Background While trastuzumab deruxtecan (T-DXd) demonstrates intracranial efficacy, the potential for radionecrosis (RN) when combined with stereotactic radiosurgery (SRS) remains a concern, given the established risk with other antibody-drug conjugates like T-DM1. This study evaluated the safety and efficacy of T-DXd and SRS in patients with HER2-positive or -low breast cancer brain metastases (BCBM). Methods We conducted a multi-center retrospective analysis of 113 patients (461 SRS treatments) treated with SRS and anti-HER2 agents. Patients were stratified into T-DXd(+) (n=29 patients, 61 treatments) and T-DXd(-) (n=84 patients, 400 treatments) groups. Endpoints included RN, radionecrosis-free survival (RNFS), and intracranial control outcomes (any intracranial progression, local failure, and distant intracranial metastasis). Results No cases of RN were observed in the T-DXd(+) group, compared with 11 cases in the T-DXd(-) group (p=0.028). On multivariate analysis, T-DXd(+) status remained significantly associated with improved RNFS (HR 0.31, p=0.009). In the treatment-level analysis, the 1-year cumulative incidence of RN was 0% for T-DXd(+) versus 4.3% for T-DXd(-) (p=0.009). Additionally, T-DXd(+) was associated with significantly better 1-year outcomes for any intracranial progression (40% vs. 76%, p<0.001), local failure (6.6% vs. 29%, p=0.002), and distant intracranial metastasis (40% vs. 66%, p=0.009). All efficacy endpoints remained significant on multivariate analysis. Conclusion Combining T-DXd with SRS demonstrated a favorable safety profile without increasing the risk of radionecrosis. Furthermore, this combination was associated with superior intracranial control, encompassing both local and distant outcomes, supporting the potential of T-DXd combined with SRS as an effective and well-tolerated approach for HER2-positive or -low BCBM.

BACKGROUND AND PURPOSE:The understanding of long-term outcomes associated with branch-incorporated aneurysms treated using a flow diverter (FD) remains limited. This study evaluated long-term outcomes of flow diversion in patients with branch-incorporated aneurysms. MATERIALS AND METHODS:We performed a retrospective analysis of a prospectively maintained database from 5 centers in South Korea. Patients who underwent FD placement for unruptured aneurysms with incorporated branch artery were identified; and long-term clinical and angiographic outcomes were evaluated. RESULTS:Sixty-five patients (median age, 61 years; male-to-female ratio, 15:50) with aneurysms (median size: 11.1 mm; median neck diameter: 7.2 mm) were identified. The median duration of clinical and imaging follow-up was 38 months (range: 13-75 months) and 26 months (range: 6-50 months), respectively. All patients exhibited favorable outcomes, with 63 having mRS scores of 0-1 and 2 having an mRS score of 2. Aneurysm occlusion was achieved in 29.2% (n=19) of patients at 6-8 months postoperatively, 53.8% (n=35) at 12-18 months postoperatively, 84.0% (n=42) at 19-48 months postoperatively, and 86.5% (n=45) at >48 months postoperatively. The incorporated branches were patent with aneurysm occlusion in 40% (n=26), patent with aneurysm remnants in 36.9% (n=24), and occluded with aneurysm occlusion in 23% (n=15) of patients at the latest follow-up. No aneurysm recanalized after occlusion was achieved. CONCLUSIONS:FD for branch-incorporated aneurysms demonstrated a low aneurysm occlusion rate in the short- to intermediate-term (6-12 months). However, long-term occlusion rates were comparable with those reported in the literature. In 23% of patients, the incorporated branches were occluded along with the aneurysm; none of these resulted in a permanent neurologic deficit.

OBJECTIVE:As endovascular coiling has grown in popularity, clipping has evolved to reduce operative burden. Yet, improvements have largely focused on surgical techniques, with little emphasis on perioperative care. Enhanced Recovery After Surgery (ERAS) programs have improved outcomes across various surgical fields but remain inconsistently applied in neurosurgery. Given the lack of standardized, pathology-specific ERAS frameworks, this study evaluated whether implementing an ERAS protocol for elective aneurysm clipping could enhance recovery by improving pain control, reducing postoperative nausea and vomiting (PONV), and promoting overall recovery quality. METHODS:This single-center, prospective, open-label study included adults undergoing elective clipping for unruptured intracranial aneurysms at Severance Hospital, Seoul. Consecutive patients were assigned to pre-ERAS (January 2023-February 2024) or ERAS (February-December 2024) cohorts. The ERAS protocol incorporated preoperative education, optimized fasting, local anesthesia, antiemetics, and early ambulation with nonopioid analgesia. Pain score, PONV incidence, and recovery quality survey (Quality of Recovery-40 [QoR-40]) results were compared between the groups using the Mann-Whitney U-test, Fisher's exact test, and multivariate regression to adjust confounders. RESULTS:A total of 414 elective aneurysm-clipping procedures were analyzed (234 pre-ERAS, 180 ERAS). Baseline demographics and aneurysm characteristics were comparable between the groups. Postoperative pain scores were significantly lower in the ERAS group across postoperative days (PODs) 0-3 (all p < 0.001), and ERAS implementation was the only independent protective factor for pain. Opioid use decreased markedly, with earlier transition to oral nonopioid analgesics. The incidence of PONV was significantly lower from PODs 1 to 3, and ERAS remained an independent protective factor after multivariate adjustment. QoR-40 scores on POD 2 were higher in the ERAS group, indicating improved comfort and well-being, while hospital stay and complication rates were comparable. CONCLUSIONS:The ERAS protocol improved pain control, reduced PONV, and enhanced recovery in patients undergoing aneurysm clipping. These findings support the feasibility of ERAS in craniotomy surgery and highlight the potential for further optimization to improve outcomes.

Although blood pressure is an important modifiable factor for the prevention of recurrent stroke after spontaneous intracerebral hemorrhage (ICH), the target blood pressure remains uncertain. Using the National Health Insurance Service database from January 2005 to December 2022, patients who survived for more than one year with prescribed antihypertensive drugs were identified. We compared the risks of mortality, ischemic stroke, and recurrent ICH among six groups divided according to systolic blood pressure (SBP). SBP was assessed at the first available health examination within 1 year after the index ICH and the date of SBP measurement was defined as the index date.The incidence rates, hazard ratios, and 95% confidence intervals were estimated using the Cox proportional hazards model. Among the 11,034 ICH survivors, 5-year incidence rates of mortality, ischemic stroke, and recurrent ICH were 13.26 per 1000 person-year, 7.71, and 12.90, respectively. Mortality incidence was lowest in the SBP 120-129 mmHg group, and SBP ≥ 160 mmHg was associated with a higher risk of mortality (adjusted HR [aHR]: 1.55 [95% CI 1.06-2.28]) compared with the reference group. Acute ischemic stroke followed linear increasing trend with significance at SBP ≥ 150 mmHg (SBP 150-159 mmHg, aHR: 1.80 [95% CI 1.18-2.74]), while recurrent ICH was significantly increased at SBP ≥ 160 mmHg (aHR: 1.87 [95% CI 1.27-2.74]). The present study showed that SBP between 120-129 mmHg was associated with the lowest risk of mortality, while higher SBP levels were associated with increased risk of ischemic stroke and ICH recurrence. These findings suggest a designated blood pressure range for managing this high-risk population.

Background: This retrospective cross-sectional study aimed to investigate the course of newly onset moderate-to-severe headaches in patients who underwent endovascular treatment (EVT) for unruptured intracranial aneurysms (UIAs). Methods: Between September 2009 and May 2022, 412 patients were included, and all met the following criteria: (1) presence of UIAs on computed tomography angiography or magnetic resonance angiography; (2) newly onset moderate-to-severe headache (Numeric Rating Scale, NRS >= 4) around the time of UIAs diagnosis; and (3) EVT of UIAs. We evaluated initial and follow-up NRS scores to determine the significance of NRS changes and identified predisposing factors for headache improvement at the 12-month follow-up. Results: Compared to the NRS score (7.14) before EVT, the average NRS score (4.02) significantly decreased at discharge (p < 0.05). Subsequently, the follow-up NRS scores at 1-month (2.14), 6-month (1.65), and 12-month (1.27) were significantly decreased (p < 0.01). Follow-up NRS scores decreased continuously until the 12-month follow-up. A history of stroke (odds ratio [OR] = 0.539, 95% confidence interval [CI] 0.196 to 0.806; p = 0.039) and procedure-related complications (OR = 0.567, 95% CI 0.218 to 0.728; p = 0.045) were identified as independent predisposing factors of headache improvement on multivariate logistic regression analysis. Conclusion: After EVT of UIAs, patients with newly onset moderate-to-severe headaches experienced significant headache improvement at discharge, with NRS continuously decreasing over the 12 months of follow-up. Headache improvement might be expected in patients who do not have a history of stroke and in those who have not experienced procedure-related complications.

Purpose:To evaluate outcomes and prognostic factors associated with metastasis-directed radiation therapy (MDRT) for oligometastatic endometrial cancer. Methods and Materials:We retrospectively analyzed 101 patients (203 lesions) with ≤5 metastatic lesions treated with MDRT between 2015 and 2025. Oligometastatic states were classified according to the European Society for Radiotherapy and Oncology-European Organisation for Research and Treatment of Cancer framework. Endpoints were overall survival (OS), progression-free survival (PFS), and local failure-free survival. Prognostic factors were assessed using multivariable Cox regression, and toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. Results:At a median follow-up of 36.4 months, 3-year OS, PFS, and 2-year local failure-free survival rates were 76.3%, 24.5%, and 64.7%, respectively. Multivariable analyses revealed that favorable oligometastatic disease classification, endometrioid histology, favorable radiation therapy (RT) response, and maximum dose ≥40 Gy (equivalent dose in 2 Gy fractions, α/β = 10) were independently associated with improved OS. All factors, except for histology, were significant for PFS. In a propensity-matched analysis, repeated MDRT for recurrent oligometastases showed a trend toward improved OS compared with a single course. One grade 3 event occurred with no grade ≥4 toxicity. Conclusions:MDRT yielded favorable outcomes in oligometastatic endometrial cancer. Oligometastatic classification, histology, and RT response were major prognostic factors. MDRT may be a viable option within a multidisciplinary framework for de novo and recurrent oligometastases, but validation in prospective multicenter studies is warranted.

Background:The role of metastasis-directed radiotherapy (MDRT) in oligometastatic cervical carcinoma (OCC) remains unclear. This study evaluated clinical outcomes of MDRT in patients with OCC and identified prognostic factors associated with survival. Materials and methods:Patients with OCC who received MDRT between 2019 and 2022 were retrospectively reviewed. Eligible patients had ≤ 5 metastatic lesions treated using stereotactic ablative radiotherapy (SABR), defined as radiotherapy delivered in ≤ 5 fractions with a fractional dose of ≥ 5 Gy. Oligometastatic disease was classified according to the ESTRO-EORTC consensus. Radiologic response, patterns of failure, progression-free survival (PFS), overall survival (OS), and treatment-related toxicities were analyzed. Results:A total of 83 patients with 114 temporally independent MDRT courses delivered using SABR were included. Repeat oligorecurrence was the most common oligometastatic subtype, observed in 35 patients. Lymph nodes were the most frequently treated sites (37 patients, 44.6%). Systemic therapy was administered either before and/or after MDRT in 54 patients (65.1%). With a median follow-up of 20 months, the local control rate was 60.8%, and disease progression predominantly occurred outside the treated fields. The 2-year PFS and OS rates were 14.5% and 62.9%, respectively. In multivariable analysis, oligometastatic disease classification and RT response were independently associated with OS. No grade 3 or higher treatment-related toxicities were observed. Conclusion:MDRT using SABR achieved favorable outcomes with minimal toxicity in OCC. Oligometastatic disease classification may assist in selecting appropriate patients for MDRT under multidisciplinary approach. Prospective studies are warranted to validate these findings and to define optimal MDRT strategies.

INTRODUCTION:This study aimed to evaluate the accuracy of the Earlier Subarachnoid Hemorrhage, Aneurysm Location, Age, Population, Aneurysm Size, And Shape (ELAPSS) score in predicting the growth risk of unruptured intracranial aneurysms across different patient subgroups. METHODS:Between 2002 and 2021, we retrospectively included patients with saccular intracranial aneurysms who underwent at least two serial angiographic imaging studies at a single tertiary center. Imaging modalities included computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography, with a minimum follow-up of six months. ELAPSS score components were recorded at diagnosis, and absolute growth risks at 3, 5, 10, 15, and 16 years were calculated. RESULTS:A total of 483 patients with 563 aneurysms were analyzed, accounting for 2,766 aneurysm- years of follow-up. Aneurysm growth was observed in 86 aneurysms (15.2%). Over a 16- year follow-up period, cumulative growth risk was significantly lower in the low-risk group compared with the intermediate- and high-risk groups. DISCUSSION:Although the ELAPSS score demonstrated long-term risk stratification for aneurysm growth, heterogeneity in patient and aneurysm characteristics may limit its accuracy for individualized clinical decision-making. CONCLUSION:This external validation study suggests that caution is warranted when applying the ELAPSS score to guide treatment decisions for unruptured intracranial aneurysms.

Importance:Primary brain and central nervous system cancer (collectively referred to as CNS cancer) comprises 2% of all human cancers and poses significant health and economic challenges in the United States. Objective:To analyze CNS cancer burden in the US, stratified by time, location (state and division), sex, age group, and Sociodemographic Index (SDI). Design, Setting, and Participants:This cross-sectional study involved a repeated analysis of Global Burden of Disease Study (GBD) 2021 data in 2024. Using data from 183 sources, CNS cancer metrics in the US were estimated across states and years. US CNS cancer metrics across all sexes and age groups were included in the GBD. Exposure:CNS cancer diagnosis. Main Outcomes and Measures:Overall and age-standardized estimates of the incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability per 100 000 population, including 95% uncertainty intervals (UIs), and time trends. Results:In 2021, for all age groups and sexes across the US, there were 31 780 incident cases (95% UI, 29971.1 to 32843.9). Age-standardized incidence, DALYs, and mortality rates per 100 000 population were 6.91 (95% UI, 6.58 to 7.12), 134.38 (95% UI, 129.83 to 137.95), and 4.1 (95% UI, 3.87 to 4.22), respectively. Despite no significant change observed in the overall incidence between 1990 and 2021, DALY and mortality rates decreased by 15.77% (95% UI, -17.75% to -13.68%) and 8.41% (95% UI, -11.09% to -6.22%), respectively. Substantial geographic variability was noted. Mississippi, Alabama, Kentucky, and Kansas (West North Central and East South Central divisions) and West Virginia faced persistently high burdens over the past 30 years. Sex differences were evident; disease burden was consistently higher in males compared with females. Age-specific estimates showed a bimodal distribution: the youngest group (<5 years) showed a significant decrease in incidence rate (-34.42% to -11.56%), whereas older age groups (>70 years) experienced increasing trends. DALYs and mortality rates were negatively correlated with SDI (ρ = -0.6860 and ρ = -0.6391; P < .001). Conclusions and Relevance:These findings provide valuable insights into the CNS cancer burden across the US by age, sex, location, and SDI, enabling better public health status assessments, health care policy restructuring, and resource redistribution for improved care.

Purpose:To evaluate the effect of regional nodal irradiation (RNI) in breast cancer patients with 1-3 residual nodal metastases (ypN1) after neoadjuvant chemotherapy (NAC). Methods:We retrospectively reviewed the medical records of breast cancer patients with clinical T1-2N1 disease who received NAC followed by surgery and postoperative radiotherapy between 2005 and 2017. Patients with 1-3 pathologically positive lymph nodes (ypN1) after axillary dissection were included. Univariate and multivariate analyses were performed to identify the prognostic factors for locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). Results:The median follow-up duration was 88.9 months (range, 5.0-200.1). A total of 245 patients were included and RNI was administered in 84.5% (n = 207). Lymphatic invasion and extranodal extension were more frequent in patients who received RNI compared with those who did not (p = 0.009 and p < 0.001, respectively), while other patient and tumor characteristics were similar between the two groups. On multivariate analysis, histologic grade was identified as a significant prognostic factor for LRRFS (p = 0.045) and lymphatic invasion was significantly associated with DMFS (p = 0.029). However, RNI was not associated with any of the survival outcomes. The 5-year LRRFS, DMFS, DFS, and OS in the RNI and non-RNI groups were 89.5% vs. 97.2%, 84.2% vs. 91.6%, 81.7% vs. 91.6% and 91.1% vs. 100%, respectively (all p > 0.05). Conclusion:RNI was not associated with additional survival benefit in cT1-2N1 breast cancer patients with ypN1 disease after NAC. These findings warrant further validation.

A cerebral aneurysm may present irregularities associated with rupture risks. However, conventional morphological parameters are limited in evaluating the aneurysm irregularity. Although the mass moment of inertia has been devised for the irregularity evaluation, its performance still needs to be improved. In this study, three novel morphological indexes (NMIs) were devised based on the mass moment of inertia (ANI, aneurysm-to-neck index; AVI, aneurysm-to-vessel index; AII, aneurysm irregularity index) to effectively describe aneurysm irregularities. 456 patients with cerebral aneurysms (367 unruptured and 89 ruptured) were enrolled and their NMIs and the conventional morphological parameters were calculated for comparison. Artificial neural networks (ANNs) were trained with each parameter and then used to predict rupture risk. All NMIs were significantly higher in ruptured cases than in unruptured cases (p-values for [Formula: see text], [Formula: see text], and [Formula: see text] were < 0.001, <0.001, and < 0.001, respectively). The highest performance for rupture risk prediction (sensitivity, 92.9%; specificity, 92.0%; and area under the receiver operating characteristic curve, 0.951) was obtained when the NMIs were considered in the ANN model. In particular, the [Formula: see text] effectively described the aneurysm irregularities that could not be evaluated using conventional morphological parameters. The NMIs were effective in evaluating aneurysm irregularities, enabling timely prediction of an aneurysm rupture.

BACKGROUND AND PURPOSE:Avoiding unnecessary radiotherapy (RT) in patients with limited life expectancy requires accurate selection. Traditional survival models based on structured data often lack precision. Large language models (LLMs) offer a novel approach to structuring unstructured electronic health record (EHR) data, potentially improving survival predictions by integrating comprehensive clinical information. MATERIALS AND METHODS:We analyzed structured and unstructured data from 34,276 RT-treated patients at Yonsei Cancer Center. An open-source LLM structured unstructured EHR data using single-shot learning. External validation included 852 patients from Yongin Severance Hospital. We compared the LLM's performance against a domain-specific medical LLM and a smaller variant. Survival prediction models using statistical, machine-learning, and deep-learning approaches incorporated both structured and LLM-structured data. RESULTS:The open-source LLM structured unstructured EHR data with 87.5 % accuracy, outperforming the domain-specific medical LLM (35.8 %). Larger LLMs were more effective in structuring clinically relevant features, such as general condition and disease extent, which correlated with survival. Incorporating LLM-structured features improved the deep learning model's C-index from 0.737 to 0.820 (internal validation) and from 0.779 to 0.842 (external validation). Risk stratification was also enhanced, with clearer differentiation among low-, intermediate-, and high-risk groups (p < 0.001). Additionally, models became more interpretable, as key LLM-structured features aligned with statistically significant predictors traditionally identified from structured data. CONCLUSION:General-domain LLMs, despite not being fine-tuned for medical data, can effectively structure large-scale unstructured EHRs, significantly improving survival prediction accuracy and model interpretability. The RT-Surv framework highlights the potential of LLMs to enhance clinical decision-making and optimize RT treatment.

BackgroundThe clinical significance of mastoid effusion (ME) in intensive care unit (ICU) patients has not been well elucidated. Recently, an association between ME and intracranial pressure (ICP) has been reported. We aimed to investigate the clinical implications of ME occurrence in the management of aneurysmal subarachnoid hemorrhage (aSAH) patients and its association with their prognosis.MethodsData from patients aged > 18 years who were treated for aSAH in a single institution between January 2020 and December 2022 were retrospectively reviewed. Brain CT or MRI images obtained within the first 14 days after the onset of SAH were evaluated for the presence of ME, which is defined as either opacification or an air-fluid level in the mastoid air cells. We examined the patients’ demographic information, neurological and medical status at admission, aneurysm and treatment characteristics, and clinical outcomes. We then analyzed how these factors were associated with the occurrence of ME.ResultsA total of 114 patients were included in the study. ME was observed in 40 patients (34.5%) within the first 14 days, occurring at a mean of 5.0 ± 3.5 days after the onset of SAH. In multivariate analysis, patients with ME were found to have a higher incidence of tracheostomy (odds ratio [OR] 10.034, p = 0.024), radiologic vasospasm (OR 4.987, p = 0.018), a higher APACHE II score (OR 1.138, p = 0.013), and poor clinical outcomes (OR 4.289, p = 0.041), defined as modified Rankin Scale score > 2 at 90 days. Poor clinical outcomes were independently associated with ME (OR 5.003, p = 0.006).ConclusionThis study demonstrated that ME was observed in 34.5% of aSAH patients and was associated with poor clinical outcomes. ME may serve as a simple and useful prognostic indicator for predicting poor outcomes in aSAH patients.

With advancements in the field of breast cancer treatment, the assessment of postsurgical cosmetic outcomes has gained increasing significance owing to its substantial impact on patients' quality of life. However, evaluating breast cosmesis is challenging because of the inherently subjective nature of expert labeling. In this study, we present a novel automated approach, attention-guided denoising diffusion anomaly detection (AG-DDAD), designed to assess breast cosmesis following surgery. The model addresses the limitations of conventional supervised learning and existing anomaly detection models. Our approach leverages the attention mechanism of distillation with no labels and a self-supervised vision transformer, combined with a diffusion model, to achieve high-quality image reconstruction and precise transformation of discriminative regions. By training the diffusion model on unlabeled data, predominantly with normal cosmesis, we adopted an unsupervised anomaly detection perspective to automatically score the cosmesis. Real-world data experiments demonstrated the effectiveness of our method, providing visually appealing representations and quantifiable scores for cosmesis evaluation. Compared with commonly used rule-based programs, our fully automated approach eliminates the need for manual annotations and offers an objective evaluation. Moreover, our anomaly detection model exhibits state-of-the-art performance, surpassing existing models in terms of accuracy. Beyond the scope of breast cosmesis, our research represents a significant advancement in unsupervised anomaly detection within the medical domain, thereby paving the way for future investigations.

BACKGROUND:Various methods have been developed to generate synthetic computed tomography (CT) images from magnetic resonance (MR) images, including segmentation-based approach with MR calculating attenuation (MRCAT) and deep learning (DL)-based approach. PURPOSE:In this study, we aimed to validate the conventional radiotherapy (RT) planning process with MRCAT and DL-based synthetic CT images for five patients with cervical cancer. METHODS:DL-based synthetic CT images of the five patients were inferred using a network trained with 40 pairs of CT and deformed, normalized T2-weighted MR scans; MRCAT images were obtained from mDixon sequences for the tested cases only. On the synthetic CT images, the contouring process for organs-at-risk (OARs) was automatically performed with minor adjustments, while two experienced radiation oncologists defined target volumes. Simultaneous integrated boost plans (2.2/2.0/1.8 Gy with 25 fractions) were produced from a commercial treatment planning system (TPS) TomoTherapy. RESULTS:The plans with two synthetic CT images were compared with those based on genuine CT images for the five test cases. High geometric similarity was confirmed for the planning target volume (PTV), with average dice similarity coefficient (DSC) of 0.844 for the DL-based and 0.829 for the MRCAT images. The mean percentage difference in gross tumor volume (GTV) was 20.71 ± $ \pm $ 34.28% for DL-based synthetic CT and 30.31 ± $ \pm $ 46.20% for MRCAT images. By contrast, PTV, encompassing GTV, exhibited minimal changes with an average increase of 0.37 ± $ \pm $ 3.10% and 1.66 ± $ \pm $ 7.62%, respectively. MRCAT images and DL-based synthetic CT revealed significant differences, relative to true CT images, in the entire volume (p = 0.03) of the bladder and in V20Gy and V30Gy of the resultant plans for the bladder (p = 0.029 and 0.063), all plans generated on the synthetic CTs were clinically acceptable and met institutional for target coverage. CONCLUSION:MRCAT and DL-based synthetic CT images demonstrated clinical applicability, achieving plan quality similar to that of plans based on genuine planning CT images.

There is limited information about the pleiotropic effects of statin on cerebrovascular diseases. The authors aimed to investigate the effect of pravastatin on non-hemorrhagic vertebral artery dissection (VAD) in a clinical setting. An exploratory randomized and controlled study was designed for the non-hemorrhage VAD (CRIS, KCT00035970). Primary outcomes were 1- and 6-month radiologic changes on vessel wall magnetic resonance imaging (VW-MRI), with secondary outcomes related to the clinical and laboratory parameters, and safety outcomes of the pravastatin use. Finally, 23 patients were enrolled, consisting of 12 in the pravastatin group and 11 in the control with similar baseline characteristics except the age (55.0 versus 45.5 years, P = .01). Morphologic changes in the early period (0–1 month) were more improved or resolved in the pravastatin group with a borderline significance (crude odds ratio: 7.500 [95 https://cris.nih.go.kr/cris/search/detailSearch.do?seq=25234 ).

Purpose:To report the dosimetric and toxicity outcomes of patients treated with 26 Gy in 5 fractions ultrahypofractionated (uHF) whole breast irradiation (WBI) using volumetric arc therapy (VMAT). Methods and Materials:We identified 476 consecutive patients who underwent WBI using VMAT-uHF between 2020 and 2021. Study endpoints included acute toxicity and dosimetric parameters for target volume and organs at risk. The dosimetric results were compared with a historical cohort at the same institution who were treated with moderately hypofractionated WBI using 3-dimensional (3D)-conformal radiation therapy (3D-CRT, n = 392), with the total dose rescaled to 26 Gy. Results:VMAT-uHF achieved a mean D95% and Dmax of the planning target volume of 96.2% and 102.8% of the prescribed dose, respectively. The VMAT-uHF group demonstrated significantly superior planning target volume coverage and improved dose homogeneity, with a 30.6% higher D95 and a 0.7% lower Dmax compared with the 3D-CRT group (both P < .05). Mean doses for the ipsilateral lung and heart were 3.12 ± 4.59 Gy and 0.92 ± 0.25 Gy, respectively, showing differences of < 0.3 Gy compared with the 3D-CRT group. The VMAT-uHF group exhibited a significantly lower left anterior descending artery Dmax (-3.73 Gy), while the contralateral breast showed a higher Dmean (+1.43 Gy), compared with the 3D-CRT group. Acute toxicity following VMAT-uHF was predominantly mild, with grade 1 toxicity observed in 114 out of 120 patients. No additional toxicities were reported after a median follow-up of 21.2 months. Conclusions:The application of VMAT in ultrahypofractionation can enhance target coverage while maintaining radiation doses to organs at risk low, albeit with an increase in contralateral breast dose compared with 3D-CRT. Given the low toxicity profile observed in our cohort with VMAT-uHF, the clinical significance of these dosimetric differences requires further investigation.