safety and cost-effectiveness. However, modern photon radiotherapy techniques are still less effective than electrons in specific indications such as total skin irradiation (mycosis fungoides) or certain thin chest wall irradiations after total mastectomy, reirradiation or paediatric treatments without protons. Flash therapy, initiated by electrons, has been developed over the last 10 years, providing high-dose irradiation in an extremely short time. Initial results show good efficacy, with fewer side effects than with conventional radiotherapy. These results are leading to clinical technological developments on a larger scale. Although it has been replaced in most indications by more modern techniques, electron radiotherapy remains essential for targeted indications in specialised centres. The emergence of flash therapy will lead to new indications, on machines equipped with this new technology, which have yet to be defined and are currently the responsibility of specialised teams.

在治疗浅表病变方面，电子放疗因其物理特性（表面剂量高、深度下降快）一直以来都比光子放疗更受青睐。其他特点（半影、斜面或不规则表面的异质性）使其难以使用。在大多数适应症（皮肤癌、头颈部肿瘤、髓母细胞瘤）中，随着技术的进步，在某些情况下已被调强适形放疗、近距离放射治疗和接触疗法所取代。其他适应症（间皮瘤引流或良性病变照射）已经消失。使用频率低导致了安全性和成本效益问题。不过，现代光子放射治疗技术在一些特殊适应症上的效果仍不如电子，如皮肤全照射（真菌病）或全乳房切除术后的某些薄胸壁照射、再照射或无质子的儿科治疗。由电子引发的闪光疗法在过去 10 年中得到了发展，可在极短的时间内提供高剂量照射。初步结果显示，这种疗法疗效良好，副作用也比传统放射疗法小。这些成果正在推动临床技术的大规模发展。尽管在大多数适应症中，电子放疗已被更现代化的技术所取代，但在专业中心，电子放疗对靶向适应症仍然必不可少。闪光灯疗法的出现将带来新的适应症，这些适应症将在配备了这种新技术的设备上进行，目前这些适应症尚未确定，目前由专业团队负责。

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引用次数: 0

Études qui changent les pratiques en oncoradiothérapie digestive [胃肠道放射肿瘤学中改变实践的临床试验]。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.09.004

Current events in radiotherapy oncology are marked by the results of strategic trials, particularly for esophageal and rectal cancers. For resectable esophageal adenocarcinoma, results of the ESOPEC study showed a benefit in overall survival from the perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel compared to chemoradiotherapy (41.4 Gy radiotherapy and carboplatin/paclitaxel chemotherapy). In definitive setting, the CONCORDE study did not show any benefit from dose escalation and the standard dose remains 50 Gy. For resectable pancreatic cancer, the NRG/RTOG0848 study that compared adjuvant chemotherapy with or without chemoradiotherapy found a significant increase of the 5-year disease-free survival rate in the subgroup of node-negative patients. For rectal cancers, the 7-year update of PRODIGE 23 study confirmed the benefit in disease-free- and overall survival of neoadjuvant folinic acid, fluorouracil, irinotecan and oxaliplatin chemotherapy before chemoradiotherapy of T3, T4 or N+ adenocarcinoma, while the update of the RAPIDO study revealed an unacceptable local recurrence rate in the experimental arm. The update of the OPRA study shows a significantly higher 5-year organ preservation rate in favor of the chemoradiotherapy arm followed by consolidation chemotherapy compared to induction chemotherapy followed by CRT. A phase 2 study, including 41 patients with mismatch repair deficient, locally advanced rectal cancer reported that exclusive treatment with anti-PDL1 immunotherapy (dostarlimab) for 6 months resulted in complete clinical response without the need of additional treatment (neither radiotherapy nor surgery). For anal carcinoma, the analysis of survival and toxicity profiles of patients treated for a small stage T1 or T2 tumor were compared depending on whether they received exclusive radiotherapy or chemoradiotherapy. The addition of chemotherapy to radiotherapy did not show any survival benefit but significantly increased toxicity and the risk of radiotherapy disruption.

肿瘤放疗领域的最新进展以战略性试验的结果为标志，尤其是针对食道癌和直肠癌的试验。对于可切除的食管腺癌，ESOPEC 研究结果显示，与化学放疗（41.4Gy 放疗和卡铂/紫杉醇化疗）相比，氟尿嘧啶加白血病素、奥沙利铂和多西他赛的围手术期化疗可提高总生存率。在确诊情况下，CONCORDE 研究并未显示剂量升级有任何益处，标准剂量仍为 50Gy。对于可切除的胰腺癌，NRG/RTOG0848 研究比较了辅助化疗加或不加化疗放疗，发现在结节阴性患者亚组中，5 年无病生存率显著提高。在直肠癌方面，PRODIGE 23研究的7年更新证实，T3、T4或N+腺癌患者在化放疗前接受亚叶酸、氟尿嘧啶、伊立替康和奥沙利铂新辅助化疗可提高无病生存率和总生存率。OPRA 研究的更新版显示，与诱导化疗后再进行 CRT 相比，化放疗后再进行巩固化疗组的 5 年器官保留率明显更高。一项包括41名错配修复缺陷、局部晚期直肠癌患者的2期研究报告称，使用抗PDL1免疫疗法（dostarlimab）进行为期6个月的独家治疗可获得完全临床应答，无需进行其他治疗（既不放疗也不手术）。在肛门癌方面，对T1期或T2期小肿瘤患者的生存期和毒性情况进行了分析比较，具体取决于他们是接受了独家放疗还是化放疗。在放疗的基础上加用化疗对生存没有任何益处，但会显著增加毒性和放疗中断的风险。

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引用次数: 0

Actualités réglementaires en radiothérapie en France en 2024 : enjeux de qualité et sécurité des soins [2024 年法国放射治疗监管新闻：医疗质量与安全问题]。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.08.003

With numerous clinical, technological or strategic innovations, radiation therapy is constantly evolving, contributing to major quality and safety issues, in a context where new regulatory standards are required. In this article, we will describe the conditions for implementing and applying the requirements for accreditation, periodic certification and peer audit in France.

随着众多临床、技术或战略创新，放射治疗不断发展，在需要新监管标准的背景下，引发了重大的质量和安全问题。在本文中，我们将介绍在法国实施和应用评审、定期认证和同行审计要求的条件。

引用次数: 0

Practice-changing trials on breast cancer 改变实践的乳腺癌试验。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.004

There is new data in the fractionation modalities and these are the really the practice-changing trials of last years: can we use hypo fractionated whole breast radiotherapy in patients presented with ductal carcinoma in situ? Can we realize hypofractionated whole breast radiotherapy with simultaneous integrated boost? What about hypofractionated irradiation after mastectomy with reconstruction? Can we do hypofractionation to lymph nodes without risk of increased toxicity? The purpose of this work is to respond with the last evidence-based recently presented or published data.

在分次治疗模式方面有了新的数据，这些数据是过去几年中真正改变实践的试验：我们能否对导管原位癌患者使用低分次全乳腺放疗？我们能否实现同时综合增强的低分次全乳腺放疗？乳房切除重建术后如何进行低分次照射？我们能否在不增加毒性风险的情况下对淋巴结进行低分次照射？这项工作的目的是对最近提出或发表的循证数据做出回应。

引用次数: 0

Role of stereotactic radiotherapy in the management of small-cell lung cancer 立体定向放射治疗在小细胞肺癌治疗中的作用。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.015

Small-cell lung cancer is the most aggressive form of lung neoplasia, treated in recent decades with chemoradiotherapy in case of limited stage and chemotherapy alone at the metastatic stage. In the last few years, the advent of immunotherapy has changed the landscape in the treatment of non-small-cell lung cancer, and to a lesser degree in small-cell lung cancer. Despite the recent advances in research, small-cell lung cancer is still considered an aggressive and lethal disease characterized by high recurrence or metastatic potential. As stereotactic radiotherapy has established itself as the standard of care in the early stage of inoperable non-small-cell lung cancer and in metastatic disease to treat brain and extracranial metastases, these same issues now arise in the management of small-cell lung cancer. This article aims to review the current knowledge and the potential of stereotactic radiotherapy in small-cell lung cancer.

小细胞肺癌是肺部肿瘤中最具侵袭性的一种，近几十年来，对局限期肺癌采用化学放疗，对转移期肺癌仅采用化疗。最近几年，免疫疗法的出现改变了非小细胞肺癌的治疗格局，也在一定程度上改变了小细胞肺癌的治疗格局。尽管最近的研究取得了进展，但小细胞肺癌仍被认为是一种具有侵袭性和致命性的疾病，其特点是复发率高或转移潜力大。由于立体定向放射治疗已成为无法手术的非小细胞肺癌早期治疗以及治疗脑转移和颅外转移疾病的标准疗法，这些问题现在也出现在小细胞肺癌的治疗中。本文旨在回顾立体定向放射治疗在小细胞肺癌中的现有知识和潜力。

引用次数: 0

Survenue d’un évènement ou d’une erreur en oncologie radiothérapie : concilier les perspectives pour préserver le soin [放射肿瘤学中的事件和错误：协调视角，支持护理]。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.017

The term “event” covers a wide range of concrete situations in radiation oncology, from particularly intense radiation-related side effects to the possibility of technical or human error. Although quality procedures are an integral part of radiotherapy oncology department operations ensuring the analysis and prevention of such events, their occurrence during radiation treatment still has a significant impact on patients and their experience of the treatment process, as well as on health professionals. These practical, emotional and symbolic impacts are all the greater when the event occurs in the aftermath of an error. The ethical approach therefore comprises three essential stages: recognizing the event as such, informing those involved of the event and, finally, creating conditions for the continuation of care. Each of these stages is marked by specific issues and questions, requiring a complex ethical approach that constantly involves reconciling the possible divergent perceptions of patients and health professionals. The occurrence of an event can also lead to a genuine crisis of confidence with multiple dimensions, which health professionals will also have to face and to support. Finally, the occurrence of an event calls into question not only our responsibility towards patients, but also our ideal of control. We need to criticize our culture of performance, rethink our approach to events and errors, and see them also as opportunities for positive change.

事件 "一词涵盖了肿瘤放射治疗中的各种具体情况，从特别强烈的放射相关副作用到可能出现的技术或人为错误。尽管质量程序是肿瘤放疗科运行中不可或缺的一部分，以确保对此类事件进行分析和预防，但在放射治疗过程中发生的此类事件仍会对患者及其治疗过程的体验以及医护人员产生重大影响。如果事件发生在错误发生之后，这些实际的、情感的和象征性的影响就会更大。因此，伦理方法包括三个基本阶段：认识到事件本身、将事件告知相关人员以及最后为继续治疗创造条件。每个阶段都有具体的问题，需要采取复杂的伦理方法，不断调和患者和医疗专业人员可能存在的不同看法。事件的发生也可能导致多层面的真正信任危机，医护人员也必须面对和支持这种危机。最后，事件的发生不仅使我们对病人的责任产生怀疑，也使我们对控制的理想产生怀疑。我们需要批判我们的绩效文化，重新思考我们处理事件和错误的方法，并将其视为积极变革的机会。

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引用次数: 0

Radiomics-driven personalized radiotherapy for primary and recurrent tumors: A general review with a focus on reirradiation 放射组学驱动的原发性和复发性肿瘤个性化放疗：以再照射为重点的综述。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.09.002

Purpose

This review systematically investigates the role of radiomics in radiotherapy, with a particular emphasis on the use of quantitative imaging biomarkers for predicting clinical outcomes, assessing toxicity, and optimizing treatment planning. While the review encompasses various applications of radiomics in radiotherapy, it particularly highlights its potential for guiding reirradiation of recurrent cancers.

Methods

A systematic review was conducted based on a Medline search with the search engine PubMed using the keywords “radiomics or radiomic” and “radiotherapy or reirradiation”. Out of 189 abstracts reviewed, 147 original articles were included in the analysis. These studies were categorized by tumor localization, imaging modality, study objectives, and performance metrics, with a particular emphasis on the inclusion of external validation and adherence to a standardized radiomics pipeline.

Results

The review identified 14 tumor localizations, with the majority of studies focusing on lung (33 studies), head and neck (27 studies), and brain (15 studies) cancers. CT was the most frequently employed imaging modality (77 studies) for radiomics, followed by MRI (46 studies) and PET (13 studies). The overall AUC across all studies, primarily focused on predicting the risk of recurrence (94 studies) or toxicity (41 studies), was 0.80 (SD = 0.08). However, only 24 studies (16.3%) included external validation, with a slightly lower AUC compared to those without it. For studies using CT versus MRI or PET, both had a median AUC of 0.79, with IQRs of 0.73–0.86 for CT and 0.76–0.855 for MRI/PET, showing no significant differences in performance. Five studies involving reirradiation reported a median AUC of 0.81 (IQR: 0.73–0.825).

Conclusion

Radiomics demonstrates considerable potential in personalizing radiotherapy by improving treatment precision through better outcome prediction and treatment planning. However, its clinical adoption is hindered by the lack of external validation and variability in study designs. Future research should focus on implementing rigorous validation methods and standardizing imaging protocols to enhance the reliability and generalizability of radiomics in clinical radiotherapy, with particular attention to its application in reirradiation.

目的：这篇综述系统地研究了放射组学在放疗中的作用，特别强调了定量成像生物标志物在预测临床结果、评估毒性和优化治疗计划中的应用。虽然综述涵盖了放射组学在放疗中的各种应用，但它特别强调了放射组学在指导复发性癌症再照射方面的潜力：方法：我们使用 "放射组学或放射组学 "和 "放射治疗或再照射 "这两个关键词，在PubMed搜索引擎的Medline检索基础上进行了系统性综述。在查阅的 189 篇摘要中，有 147 篇原创文章被纳入分析。这些研究按照肿瘤定位、成像方式、研究目标和性能指标进行了分类，特别强调了是否包含外部验证和是否遵循标准化的放射组学流程：审查确定了 14 种肿瘤定位，其中大部分研究集中在肺癌（33 项研究）、头颈癌（27 项研究）和脑癌（15 项研究）。CT 是放射组学最常用的成像模式（77 项研究），其次是 MRI（46 项研究）和 PET（13 项研究）。所有研究（主要集中在预测复发风险（94 项研究）或毒性（41 项研究））的总体 AUC 为 0.80（SD=0.08）。不过，只有 24 项研究（16.3%）包含外部验证，其 AUC 略低于未包含外部验证的研究。在使用 CT 与 MRI 或 PET 的研究中，两者的 AUC 中位数均为 0.79，CT 的 IQR 为 0.73-0.86，MRI/PET 的 IQR 为 0.76-0.855，显示两者的性能无显著差异。五项涉及再照射的研究报告的中位AUC为0.81（IQR：0.73-0.825）：结论：放射组学通过更好的结果预测和治疗计划来提高治疗的精确性，在个性化放疗方面具有相当大的潜力。然而，由于缺乏外部验证和研究设计的差异性，其临床应用受到了阻碍。未来的研究应侧重于实施严格的验证方法和标准化成像方案，以提高放射组学在临床放疗中的可靠性和可推广性，尤其要关注其在再照射中的应用。

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引用次数: 0

Personalizing radiotherapy with adaptive radiotherapy: Interest and challenges 利用自适应放疗实现个性化放疗：兴趣与挑战。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.007

Adaptive radiotherapy (ART) is a recent development in radiotherapy technology and treatment personalization that allows treatment to be tailored to the daily anatomical changes of patients. While it was until recently only performed “offline”, i.e. between two radiotherapy sessions, it is now possible during ART to perform a daily online adaptive process for a given patient. Therefore, ART allows a daily customization to ensure optimal coverage of the treatment target volumes with minimized margins, taking into account only the uncertainties related to the adaptive process itself. This optimization appears particularly relevant in case of daily variations in the positioning of the target volume or of the organs at risk (OAR) associated with a proximity of these volumes and a tenuous therapeutic index. ART aims to minimize severe acute and late toxicity and allows tumor dose escalation. These new achievements have been possible thanks to technological development, the contribution of new multimodal and onboard imaging modalities and the integration of artificial intelligence tools for the contouring, planning and delivery of radiation therapy. Online ART is currently available on two types of radiotherapy machines: MR-linear accelerators and recently CBCT-linear accelerators. We will first describe the benefits, advantages, constraints and limitations of each of these two modalities, as well as the online adaptive process itself. We will then evaluate the clinical situations for which online adaptive radiotherapy is particularly indicated on MR- and CBCT-linear accelerators. Finally, we will detail some challenges and possible solutions in the development of online ART in the coming years.

自适应放射治疗（ART）是放射治疗技术和个性化治疗的最新发展，可根据病人每天的解剖变化进行治疗。虽然直到最近它还只能在 "离线 "状态下进行，即在两次放疗之间进行，但现在在 ART 期间可以对特定患者执行每日在线自适应过程。因此，ART 允许每天进行定制，以确保治疗靶区的最佳覆盖范围和最小边缘，同时只考虑与自适应过程本身相关的不确定性。当目标体积或危险器官（OAR）的位置每天都在变化时，这种优化就显得尤为重要。ART 旨在最大限度地减少严重的急性和晚期毒性，并允许肿瘤剂量升级。这些新成就的取得要归功于技术的发展、新的多模态和机载成像模式的贡献，以及人工智能工具在放射治疗的轮廓、计划和实施方面的集成。在线 ART 目前可用于两种类型的放射治疗机：MR 线性加速器和最近的 CBCT 线性加速器。我们将首先介绍这两种模式各自的优点、优势、制约因素和局限性，以及在线自适应过程本身。然后，我们将评估在线自适应放疗特别适用于磁共振和 CBCT 线性加速器的临床情况。最后，我们将详细介绍在线自适应放疗在未来几年的发展中面临的一些挑战和可能的解决方案。

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引用次数: 0

Diagnosis and management of brain radiation necrosis 脑放射线坏死的诊断和处理。

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.014

Brain radiation necrosis (BRN) is a significant and complex side effect of stereotactic radiotherapy (SRT). Differentiating BRN from local tumor recurrence is critical, requiring advanced diagnostic techniques and a multidisciplinary approach. BRN typically manifests months to years post-treatment, presenting with radiological changes on MRI and may produce neurological symptoms. Key risk factors include the volume of irradiated brain tissue, the radiation dose, and prior radiotherapy history. This manuscript reviews the diagnostic process for BRN, emphasizing the importance of assessing baseline risk, clinical evaluation, and advanced imaging modalities. Multimodal imaging enhances diagnostic accuracy and aids in distinguishing BRN from tumor relapse. Therapeutic management varies based on symptoms. Asymptomatic BRN may be monitored with regular imaging, while symptomatic BRN often requires corticosteroids to reduce inflammation. Emerging therapies like bevacizumab have shown promise in clinical trials, with significant radiographic and symptomatic improvement. Surgical intervention may be necessary for histological confirmation and severe, treatment-resistant cases. Ongoing research aims to improve diagnostic accuracy and treatment efficacy, enhancing patient outcomes and quality of life. This review underscores the need for a multidisciplinary approach and continuous advancements to address the challenges posed by BRN in brain tumor patients.

脑放射坏死（BRN）是立体定向放射治疗（SRT）的一种严重而复杂的副作用。区分脑放射坏死和局部肿瘤复发至关重要，需要先进的诊断技术和多学科方法。BRN通常在治疗后数月至数年出现，在核磁共振成像上表现为放射学改变，并可能产生神经症状。主要风险因素包括受照射脑组织的体积、放射剂量和既往放疗史。本手稿回顾了 BRN 的诊断过程，强调了评估基线风险、临床评估和先进成像模式的重要性。多模态成像提高了诊断的准确性，有助于区分 BRN 和肿瘤复发。治疗方法因症状而异。无症状的 BRN 可通过定期成像进行监测，而有症状的 BRN 通常需要皮质类固醇来减轻炎症。贝伐单抗等新疗法在临床试验中显示出良好的前景，可明显改善放射影像和症状。对于组织学确诊病例和严重的耐药病例，可能需要进行手术治疗。正在进行的研究旨在提高诊断准确性和治疗效果，改善患者的预后和生活质量。本综述强调了采用多学科方法和不断进步来应对脑肿瘤患者 BRN 所带来的挑战的必要性。

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引用次数: 0

Delineation of target volume by radiation therapists during online adaptive radiation therapy: What authorization? 放射治疗师在在线自适应放射治疗中划定靶区：什么是授权？

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie

Pub Date : 2024-11-01 DOI: 10.1016/j.canrad.2024.07.016

The evolution of radiation therapy techniques goes hand in hand with the evolution of the profession of radiation therapist. In the particular context of online adaptive radiotherapy based on cone beam computed tomography images, delegation of certain tasks from the physician to the radiation therapist is possible within the framework of a cooperation protocol. This delegation requires prior theoretical and practical training. It enriches the practice of radiation therapists by allowing them to acquire new skills and greater autonomy. It foreshadows access for radiation therapists to advanced practice.

放射治疗技术的发展与放射治疗师职业的发展是相辅相成的。在基于锥形束计算机断层扫描图像的在线自适应放射治疗的特殊情况下，在合作协议的框架内，医生可以将某些任务委托给放射治疗师。这种授权需要事先进行理论和实践培训。它丰富了放射治疗师的实践，让他们获得新的技能和更大的自主权。它预示着放射治疗师可以进入高级实践阶段。

引用次数: 0