Background and purpose Lack of international guidelines is hampering treatment quality and progress in the field of rectal endoluminal high dose rate brachytherapy (EHB). Standardisation of dose reporting would allow for better comparison of clinical results between patient cohorts and allow tumour control and normal tissue complication probability modelling. This work presents consensus recommendations for target volume and organs at risk (OAR) delineation in rectal EHB to support standardised dose reporting, for which consistent delineation is a prerequisite. Materials and methods Recommendations were developed according to the AGREE II instrument, using a modified Delphi approach. The process included selection of international experts, a survey on current practices, delineation of three patient cases, and three consensus meetings to discuss the findings and formulate recommendations. Results The expert group included 30 members from nine countries. The survey and first delineation round showed marked variation in treatment preparation and in the definition and delineation of target volumes and OARs. Consensus was reached on prerequisites for adequate delineation. Target volumes for dose reporting were defined: GTV primary at the time of EHB (GTVp_BT), an evaluation structure (GTVp_BT_ev05), and any macroscopic lymph nodes at the time of EHB (GTVn_BT). Recommendations for OAR selection and delineation were also established. Conclusion The GI GEC working group of GEC-ESTRO has developed consensus recommendations for target volume definition and OAR delineation in rectal EHB. These recommendations will be implemented in clinical practice. The proposed structures provide a foundation for standardised dose reporting, independent of local prescription practices.
Purpose Bone metastases from head and neck squamous cell carcinoma (HNSCC) are a rare clinical entity, with limited data guiding management. This study aimed to evaluate the oncological outcomes of stereotactic body radiotherapy (SBRT) for this rare condition. Methods Patients who received SBRT for HNSCC-derived bone metastases between 2015 and 2024 were analyzed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. The cumulative incidence of local failures (LF) and post-SBRT fractures was analyzed with death as competing event. Adverse events were graded according to CTCAE v5.0. Results Thirty-four patients with 54 irradiated bone metastases from 11 European centers were included. Median age was 63 years (range, 39–86); and the most common primary sites were the oropharynx (n = 12, 35.3%), nasopharynx (n = 8, 23.5%), and oral cavity (n = 5, 14.7%). The median prescribed biologically effective dose (BED10) was 60.0 Gy (IQR, 56.0–72.0 Gy). After a median follow-up of 23.3 months in patients alive at last contact, 2-year OS and PFS were 41.2% (95% CI, 24.3–57.3%) and 8.8% (95% CI, 2.3–21.1%), while the 2-year cumulative incidence of LF and fractures was 14.1% (95% CI, 3.0–27.8%) and 1.9% (95% CI, 0.0–6.9%). In exploratory analyses, patients treated for >1 bone metastases had inferior OS compared to those with a single treated bone metastasis (HR 2.58; 95% CI, 1.08–6.15; p = 0.033). Grade 3 adverse events occurred in one patient (2.9%), with no grade 4–5 events. Conclusion Although PFS remained limited, SBRT was associated with high local control and a low observed rate of severe adverse events in patients with HNSCC-derived bone metastases. Prospective studies are warranted to validate these findings and optimize patient selection.
Proton therapy is increasingly used for patients with isocitrate dehydrogenase (IDH )-mutated gliomas. This is related to its favorable dose distribution and an anticipated reduction in treatment-related side effects compared with photon therapy. However, some studies have reported a concerning risk of radiation-induced contrast enhancement (RICE) also following proton therapy. The definition, incidence, and risk factors of RICE remain poorly characterized. With this systematic review we aimed to assemble and systematize available evidence on RICE in patients with IDH -mutated gliomas grade 2–4. The following databases were searched December 12th, 2025 and rerun June 29th, 2026: Ovid Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews. In total, 3822 references were found. Following removal of duplicates, 2201 records were screened. A total of 146 full-text studies were assessed for eligibility, and 30 study cohorts were included in the review. Substantial heterogeneity in study design, patient population, and RICE definitions was observed. RICE incidence varied from 2 to 50%, median time to occurrence differed from one month to two years, and median follow-up ranged from 20 to 118 months. Patient cohorts varied in number from 34 to 792. Some studies showed higher incidence of RICE following protons than photons, several found the periventricular zone to be a predilection site for RICE, and some studies demonstrated an increased risk of RICE in oligodendroglioma compared to astrocytoma. Standardized definitions and data from prospective studies on RICE are needed to better understand its incidence, risk factors, and clinical implications. PROSPERO registration: CRD42024512593.
Background De novo metastatic nasopharyngeal carcinoma (mNPC) carries a poor prognosis with systemic therapy alone. Locoregional radiotherapy (LRRT) improves survival in chemotherapy-responsive patients, but the incremental role of metastasis-directed therapy (MDT) remains undefined. Methods This retrospective cohort included 54 patients with de novo mNPC treated between 2013 and 2024 at a tertiary cancer centre. All received platinum-based induction chemotherapy followed by definitive LRRT; selected patients underwent MDT to metastatic sites. Overall survival (OS), recurrence-free survival (RFS) and distant recurrence-free survival (DRFS) were estimated by Kaplan–Meier methods, with Cox regression for univariable and multivariable analysis. Results At a median follow-up of 27 months, 2-year OS, RFS and DRFS were 67.5%, 45.4% and 52.7%. MDT was associated with improved 2-year OS (92.3% vs 55.2%; p = 0.0069), RFS (81.9% vs 28.2%; p < 0.001) and DRFS (93.8% vs 35.0%; p < 0.001). On multivariable analysis MDT remained associated with improved RFS (HR 0.27, 95% CI 0.08–0.98; p = 0.047), with consistent estimates in a 2-month landmark analysis (HR 0.26, 95% CI 0.075–0.90) and with MDT modelled as a time-varying covariate (HR 0.17, 95% CI 0.040–0.76); the association with OS was not statistically significant (HR 0.25, 95% CI 0.06–1.13; p = 0.072). Oligometastatic disease was more frequent among patients receiving MDT (88% vs 41%). The association was most evident in the oligometastatic subgroup. In exploratory analyses, detectable post-treatment plasma EBV DNA and elevated post-LRRT PET SUV were associated with inferior survival. Conclusion In chemotherapy-responsive de novo mNPC treated with definitive LRRT, consolidative MDT was associated with improved disease control in multivariable, landmark and time-varying analyses, with a directionally consistent but non-significant association with OS. As residual confounding cannot be excluded, these findings support prospective evaluation in selected patients.
Objective To determine the observed incidence and risk factors of osteoradionecrosis (ORN) following reirradiation for recurrent or second primary head and neck cancer. Methods A systematic review with meta-analysis was conducted according to the PRISMA guidelines, with the study protocol prospectively registered with PROSPERO (CRD42025635226). A literature search was performed in PubMed/MEDLINE and Web of Science. Randomized and observational studies investigating reirradiation for recurrent or second primary head and neck tumors were included. The primary endpoint was occurrence of ORN of the maxilla and/or mandible. Results Of 580 identified records, 62 studies involving 3278 patients (median age, 61 years; 2087 [63.7%] male) were included, among them 14 prospective and 48 retrospective studies. Teletherapy was administered in 2546 patients (77.7%), and brachytherapy in 684 patients (20.9%). At a median follow-up of 26 months, the pooled observed incidence of ORN of the mandible and/or maxilla was 3.6% (95% CI, 2.8%–4.6%). When restricted to patients evaluable for late adverse events, pooled observed ORN incidence was 4.0% (95% CI, 3.0%–5.3%). A higher study-level proportion of patients receiving adjuvant reirradiation was associated with increased observed ORN incidence (β = 1.091; 95% CI, 0.256–1.926; P = .01), whereas radiation dose, modality, and interval between primary radiotherapy and reirradiation were not predictive. Conclusion This meta-analysis demonstrates that the observed incidence of ORN after reirradiation for recurrent or second primary head and neck cancer is approximately 4%. These findings provide a benchmark for patient counseling, while highlighting the need for standardized ORN assessment in future studies.
