Purpose:Total mesorectal excision (TME) is the standard treatment for early rectal cancer, but radiation therapy (RT) with or without chemotherapy may be considered as an alternative organ-preserving option. This study evaluated the oncologic outcomes, patterns of failure, salvage treatment efficacy, and TME-free survival (TME-FS) following RT without radical surgery after local excision or biopsy in selected patients. Materials and Methods:We retrospectively analyzed 40 patients with cT1-2N0 rectal adenocarcinoma who received RT after local excision or biopsy without subsequent radical surgery between 2007 and 2023. Indications for RT included clinical T1 disease with high-risk features, clinical T2 disease, or tumors located close to the anal verge. The median RT dose was 50.2 Gy, and 29 patients received chemotherapy. Survival outcomes, recurrence patterns, salvage treatments, toxicities, and TME-FS were assessed. Results:The median follow-up was 38 months. The 5-year overall survival rates were 87.5% for the cT1 group and 85.6% for the cT2 group, and the 5-year cancer-specific survival rate was 100% in both groups. The 5-year recurrence-free survival rates were 79.3% and 62.8%, respectively. Overall, nine patients experienced treatment failure, and four patients ultimately underwent salvage TME. The 5-year TME-FS were 87.5% in the cT1 group and 78.6% in the cT2 group. No grade 2 or higher late toxicities were observed. Conclusion:RT without radical surgery may be a feasible treatment option for cT1-2N0 rectal cancer patients who are unsuitable for, or decline, radical surgery. Close surveillance and timely salvage treatment remain essential, particularly for those with cT2 disease.
Purpose:This study aimed to compare left-sided breast volumetric modulated arc therapy plans using heart-only dose constraints with plans that include additional left ventricle (LV) and left anterior descending coronary artery (LAD) dose constraints (heart + LV + LAD). Materials and Methods:Thirty patients treated with whole-breast irradiation with simultaneous integrated boost were replanned using both strategies. The heart + LV + LAD strategy applied dose constraints based on German Society for Radiation Oncology recommendations and Danish Breast Cancer Group HYPO protocol (LV: Dmean [mean dose] <3 Gy, V5Gy [percentage of volume receiving ≥5 Gy] <17%, V23Gy <5%; LAD: Dmean <10 Gy, Dmax [maximum dose] <17 Gy). Target and organ-at-risk (OAR) metrics were compared using Wilcoxon signed-rank tests. For exploratory analyses, LAD-planning target volume (PTV) distance was defined as the minimum distance between LAD and whole-breast PTV, and Spearman's correlations between LAD-PTV distance and LAD or target metrics were evaluated. Results:Compared with heart-only plans, heart + LV + LAD plans reduced LV Dmean, V5Gy, and V23Gy, as well as LAD Dmean and Dmax (all p < 0.001), meeting all prespecified dose constraints except LV Dmean and LAD Dmax (achieved in 70.0% and 63.3%, respectively). Target metrics showed small compromises (e.g., PTV V95% [percentage of volume receiving ≥95% of the prescription dose] 98.391% vs. 99.431%; p < 0.001). Ipsilateral lung Dmean and V5Gy decreased, whereas contralateral breast Dmean and lung V10Gy increased (all p < 0.05). In heart + LV + LAD plans, greater LAD-PTV distance correlated with lower LAD Dmax and Dmean and higher PTV D98%. Conclusion:Applying LV and LAD dose constraints improved cardiac substructure sparing with modest trade-offs in target and contralateral OAR metrics. LAD-PTV distance may influence the feasibility of LAD sparing, but this exploratory association warrants further study.
Extramammary Paget's disease (EMPD) is a rare adenocarcinoma with a poor prognosis when invasive. Here, we report an exceptionally rare case of invasive vulvar EMPD in a 70-year-old woman who presented with extensive lymphadenopathy involving the inguinal, pelvic, para-aortic, and left supraclavicular regions. Histopathology confirmed dermal and lymphovascular invasion. Given the systemic nodal spread, the patient underwent definitive concurrent chemoradiotherapy (CCRT) with weekly cisplatin. Radiotherapy was delivered to the inguinal-to-paraaortic nodes at 57.6 Gy in 32 fractions and to the supraclavicular nodes at 51.0 Gy in 17 fractions. Follow-up imaging 6 months after treatment demonstrated a complete response per Response Evaluation Criteria in Solid Tumor criteria. This case is notable because supraclavicular involvement in EMPD is extremely rare and usually reflects advanced systemic dissemination. Our findings suggest that intensive CCRT may achieve excellent locoregional and systemic disease control, supporting its potential role as an effective primary treatment option for patients with advanced metastatic EMPD.
Purpose:Optimal management of borderline and malignant phyllodes tumors (PT) is not well established, especially regarding margin width and the use of adjuvant radiotherapy (RT). This multicenter study aimed to identify prognostic factors and to assess the effectiveness of adjuvant RT. Materials and Methods:We conducted a retrospective analysis of 183 patients (155 surgery-only, 28 adjuvant RT) diagnosed with borderline or malignant PT from 2009 to 2025. To address selection bias, whereby RT is preferentially given to higher-risk patients, we used overlap weighting based on propensity scores, which estimates the average treatment effect in the overlap population (ATO). Independent prognostic factors were identified through multivariable Cox regression with Firth's penalized likelihood. Results:A resection margin <1 mm was identified as the only independent predictor of local recurrence in multivariable analysis (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.03 to 4.08; p = 0.043). Although conventional analysis did not show a benefit from RT, overlap-weighted analysis suggested an improved local recurrence-free survival with adjuvant RT, though this was not statistically significant (HR, 0.25; 95% CI, 0.05 to 1.19; p = 0.081). Distant metastasis events were rare (n = 3), and no significant difference in DMFS was observed after overlap weighting (HR, 2.27; 95% CI, 0.33 to 15.66; p = 0.404). In an exploratory subgroup analysis, no local recurrence (LR) was observed in the 12 borderline patients who received adjuvant RT (0/12 vs. 27/136 in surgery-only). Conclusion:Margins <1 mm were independently linked to an increased risk of LR. After adjusting for selection bias, adjuvant RT showed a trend toward reduced LR, though it did not achieve statistical significance. Adjuvant RT might be considered for selected high-risk patients.
Purpose: No comprehensive nationwide population-based cohort study has been conducted to fully evaluate the impact of radiotherapy (RT) on late side effects in pediatric patients with brain tumor in a nationwide population, including endocrinopathies, late-delayed complications, and late cerebrovascular complications. Materials and Methods: This population-based, retrospective cohort study included 815 pediatric patients with brain tumor receiving RT (RT group) and 1,630 matched controls without RT (non-RT group), extracting all data from the National Health Insurance Research Database of Taiwan. Results: RT group patients exhibited 1.172-fold and 1.796-fold higher risk of long-term endocrinopathies and late-delayed complications, respectively, than did non-RT group patients. In addition to older age (0.270-0.248-fold), prior surgery (1.856-fold), or chemotherapy (1.679-fold), the risk of overall late side effects in the RT group was 1.173-fold (95% confidence interval, 1.063 to 1.430) higher than that in the non-RT group. Patients with RT had 1.602-fold and 1.120-fold higher risk for gonadotropin deficiency and hypothalamic pituitary dysfunction, respectively, and 3.208-fold higher risk for brain stem necrosis than their non-RT counterparts. Conclusion: In addition to prior surgery or chemotherapy, RT is an independent predictor of increased risk of late side effects in pediatric patients with brain tumor, particularly in patients who are younger at tumor diagnosis. Gonadotropin deficiency, hypothalamic-pituitary dysfunction, and brainstem necrosis are the main RT-related late side effects in pediatric patients with brain tumor. Frequency of these deficits increases with time, warranting long-term surveillance.
Purpose: This study aimed to evaluate whether lower-neck involvement and post-concurrent chemoradiotherapy (CCRT) response predict distant metastasis (DM) in patients with head and neck squamous cell carcinoma (HNSCC) treated with definitive intensity-modulated radiotherapy (IMRT)-based CCRT. Materials and Methods: We retrospectively analyzed 210 patients with non-metastatic HNSCC treated with definitive IMRT-based CCRT between 2009 and 2020. Lower-neck involvement was defined as radiologic involvement of inferior cervical lymph nodes. Post-treatment response was categorized as complete response (CR) versus non-CR. Logistic and Cox regression models were used to identify predictors of DM and survival outcomes. Results: At a median follow-up of 59.8 months, DM developed in 51 patients (24.3%). In multivariable logistic analysis, lower-neck involvement (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.18 to 4.54; p = 0.014) and non-CR (OR, 2.57; 95% CI, 1.31 to 5.05; p = 0.006) independently predicted DM. In Cox analyses, lower-neck involvement was associated with inferior distant metastasis-free survival (DMFS) (hazard ratio [HR], 2.07; 95% CI, 1.15 to 3.75; p = 0.016) and progression-free survival (PFS) (HR, 1.93; 95% CI, 1.19 to 3.14; p = 0.008), whereas non-CR predicted worse DMFS (HR, 2.71; 95% CI, 1.49 to 4.95; p = 0.001), PFS (HR, 3.77; 95% CI, 2.25 to 6.33; p < 0.001), and overall survival (HR, 5.08; 95% CI, 1.94 to 13.34; p < 0.001). Conclusion: Lower-neck involvement and post-CCRT response independently predict DM after definitive CCRT for HNSCC and may improve risk stratification for systemic failure.
PURPOSE:Trials show similar pain outcomes for hypofractionated and multi-fraction regimens in bone metastases, yet clinical adoption of hypofractionation remains limited. The coronavirus disease 2019 (COVID-19) pandemic may have increased hypofractionation to minimize hospital visits and optimize resources. This study evaluated fractionation patterns before, during and after COVID-19 and compared pain outcomes between regimens in routine practice. MATERIALS AND METHODS:Data on treatment regimens for bone metastases between 2018 and 2022 were collected from 11 of 22 Dutch radiotherapy departments. Trends in utilization of hypofractionated (1-2 times 8 Gy) and multi-fraction (≥5 fractions) regimens were analyzed. For a subset of patients (n = 278), self-reported pain scores were collected at baseline, 4 and 8 weeks, and 3 months. Pain scores and pain response were compared for hypofractionated and multiple-fraction regimens, with complete (pain score 0) or partial (reduction ≥2 points) response classified as responders. RESULTS:A total of 17,336 patients were included, receiving 31,677 treatment regimens. The majority of the regimens were hypofractionated (n = 25,790, 81%). The use of hypofractionated regimens ranged from 34% to 99% between radiotherapy departments. A statistically significant increase in hypofractionated regimens was observed since the onset of the COVID-19 pandemic in 2020 (p < 0.001). In an exploratory analysis of patients with available pain scores, pain response in the three months post-treatment did not differ significantly between hypofractionated and multi-fraction regimens (56% vs. 63%, p = 0.406). CONCLUSION:This study demonstrates a high adoption of hypofractionated regimens, with a slight increase since the COVID-19 pandemic, though considerable variation remains between departments. Pain outcomes were comparable between hypofractionated and multi-fraction regimens, suggesting equal palliation and less treatment burden with hypofractionation.
Purpose: This study aimed to investigate treatment outcomes and explore optimal adjuvant treatment options for patients with early-stage uterine serous carcinoma (USC) and clear cell carcinoma (CCC). Materials and Methods: We retrospectively reviewed the records of 63 patients diagnosed with stage I-II (2009 International Federation of Gynecology and Obstetrics [FIGO]) USC or CCC. Survival outcomes were estimated using the Kaplan-Meier method, and comparisons between groups were performed with the log-rank test. Results: Among the 63 patients, 36 (57.1%) had USC and 25 (39.7%) had CCC. According to the revised 2023 FIGO staging system, 23 patients (36.5%) were stage IC, and 40 (63.5%) were stage IIC. Adjuvant treatment included no adjuvant therapy (23.8%), chemotherapy alone (39.7%), radiotherapy alone (28.6%), and combined chemotherapy plus radiotherapy (8.0%). After a median follow-up of 54 months (range, 5 to 227 months), the 5-year progression-free survival (PFS) and overall survival (OS) for the entire cohort were 89.5% and 85.7%, respectively. Patients with CCC had a 5-year PFS of 95.8% and OS of 92.3%, whereas those with USC had a 5-year PFS of 85.1% and OS of 81.4%. Most recurrences (7/63, 11.1%) were distant, occurring predominantly in USC cases (6/7) and 2023 stage IIC (7/7). Conclusion: In this retrospective study, early-stage USC and CCC had very favorable PFS and survival outcomes. Thus, future randomized clinical trial or large cohort study is necessary to determine the optimal adjuvant treatments in these patients.
PURPOSE:Maintaining patient immobility during radiotherapy is essential for accurate dose delivery; however, patients may experience discomfort during treatment, leading to involuntary movement. Continuous imaging to detect intrafractional changes is not routinely feasible in conventional fractionation due to radiation exposure. This study aimed to evaluate the feasibility of knee-based surface-guided radiotherapy (SGRT) as a real-time method for detecting subtle patient motion during prostate radiotherapy. MATERIALS AND METHODS:A total of 125 patients undergoing prostate intensity-modulated radiation therapy (2,527 fractions) were monitored using an SGRT system with the knees as the region of interest. Mean and maximum displacement per fraction were analyzed. Clinical factors, including bladder volume, age, International Prostate Symptom Score, laxative use, and overactive bladder medication, were evaluated. A displacement threshold of ≥4 mm was defined as an operational level to identify notable motion events. RESULTS:Displacement ≥4 mm was observed in 357 of 2,527 fractions (14.1%). Larger displacements were more frequent in the latter half of sessions and were often suggestive of urinary urgency. In a single case, motion improved following verbal instruction. Bladder volume was significantly associated with both mean displacement (p = 0.025) and the proportion of fractions with displacement ≥4 mm (p = 0.004), whereas other factors were not consistent predictors. Knee motion monitoring allowed real-time detection of patient movement requiring clinical attention. CONCLUSION:Knee-based SGRT appears to be a feasible, non-invasive method for monitoring patient motion. While not a surrogate for prostate displacement, it may help identify patient instability and support timely clinical responses.
Purpose: This study aimed to report acute toxicity and quality of life (QoL) outcomes in postoperative prostate cancer patients treated with stereotactic body radiation therapy (SBRT) to the prostate bed and pelvic lymph nodes. Materials and Methods: Patients with prostate cancer who underwent radical prostatectomy and were referred for salvage radiotherapy between January and December 2023 were included. Treatment consisted of 25 Gy to the pelvic nodal areas with a simultaneous integrated boost delivering a total of 30 Gy to the prostate bed, all in 5 fractions, delivered with an empty rectum and comfortably full bladder. Acute gastrointestinal (GI) and genitourinary (GU) toxicities were graded according to Common Terminology Criteria for Adverse Events v5.0. QoL was assessed via phone interview using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-PR25) questionnaire. Results: A total of 166 patients were treated, of whom 61 had at least 6 months of follow-up. Median age was 65 years, and 77.0% received androgen deprivation therapy. Indications for radiotherapy included biochemical persistence (36.1%), biochemical recurrence (27.9%), local recurrence (21.3%), regional recurrence (6.6%), and combined recurrence (8.2%). All plans met organ-at-risk constraints (mean rectal D1cm³ [dose to the most irradiated 1 cm³] 3,000.7 cGy; bowel D1cm³ 2,457.8 cGy). Acute toxicity data was available for 47 patients. No grade ≥3 acute GI or GU toxicity was observed. Grade 2 GI and GU toxicities occurred in 25.5% and 2.1% of patients, respectively. Among the 62.3% who completed the QoL survey, mean symptom scores were low (urinary, 19.1; bowel, 4.2), and sexual functioning averaged 44.4.Conclusion: Postoperative pelvic SBRT demonstrated low acute toxicity and favorable short-term QoL outcomes, supporting its feasibility and safety for further prospective evaluation.
PURPOSE:This study aimed to evaluate long-term tumor control, safety, and prognostic factors following single-fraction stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). MATERIALS AND METHODS:In this retrospective single-institution study, 68 patients with VS were treated with photon-based single-fraction SRS (mean dose, 13.1 Gy; range, 12 to 15 Gy). Treatment planning was based on computed tomography-magnetic resonance imaging (MRI) fusion with organ-at-risk sparing and a planning target volume margin of 0-2 mm. The primary endpoint was local control (LC). Secondary endpoints included toxicity and predictors of treatment failure. RESULTS:After a median follow-up of 68 months, LC was maintained in 95.6% of patients. Actuarial LC rates at 5 and 10 years were both 98.5%. MRI showed tumor shrinkage in 41.2% and stability in 57.4% of cases. Treatment was well tolerated. Acute adverse events were infrequent and mild. Localized alopecia occurred acutely in one patient (1.5%) and did not persist into late follow-up. Vertigo and tinnitus were analyzed as disease-related symptoms rather than treatment-related toxicities. Severe toxicity (grade ≥ 3) was rare (<3%). Cox regression revealed no statistically significant predictors of local failure, though trends suggested higher risk after prior surgery and with doses ≥14 Gy. CONCLUSION:Single-fraction SRS provides durable long-term LC of VS with a favorable toxicity profile, supporting its role as a primary treatment modality. Optimal outcomes appear to be associated with lower prescription doses (<14 Gy) and treatment of de novo tumors.
Sialoblastoma is a rare, aggressive pediatric salivary gland tumor often refractory to conventional therapies, which carry significant risks of growth impairment in children. We report the 52-month follow-up of a 6-year-old girl with recurrent sialoblastoma treated with two sessions of boron neutron capture therapy (BNCT). She achieved a 23-month complete response after the first session and a sustained partial response following the second. Dosimetric analysis using a conservative α/β ratio of 2.0 Gy for late-responding tissues showed that the equivalent dose in 2-Gy fractions to the mandible area was approximately 4.3 Gy-Eq. This is substantially below the 15 Gy threshold recognized for skeletal impairment. Our findings suggest that BNCT is a highly selective salvage option that effectively controls refractory pediatric tumors while preserving craniofacial development.
PURPOSE:Manual delineation of target volumes and organs-at-risk (OARs) for glioblastoma radiotherapy is a critical bottleneck prone to inter-observer variability. This study developed a fully automated, dual-modality deep learning framework to validate its clinical utility by demonstrating the dosimetric equivalence of generated contours against an expert standard. MATERIALS AND METHODS:A deep learning framework was developed using a retrospective dataset of 100 patients. It integrates two specialized networks operating without pre-alignment: a specialized dual-encoder attention U-Net for computed tomography (CT) (used for OARs delineation and dose calculation), and a single-encoder attention U-Net for T2-FLAIR magnetic resonance imaging (MRI) (used for precise target volumes definition). A modality dispatcher routes images to the appropriate model. Geometric performance was evaluated using the Dice similarity coefficient (DSC). For clinical validation, automated CT contours were used to generate volumetric modulated arc therapy plans. These plans were compared to those based on expert manual contours via paired statistical analysis. RESULTS:The framework demonstrated excellent geometric accuracy on the independent test set. Mean planning target volume (PTV) DSC was 0.94 ± 0.03 on MRI and 0.92 ± 0.04 on CT. Dosimetric analysis confirmed clinical viability. No statistically significant differences (p > 0.05) were observed between automated and manual plans for PTV coverage (D₉₅%), OAR maximum doses, or any evaluated metric. CONCLUSION:The automated framework provides accurate segmentation on both CT and MRI. Demonstrated dosimetric equivalence validates clinical reliability and potential to enhance planning efficiency while reducing inter-observer variability.
PURPOSE:This study aimed to develop and validate a 10-point, threshold-based variation score (VS) that integrates magnetic resonance imaging (MRI)-derived spacer morphology and assesses its association with rectal dose after low-dose-rate (LDR) prostate brachytherapy. MATERIALS AND METHODS:We retrospectively studied 149 men treated with iodine-125 LDR brachytherapy and polyethylene-glycol spacers (August 2022-April 2023). Using day 30 fused computed tomography-MRI, the VS assigned one point each for total volume >5 mL; hemisphere volumes (apex, base, left, and right) >5 mL; midgland thickness >5 mm; and thickness >5 mm 1-cm toward apex, base, left, and right. Univariable linear regression tested VS versus change in rectal D1cc (maximum dose to 1 mL). Bonferroni-adjusted Fisher's exact tests evaluated component differences across prespecified VS thresholds (≥6, ≥8, and 10). RESULTS:Median rectal D1cc decreased from 92.4% pre-spacer to 53.4% of prescription at day 30. Each one-point higher VS was associated with 5.4 Gy lower D1cc (95% confidence interval, 3.4 to 7.4; p < 0.001, R² = 0.166). Threshold analyses identified key contributors: midgland separation distinguished VS <6 from 6-7 (adequacy 57%→100%; adjusted p = 0.026); uniform directional thickness, especially apical, distinguished 6-7 from 8-9 (22%→91%; adjusted p < 0.001); apical volume >5 mL was required for VS = 10 (19%→100%; adjusted p < 0.001). CONCLUSION:VS is a simple, objective metric linking spacer morphology with rectal dose reduction. Threshold-oriented targets, midgland separation for VS ≥ 6, uniform thickness for VS ≥ 8, and robust apical volume for VS = 10, may guide technical optimization and quality assurance in prostate LDR brachytherapy.
PURPOSE:This study evaluated the impact of neutrophil-to-lymphocyte ratio on the survival of patients with esophageal squamous cell carcinoma (ESCC) who underwent proton beam therapy with concurrent chemotherapy. MATERIALS AND METHODS:Data of patients with ESCC who received definitive proton beam therapy with concurrent chemotherapy between January 2015 and January 2020 were retrospectively analysed. The 3-year overall and progression-free survival rates were calculated. Prognostic factors, including neutrophil-to-lymphocyte ratio, were examined. RESULTS:In total, 116 consecutive patients with ESCC (median age, 68 years; range, 45 to 90 years) were included. The median follow-up time was 51.2 months (range, 3.0 to 114.0). Complete clinical response was observed in 75 patients (64.7%). The 3-year overall and progression-free survival rates were 82.4% and 59.4%, respectively. In a multivariate analysis, a Eastern Cooperative Oncology Group performance status ≥1 (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.00 to 6.34; p = 0.049), clinical stage Ⅳ disease according to the Union for International Cancer Control 8th edition (HR, 3.37; 95% CI, 1.30 to 8.77; p = 0.013), and a neutrophil-to-lymphocyte ratio ≥3.00 (HR, 3.89; 95% CI, 1.36 to 11.19; p = 0.012) were significantly associated with poorer overall survival. Clinical stage Ⅳ disease (HR, 2.86; 95% CI, 1.50 to 5.44; p = 0.003) and neutrophil-to-lymphocyte ratio ≥3.00 (HR, 2.40; 95% CI, 1.32 to 4.39; p = 0.004) were significantly associated with poorer progression-free survival. CONCLUSION:In patients with ESCC who received definitive proton beam therapy with concurrent chemotherapy, a high neutrophil-to-lymphocyte ratio was a significant poor prognostic factor for both overall and progression-free survival.
Purpose: Patients with non-small cell lung cancer (NSCLC) and brain metastases (BM) represent a markedly heterogeneous population. The diagnosis-specific graded prognostic assessment is one of the prognostic indexes, which includes patient age, performance status, extracranial disease, and number of BM. As an updated prognostic model (lung molecular graded prognostic assessment [Lung-molGPA]) with the incorporation of the molecular factor (epidermal growth factor receptor [EGFR] and anaplastic lymphoma kinase [ALK] alterations) was introduced, this study aims to validate the Lung-molGPA model in Korean patient population. Materials and Methods: Four hundred thirty-three patients (368 adenocarcinoma and 65 nonadenocarcinoma) with NSCLC with newly diagnosed BM between 2005 and 2017 were reviewed retrospectively and scored using the Lung-molGPA model. Results: The overall median survival for the cohort in the present study was 14 months (16.5 months in the adenocarcinoma and 8.0 months in the nonadenocarcinoma, respectively; p = 0.003). For patients with adenocarcinoma, the median survival for patients with a Lung-molGPA score of 3.5 to 4.0 was 44.7 months, while the median survival was only 8.9 months in patients scoring 0-1.0, 17.0 months in patients scoring 1.5-2.0, and 30.2 months for scores of 2.5-3.0 (p < 0.001). For patients with nonadenocarcinoma, the median survival for scores 0-1.0, 1.5-2.0, and 2.5-3.0 were 6.7, 10.3, and 13.2 months, respectively (p = 0.041). Conclusion: Notable prognostic factors for patients with NSCLC and BM include the patient's age, performance status, metastatic lesions, and the molecular status of the adenocarcinoma. Our independent validation in a single-institution Korean patient cohort confirmed the applicability of Lung-molGPA as a prognostic tool.
Purpose: Malignant diseases are among the most pressing public health challenges, exerting significant pressure on healthcare resources. Innovative cancer treatments like carbon ion radiation therapy (CIRT) by virtue of its advantages in physical properties, biological effectiveness, and dose distribution compared to photon and proton therapies stands out. This study aims to assess the cost-effectiveness of CIRT in cancer treatment by systematically reviewing existing economic evaluations.Material and Methods: The protocol is registered with PROSPERO and employed PRISMA Guidelines. Systematic searches across PubMed, Embase, and Web of Science, between January 2000 and March 2025 were conducted and CIRT pharmacoeconomic articles were included. Screening of the search results, critical quality assessment using Drummond and CHEERS checklist and data extraction were performed.Results: Out of the 10 studies included in this systematic review, seven analysed cost effectiveness and three analysed cost. Total cost for CIRT ranged from €16,937 (approx. USD 19,595) to €43,600 (approx. USD 50,443) and JPY 3,140,000 (approx. USD 20,450) to JPY 4,974,278 (approx. USD 32,396) in Germany and Japan, respectively. Seven studies assessed and reported increased effectiveness of CIRT. Reduction in CIRT technical fees, reirradiation with IMRT, increased survival rate with CIRT, local control rate by 60% with CIRT were found to reduce incremental cost effectiveness ratio.Conclusion: Nine studies show CIRT is cost effective in NSCLC, Adenoid cystic carcinoma, head and neck cancer, skull-based chordoma, recurrent rectal cancer, and hepatocellular carcinoma. The cost-effectiveness of CIRT is likely to improve more in real-world clinical practice due to enhanced efficacy, reduced toxicity, reduced fractionation, and cost reductions.
Purpose: This study evaluated the usefulness of non-coplanar volumetric modulated arc therapy (VMAT) using a novel O-ring-type linear accelerator, OXRAY, in patients with prostate cancer (PCa). The focus was on those with the planning target volume (PTV) adjacent to the small or large intestine. Materials and Methods: We enrolled 10 consecutive PCa patients with the PTV less than 10 mm from the small or large intestine. These patients underwent conventional coplanar VMAT (Conv-VMAT) using Halcyon, another O-ring-type linear accelerator, at our institute between July 2023 and July 2024. To evaluate the utility of OXRAY, we developed two simulation plans: biaxially rotational dynamic radiation therapy (BROAD-RT) and swing-fixed non-coplanar VMAT (SF-VMAT). A total dose of 63 Gy in 21 fractions was prescribed for all plans. Dosimetric parameters of the PTV and organs at risk were compared among the three plans using paired t-tests. Results: No significant differences in the dose received to 95% of the volume (D95) of the PTV were observed among the three plans. However, the D95 of the PTV-base, defined as the three cranial slices of the PTV, significantly improved in BROAD-RT compared to Conv-VMAT, adhering to dose constraints of the small or large intestine. On the other hand, the improvement in SF-VMAT was insignificant. BROAD-RT and SF-VMAT significantly improved rectal dose indices compared to Conv-VMAT. Conclusion: For PCa patients with the PTV close to the small or large intestine, non-coplanar VMAT using OXRAY may improve the PTV-base coverage and decrease rectal dose compared to conventional VMAT plans, while adhering to dose constraints of the small or large intestines.
