Abstract Purpose To implement and preliminarily evaluate a practical digital acquisition‐and‐analysis workflow for routine laser‐radiation field coincidence quality assurance (QA) on the CyberKnife M6 by integrating multileaf collimator (MLC) QA tool‐based laser reference definition, QA StereoChecker (QASC)‐based external digital image acquisition, and automated analysis with CKQA, an in‐house CyberKnife QA software, and to compare this workflow with clinically realistic film‐based alternatives. Methods Methods a and b were film‐based measurements performed at the perch position. Method a used manual laser marking on film, whereas method b used the central metal marker of the MLC QA tool to define the laser reference. Method c used QASC as an external digital image‐acquisition platform in combination with the MLC QA tool, and method d used film on the same QASC‐based setup as a control. All methods were tested with 10 fixed collimators (5–40 mm). Images were analyzed using ImageJ and CKQA. Mean deviation, standard deviation, root mean square error (RMSE), and pairwise two‐sided exact Wilcoxon signed‐rank tests were used for exploratory comparisons. Results All evaluated workflows achieved submillimeter mean deviations. Across both analysis approaches, the mean deviation ranked consistently in descending order: method a > method b > method d > method c. Under the present experimental conditions, method c yielded the lowest mean deviation and RMSE (0.116 mm and 0.155 mm with CKQA), whereas method a showed the largest deviations. Dataset‐level exact Wilcoxon signed‐rank tests showed that several comparisons involving method a were statistically significant, but statistically significant differences were not uniform across both ImageJ‐ and CKQA‐based comparisons. For comparisons between analysis methods within each workflow, CKQA and ImageJ were not significantly different for methods a and b, whereas CKQA yielded significantly lower deviations than ImageJ for methods c and d ( p < 0.05). Conclusions Laser‐radiation field coincidence testing is an established CyberKnife QA procedure. The present study implemented and preliminarily evaluated a practical digital acquisition‐and‐analysis workflow for this routine task. The workflow combining MLC QA tool‐based laser reference definition, QASC‐based external digital image acquisition, and automated CKQA analysis provided a standardized and less operator‐dependent procedure under the present experimental conditions. Its main value lies in reducing manual marking, film handling, scanning, and subjective image‐analysis steps rather than in introducing a new physical measurement principle. In centers where QASC is not available, the film‐based workflow using the MLC QA tool (method b) may serve as a practical alternative.
Abstract This planning study evaluated ultra‐hypofractionated three‐dose‐level radiotherapy for prostate cancer with a dominant intraprostatic lesion (DIL) abutting the urethral high‐dose avoidance zone (HDAZ). Ten patients (30 volumetric modulated arc therapy [VMAT] plans) were re‐planned with 25 Gy to the pelvis, 35 Gy to the prostate, and 50 Gy to the DIL in five fractions. All plans achieved coverage while keeping urethral doses below the 90 GyEQD2 threshold and meeting organ‐at‐risk constraints, irrespective of DIL size or HDAZ contact. The findings demonstrate the feasibility of urethra‐sparing with effective DIL dose escalation, even in peri‐HDAZ locations.
This article discusses the emerging radiotherapy-free and chemo-free strategies in PD-L1-high, unresectable stage III NSCLC, reviewing the Evolution trial and comparing it with existing treatments. We highlight the need for further research to validate these approaches and ensure safe de-escalation without compromising curability.
Abstract Objectives Fluorine 18 (18F)‐labeled fibroblast activation protein inhibitor‐04 (denoted as FAPI‐04) positron emission tomography/computed tomography (PET/CT) has showed excellent diagnostic performance for multiple solid tumors. However, its utility in characterizing myocardial injury has not yet been reported. In this study, the additional value of 18F‐FAPI‐04 PET/CT in assessing myocardial injury was evaluated in patients with cancer. Methods Myocardial tracer uptake in 168 patients who underwent 18F‐FAPI‐04 PET/CT was analyzed retrospectively. Maximum and mean standard uptake values in the myocardium (SUVmax‐myocardium and SUVmean‐myocardium) and blood pool (SUVmax‐BP and SUVmean‐BP) were recorded. The ratio of SUVmax‐myocardium to SUVmean‐BP was denoted as the target‐to‐background ratio (TBR). Myocardial uptake higher than the background was visual uptake (n = 49), and uptake consistent with the background was no visual uptake (n = 119). Patients with abnormal uptake but without cardiovascular disease (CVD) were followed up. Results Myocardial uptake higher than the background was visual uptake (n = 49), and uptake consistent with the background was no visual uptake (n = 119). The prevalence of hypertension, diabetes mellitus (DM), CVD, and levels of cardiac troponin T and pro‐BNP were higher in the visual uptake group (all p < 0.05). SUVmax‐myocardium and TBR were significantly correlated with age and pro‐BNP levels (p < 0.05). Hypertension, DM, CVD, pro‐BNP>125 pg/mL, and prior chest radiotherapy were independent risk factors for abnormal uptake (p < 0.05). The area under the curve (AUC) values of myocardial 18F‐FAPI‐04 uptake to predict myocardial injury were 0.79 and 0.87 for SUVmax‐myocardium and TBR, respectively (p < 0.001). Conclusion 18F‐FAPI‐04 PET/CT imaging identified features of myocardial injury in patients with cancer, providing complementary value beyond tumor staging.
Abstract As a core modality for local control of thoracic tumors, including lung and esophageal cancers, radiotherapy (RT) shows synergistic effects with immunotherapy, fundamentally reshaping the landscape of cancer treatment. Given the rapid advancements in immunotherapy, this review explores the critical role of precise delineation of radiotherapy targets in achieving synergistic effects between RT and immunotherapy. It elucidates the dual‐edged nature of RT, which can both activate antitumor immune responses and suppress immune function. Notably, larger radiation target volumes often cause destruction of tumor‐draining lymph nodes and reduce the number of peripheral blood lymphocytes, thereby impairing the efficacy of immunotherapy. To address this challenge, we discuss strategies tailored to thoracic tumors, including reducing target volumes, optimizing irradiation fields, and adjusting target positioning to protect key immune components. Furthermore, we highlight recent advancements in multimodal imaging, real‐time dynamic tracking technologies, and deep learning‐enabled automated segmentation methods that can increase the precision of target delineation. Additionally, emerging RT techniques, such as proton therapy and FLASH‐RT, demonstrate unique advantages in minimizing irradiation of normal tissues and circulating immune cells while enhancing immunomodulatory effects and thereby facilitating precise RT. This review aims to provide a theoretical foundation and technical support for accurate target delineation in the era of immunotherapy, particularly for thoracic malignancies, to promote the deep integration of RT and immunotherapy and improve patient outcomes.
