To evaluate the prognostic value of body composition parameters combined with clinical factors in patients with locally advanced nasopharyngeal carcinoma (LA-NPC). Body composition parameters were assessed in patients with LA-NPC during radiotherapy. Based on the occurrence of disease progression, patients were divided into the non-recurrence/metastasis group and the recurrence/metastasis group. Clinical characteristics and body composition parameters were compared between the two groups. Independent predictors of progression-free survival (PFS) were identified, and a predictive model was constructed and validated. After radiotherapy, reductions in body composition parameters were significantly greater in the recurrence/metastasis group than in the non-recurrence/metastasis group (P < 0.05). Immunotherapy, pre-radiotherapy Epstein-Barr virus (EBV) DNA level, pre-radiotherapy platelet-to-lymphocyte ratio (PLR), skeletal muscle mass, and phase angle were independent predictors of 3-year PFS in patients with LA-NPC. Among these, skeletal muscle mass exhibited the highest predictive performance (area under the curve [AUC] = 0.952). The nomogram incorporating all predictors had higher predictive efficacy, with an AUC of 0.987, a sensitivity of 1.00, and a specificity of 0.92, along with good calibration and clinical utility. A prognostic model incorporating immunotherapy status, pre-radiotherapy EBV DNA level, pre-radiotherapy PLR, skeletal muscle mass, and phase angle can effectively predict the prognosis of patients with LA-NPC. Not applicable
Patient-reported outcomes (PRO) capture patients’ self-reported and treatment-related experiences, including functional impairment, symptoms, and health-related quality of life (HRQOL). Although PRO have shown benefits in many studies and are recommended by guidelines, systematic PRO assessment is still rarely integrated into routine cancer care. This paper describes results of the long-term implementation of electronic PRO assessment (ePRO) in the routine workflow of a radiation oncology inpatient clinic by analyzing patients’ HRQOL at admission. Admission ePRO included the EORTC QLQ-C30. PRO data were analyzed descriptively and stratified by sex, age, and primary tumor diagnosis. The sample included 1,423 patients. More than half reported clinically important burden in physical and emotional functioning and fatigue. Male patients tended to report better functioning and lower symptom burden. Older patients reported greater burden in physical functioning, appetite loss, and constipation but less burden in social functioning and financial problems. Global health status showed little to no differences by sex, age, or tumor diagnosis. The analyses showed substantial self-reported functional impairment and symptom burden at admission in inpatient radiation oncology and highlight the value of ePRO for identifying needs early, when patients’ clinical status is not yet well known to the care team. At the organizational level, these results can help set priorities for supportive care during hospitalization and support more efficient resource allocation. Not applicable, the analysis used only PRO data collected as part of routine care in the inpatient radiation oncology clinic (see also the declaration of no objection).
Microbeam Radiotherapy (MRT) is an emerging radiotherapy technique which delivers spatially fractionated beams on a micrometre scale. In preclinical studies MRT has demonstrated superior normal tissue sparing compared to conventional radiotherapy while maintaining tumour control. However, MRT has traditionally been achievable only at large synchrotron facilities which has impeded clinical translation. The development of a compact line-focus X-ray tube (LFXT) provides a pathway for clinical MRT, but identification of clinically and dosimetrically suitable patient scenarios is required for first-in-human trials. Potentially eligible patients were selected from our patient cohort based on clinical criteria including palliative treatment indication, superficial tumour location, reproducible and safe positioning, minimal interference from other therapies, and expected benefit from MRT. Three-dimensional forward treatment planning was performed in Eclipse using gantry rotations, collimator positioning, and conformal masks to treat the clinical target volume (CTV). Dose was calculated in Eclipse using a custom Monte Carlo–based hybrid algorithm adapted for the compact LFXT system with a 300 kVp beam and an eccentric focal spot. A single-fraction equivalent uniform doses (EUD) of 3 Gy was prescribed to the target volume. Dose distributions were analysed using dose-volume histograms (DVHs), peak and valley depth dose profiles, and peak-to-valley dose ratios (PVDRs). Selected cases included primary lymphoma, squamous cell carcinoma, and superficial soft tissue metastases. Dosimetric analysis under exploratory assumptions demonstrated dosimetrically feasible treatment plans with optimal target coverage and organ-at-risk (OAR) sparing for gluteal, nuchal, and inguinal tumours. Maximum OAR doses remained below 8.5 Gy, except in bone or overlapping high-density regions. The mean peak and valley dose across all plans was 57.2 Gy and 3.9 Gy, respectively, with a mean PVDR of 15.4. Dose inhomogeneities were observed due to tissue heterogeneity, kilovoltage beam interactions, and a limited range of suitable gantry angles. Tumours in anatomically complex regions, including those in proximity to OARs or tissue inhomogeneities, showed less favourable trade-offs between target coverage and OAR sparing. This study identifies clinically and dosimetrically suitable scenarios for first-in-human MRT trials, highlighting superficial tumours as optimal initial indications. While peak, valley, and PVDR values align with preclinical evidence, their clinical significance remains uncertain. Careful, safety-driven dose escalation studies will be required to establish a foundation for responsible and effective clinical application of MRT in early-phase clinical trials.
Under the 9th edition AJCC/UICC staging system, Stage IB nasopharyngeal carcinoma (NPC, T1-2N1M0) represents a biologically heterogeneous population for which uniform chemoradiotherapy may be suboptimal. We aimed to develop a prognostic nomogram integrating MRI nodal features and plasma EBV DNA for individualised prognostic risk stratification. 446 consecutive TNM-9 stage IB NPC patients treated with intensity-modulated radiotherapy (IMRT) with or without chemotherapy between July 2016 and December 2023 were retrospectively analysed. Pretreatment MRI was assessed for radiologic extranodal extension (rENE) and lymph node necrosis (LNN). The nomogram was internally validated using bootstrap resampling. With a median follow-up of 43 months and 42 PFS events, 5-year PFS and OS were 87.6
Adjuvant whole-breast radiation therapy following breast-conserving surgery is a standard of early-stage breast cancer management, with tumor bed boost delivery representing a critical component for optimizing local control. Two principal boost techniques exist: the conventional sequential boost (SeB), delivered after whole-breast irradiation, and the simultaneous integrated boost (SIB), delivered concurrently using advanced radiotherapy techniques. Given the expanding adoption of SIB alongside the established track record of SeB, a comprehensive synthesis of their comparative outcomes is essential for informing clinical decision-making. This narrative review summarizes the current evidence comparing SIB and SeB in patients undergoing adjuvant whole-breast radiotherapy after breast-conserving surgery. A structured literature search was conducted to identify clinical trials, cohort studies, and comparative dosimetric studies evaluating SIB and SeB. Studies reporting toxicity, cosmetic, dosimetric, oncological, or treatment-efficiency outcomes were included, and the findings were synthesized narratively because of heterogeneity in study design, fractionation schedules, and treatment techniques. SIB and SeB generally showed similar oncological outcomes, with low recurrence rates and no consistent differences in overall or disease-free survival. SIB shortened overall treatment time and was associated with lower acute skin toxicity in several studies, while late toxicity and cosmetic outcomes were generally comparable. Several SIB-based regimens showed favorable target conformity and lower heart or ipsilateral lung doses, although these findings were influenced by treatment technique and fractionation. SIB is a clinically feasible alternative to SeB that can reduce treatment duration while maintaining similar oncological outcomes, although treatment technique, dose schedule, and patient selection should be considered when interpreting its potential dosimetric and toxicity advantages. Not applicable.
