{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:05:38Z","timestamp":1779681938576,"version":"3.53.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":124,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glioblastoma is the most aggressive brain tumor, with a 5-year survival rate of only 8%. Radiotherapy plays a crucial role in multimodal treatment. With novel therapy approaches emerging, we evaluated specific imaging patterns of progression in patients treated with a sequential proton boost after standard radiochemotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 144 patients with histologically confirmed glioblastoma (CNS-WHO grade4), 94 received a sequential proton boost, and 50 underwent conventional photon radiation. Tumor progression (TP) was confirmed histologically or according RANO criteria. MRI segmentation was automated using CE-marked AI software, tumor voxels were classified by location (inside or outside the clinical target volume [CTV]) and CBV-perfusion status (inclusion-zone).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At progression, the proton group showed significantly larger contrast-enhancing tumor volumes outside the CTV (P\u2009=\u2009.007), focused in the CTV-PTV-transition-zone (P\u2009=\u2009.004) with no significant difference inside the CTV (P\u2009=\u2009.43). Subgroup analysis revealed greater extra-CTV volumes in MGMT-unmethylated (P\u2009=\u2009.019), TERT-mutant (P\u2009=\u2009.004), and RTK II subtype patients (P\u2009=\u2009.044). Metabolically active tumor tissue showed no significant differences between groups, inside or outside the CTV (P\u2009=\u2009.15 and .30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sequential proton boost therapy was associated with a distinct spatial pattern of radiographic progression, characterized by increased contrast enhancement beyond the CTV, especially in the CTV-PTV-transition-zone, without a corresponding rise in metabolic activity. These findings are hypothesis-generating and may reflect radiobiological range-edge effects or treatment-related tissue responses rather than true TP. Prospective studies integrating dosimetric and metabolic data are warranted to elucidate underlying mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/noajnl\/vdag116","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T12:20:27Z","timestamp":1777638027000},"source":"Crossref","is-referenced-by-count":0,"title":["Imaging patterns of glioblastoma progression: Comparative analysis of sequential proton boost versus conventional photon therapy"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7817-4823","authenticated-orcid":false,"given":"Ludwig","family":"Singer","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg , Erlangen,","place":["Germany"]},{"name":"Department of Neuroradiology, University Hospital Giessen, Justus Liebig University , Giessen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"G\u00f6tt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Eberhard Karls University , T\u00fcbingen,","place":["Germany"]},{"name":"Department of Neurosurgery, University Hospital Giessen, Justus Liebig University , Giessen, , (H.G., M.S., E.U.)","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viet Duc","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus Liebig University , Giessen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Engenhart-Cabillic","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital Marburg, Philipps-Universit\u00e4t Marburg, Germany; Marburg Ion-Beam Therapy Center (MIT) 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Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg , Erlangen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Giessen, Justus Liebig University , Giessen, , (H.G., M.S., E.U.)","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberhard","family":"Uhl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Giessen, Justus Liebig University , Giessen, , (H.G., M.S., E.U.)","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnd","family":"D\u00f6rfler","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg , 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