International Journal of Radiation Oncology, Biology, Physics

BACKGROUND: Neoadjuvant radiotherapy(RT) with standard techniques(ST) offers a modest benefit in retroperitoneal sarcoma(RPS). As the high-risk region(HRR) at risk for a positive surgical margin and recurrence is posterior and away from radiosensitive organs at risk, utilizing a simultaneous integrated boost(SIB) allows targeted dose-escalation to the HRR while sparing these organs. We hypothesized that neoadjuvant SIB RT can improve disease control compared to ST, without increasing toxicity...

OBJECTIVE: The 2020 World Health Organization (WHO) classification divided endocervical adenocarcinoma (ADC) into human papillomavirus (HPV)-associated (HPVA) and HPV-independent (HPVI) ADCs. This multi-institutional study aimed to investigate the clinical features and prognosis of patients with endocervical ADC based on the updated WHO classification. METHODS: We retrospectively reviewed the 365 patients with endocervical ADC who underwent radical hysterectomy from seven institutions...

PURPOSE: To report neurocognitive, imaging, ophthalmologic, and safety outcomes following low-dose whole brain radiation therapy (LD-WBRT) for patients with early Alzheimer's dementia (eAD) treated on a pilot trial. METHODS AND MATERIALS: Trial enrolled patients were at least 55 years of age and had eAD meeting NINCDS-ADRDA criteria, with confirmatory FDG and Florbetapir PET findings, and had the capacity to complete neurocognitive function (NCF), psychological function (PF), and quality of life (QOL) assessments, with a Rosen Modified Hachinski Score <4, and estimated survival >12 months...

PURPOSE: Radiotherapy-induced xerostomia (RIX) significantly affects quality of life in head and neck cancer (HNC) survivors. Neuro-electrostimulation of the salivary glands may safely increase natural salivation and reduce dry mouth symptoms. METHODS AND MATERIALS: Multicentre double-masked randomised sham-controlled clinical trial to assess the long-term effects of a commercially available intra-oral neuro-electrostimulating device in lessening xerostomia symptoms, increasing salivary flow and improving quality of life in individuals with RIX...

PURPOSE: To evaluate a formulation of pegylated liposomal mitomycin C lipidic prodrug (PL-MLP) in patients concomitantly undergoing external beam radiotherapy (RT). PATIENTS AND METHODS: Patients with metastatic disease or inoperable primary solid tumors requiring RT for disease control or symptom relief, were treated with two courses of PL-MLP (1.25, 1.5 or 1.8 mg/kg) at 21-day intervals, along with 10 fractions of conventional RT or 5 SBRT fractions initiated 1-3 days after the first PL-MLP dose and completed within 2 weeks...

PURPOSE: 18 F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) parameters are prognostic of oncologic outcomes in human papillomavirus-associated oropharyngeal squamous cell carcinoma (OPSCC). We utilized FDG-PET imaging biomarkers to select patients for de-escalated chemoradiotherapy (CRT) hypothesizing that acute toxicity will be improved with de-escalation. METHODS: This is a planned interim initial feasibility and acute toxicity report from a phase II prospective, non-randomized study which enrolled patients with stage I-II p16+ OPSCC...

BACKGROUND: XXXX XXXX XXXX XXXX (XXXX) XXXX was the first clinical trial evaluating multi-institution feasibility of IMRT for head and neck cancer. The primary endpoints of 2-year local-regional failure and reduction in acute xerostomia were reported previously. This report provides secondary endpoints with long-term follow-up. METHODS: Eligibility included patients diagnosed with T1-2, N0-1 oropharyngeal cancer. Secondary endpoints included disease control and overall survival...

BACKGROUND: The treatment of unresectable, locally advanced stage III non-small cell lung cancer (NSCLC) is concurrent chemoradiation therapy (CRT), followed by consolidation durvalumab. This study aims to evaluate the benefit of neoadjuvant osimertinib as an alternative therapy to this approach with the aim of reducing the radiation field. METHODS: This investigation was a nonrandomized, open-label, single-arm, phase II prospective, proof-of-concept study. Eligible patients were treatment-naïve, nonoperable, stage III EGFR-mutant NSCLC patients...

PURPOSE: The optimal dose and fractionation of stereotactic body radiotherapy (SBRT) for locally advanced pancreatic cancer (LAPC) have not been defined. Single fraction SBRT was associated with more gastrointestinal (GI) toxicity so 5-fraction regimens have become more commonly employed. We aimed to determine the safety and maximally tolerated dose of 3-fraction SBRT for LAPC. MATERIALS AND METHODS: Two parallel phase 1 dose escalation trials were conducted from 2016 to 2019 at XXX1 and XXX2...

BACKGROUND: Since patients with untreated brain arteriovenous malformations (BAVMs) are at variable risks of cerebral hemorrhage and associated mortality and morbidity, it is essential to identify patient populations who benefit most from prophylactic interventions. This study aimed to examine age-dependent differences in the therapeutic effect of stereotactic radiosurgery (SRS) on BAVMs. METHODS: This retrospective observational study enrolled patients with BAVMs who underwent SRS at our institution between 1990 and 2017...

Over the past decade, concerns have arisen in radiation oncology regarding potential workforce supply and demand imbalance. The American Society for Radiation Oncology commissioned an independent analysis in 2022, looking at supply and demand in the United States radiation oncology workforce and projecting future trends for 2025 and 2030. The final report entitled, "Projected Supply and Demand for Radiation Oncologists in the U.S. in 2025 and 2030" is now available. The analysis included evaluating radiation oncologist supply (new graduates, exits from the specialty), potential changes in demand (growth of Medicare beneficiaries, hypofractionation, loss of indications, new indications) as well as radiation oncologist productivity (growth of work RVUs produced) and demand per beneficiary...

PURPOSE: To establish the feasibility of a randomised clinical trial comparing stereotactic ablative radiotherapy (SABR) to the prostate-only (P-SABR) or to prostate plus pelvic lymph nodes (PPN-SABR) in patients with unfavourable intermediate- or high-risk localised prostate cancer and explore potential toxicity biomarkers. MATERIALS & METHODS: Thirty adult men with at least one of the following features; clinical MRI stage T3a N0 M0, Gleason score ≥ 7 (4+3), PSA > 20 ng/mL were randomised 1:1 to P-SABR or PPN-SABR...

PURPOSE: To assess the safety and efficacy of ultra-hypofractionated low-dose total skin electron beam therapy (TSEBT) regimen in patients with advanced mycosis fungoides (MF) or Sézary syndrome (SS). PATIENTS AND METHODS: In this multicenter observational study from five German centers, 18 total patients with MF/SS underwent TSEBT with a total dose of 8 Gy in two fractions. The primary endpoint was the overall response rate (ORR). RESULTS: 15 of 18 patients with stage IIB-IV MF or SS were heavily pre-treated with a median of four prior systemic therapies...

Lymphovascular space invasion (LVSI) predicts for higher rates of recurrence and increased mortality in endometrial cancer. Using three-tier LVSI scoring, a PORTEC 1&2 trials analysis demonstrated that substantial LVSI was associated with worse locoregional (LR-DFS) and distant metastasis disease free survival (DM-DFS), and these patients possibly benefited from external beam radiation therapy (EBRT). Furthermore, LVSI is a predictor for lymph node (LN) involvement, but the significance of substantial LVSI is unknown in patients with a pathologically negative LN assessment...

BACKGROUND: Radiation pneumonitis (RP) is the most common dose-limiting toxicity for thoracic radiation therapy. Nintedanib is used for the treatment of idiopathic pulmonary fibrosis, which shares pathophysiological pathways with the subacute phase of RP. Our goal was to investigate the efficacy and safety of nintedanib added to a prednisone taper compared to a prednisone taper alone in reducing pulmonary exacerbations in patients with grade 2 or higher (G2+) RP. METHODS: In this phase II, randomized, double-blinded, placebo-controlled trial, patients with newly diagnosed G2+ RP were randomized 1:1 to nintedanib or placebo in addition to a standard 8-week prednisone taper...

PURPOSE: We evaluated our institutional experience to assess potential racial inequities in insurance coverage for proton therapy in head and neck (HN) cancer patients. METHODS: We examined the demographics of 1519 HN cancer patients seen in consultation at our HN multidisciplinary clinic (HN MDC) and 805 patients for whom a proton insurance authorization was sought (PAS) from 01/2020 to 06/2022. The prospects for proton therapy insurance authorization were prospectively noted based on each patient's ICD-10 diagnosis code and their specific insurance plan...

BACKGROUND AND PURPOSE: Although radiation dose escalation improves prostate cancer disease control, it can cause increased toxicity. Genitourinary (GU) symptoms after prostate radiotherapy impact patient health related Quality of Life (QoL). We compared patient-reported genitourinary QoL outcomes following two alternative urethral sparing SBRT (US-SBRT) regimens. MATERIALS AND METHODS: EPIC-26 GU scores were compared between two US-SBRT trials. The SPARK trial prescribed a "Monotherapy" dose of 36...

PURPOSE: This retrospective study aimed to evaluate the safety and efficacy of repeated carbon-ion radiotherapy (CIRT) in patients with intrahepatic recurrent hepatocellular carcinoma (HCC). METHOD AND MATERIALS: We reviewed patients who underwent repeated CIRT for intrahepatic recurrent HCC between 2010 and 2020. RESULTS: Forty-one patients received multiple CIRT courses for HCC. During the second course, 17 (41.5%) and 24 (58.5%) of 41 patients underwent CIRT for local recurrence (LR) and intrahepatic recurrence following the first irradiation, respectively...

PURPOSE: We investigated the impact of central review of the interim fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan response (iPET) assessment on treatment allocation on the risk-based, response-adapted, Children's Oncology Group study AHOD1331 (ClinicalTrials.gov: NCT02166463) for pediatric patients with high-risk Hodgkin lymphoma. METHODS AND MATERIALS: Per protocol, after 2 cycles of systemic therapy, patients underwent iPET, with visual response assessment by 5-point Deauville score (DS) at their treating institution and a real-time central review, with the latter considered the reference standard...

BACKGROUND: Autologous stem cell transplantation (HSCT) using myeloablative total body irradiation (TBI) and anti-thymocyte globulin (ATG) as a conditioning regimen has become a standard treatment option for certain patients with systemic sclerosis (SSc). Normal organs are more radiosensitive and prone to compromised function in SSc, and therefore lungs and kidneys require dose reduction. We evaluated the role of intensity modulated radiation therapy (IMRT) TBI compared to standard anteroposterior (AP)/posteroanterior (PA) TBI technique...