{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:51:17Z","timestamp":1782449477900,"version":"3.54.5"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100019978","name":"Shanghai Pudong New Area Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019978","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Temporal lobe injury (TLI) is a significant complication after carbon-ion re-irradiation (reRT-CIRT) for locally recurrent nasopharyngeal carcinoma (rNPC). This study established normal tissue complication probability (NTCP) models for TLI based on (1) the second-course CIRT dose alone and (2) the cumulative dose of both radiotherapy courses, with the goal of defining clinically applicable, modality-specific dose constraints.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>\n                      Eighty-nine rNPC patients who underwent reRT-CIRT between 2016 and 2020 were retrospectively analyzed. Deformable image registration transferred initial IMRT dose distributions onto CIRT planning scans, and voxel-wise cumulative equivalent doses in 2-Gy fractions (EQD\n                      <jats:sub>2<\/jats:sub>\n                      , \u03b1\/\u03b2 = 3 Gy) were calculated. Patients were stratified into training (n = 52) and validation (n = 37) cohorts. Multivariate logistic regression identified TLI predictors under two scenarios\u2014second-course dose only versus cumulative two-course dose\u2014and model performance was evaluated by ROC analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TLI occurred in 27 patients (30.3%), predominantly unilateral (24\/27); 14 were Grade 1 (asymptomatic, MRI-detected only), 7 Grade 2, 5 Grade 3, and 1 Grade 4. The second-course D\n                      <jats:sub>0.5<\/jats:sub>\n                      cc model [TD\n                      <jats:sub>5<\/jats:sub>\n                      34.27 Gy (RBE); TD\n                      <jats:sub>50<\/jats:sub>\n                      78.53 Gy (RBE); AUC 0.8450, 95% CI 0.7571\u20130.9329] and the cumulative D\n                      <jats:sub>5<\/jats:sub>\n                      cc model (TD\n                      <jats:sub>5<\/jats:sub>\n                      41.60 Gy; TD\n                      <jats:sub>50<\/jats:sub>\n                      124.31 Gy; AUC 0.8225, 95% CI 0.7228\u20130.9222) yielded equivalent and concordant risk stratification, with the inter-group dose difference primarily driven by the re-irradiation course. Compared with our previous photon-based reRT model, the CIRT-derived TD\n                      <jats:sub>50<\/jats:sub>\n                      for D\n                      <jats:sub>0.5<\/jats:sub>\n                      cc and D\n                      <jats:sub>1<\/jats:sub>\n                      cc were ~20% higher (78.5 vs. 65.4 Gy; 76.8 vs. 62.9 Gy), indicating that photon-based constraints systematically overestimate TLI risk under CIRT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      A CIRT-specific NTCP model based on the second-course D\n                      <jats:sub>0.5<\/jats:sub>\n                      cc achieves predictive performance equivalent to cumulative two-course dose summation, obviating prior-course dose reconstruction. This simplified, modality-specific tool offers practical guidance for individualized risk assessment and dose-constraint optimization in carbon-ion re-irradiation for rNPC.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1853143","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:37:52Z","timestamp":1782448672000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Normal tissue complication probability model of temporal lobe injury following re-irradiation of CIRT for local recurrent nasopharyngeal carcinoma"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiyin","family":"Guan","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Radiation Oncology","place":["Shanghai, 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Medical College, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Xing","sequence":"additional","affiliation":[{"name":"Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy","place":["Shanghai, China"]},{"name":"Department of Radiation Oncology, Fudan University Shanghai Cancer Center","place":["Shanghai, China"]},{"name":"Department of Oncology, Shanghai Medical College, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaosu","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital","place":["Shanghai, China"]},{"name":"Shanghai Key Laboratory of Radiation Oncology","place":["Shanghai, China"]},{"name":"Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2019.101890","article-title":"Management of locally recurrent nasopharyngeal carcinoma","volume":"79","author":"Lee","year":"2019","journal-title":"Cancer Treat Rev"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25892","article-title":"Patterns of care and treatment outcomes for local recurrence of NPC after definite IMRT\u2014a study by the HKNPCSG","volume":"41","author":"Ng","year":"2019","journal-title":"Head Neck"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33197","article-title":"Clinical outcomes of carbon-ion radiotherapy for patients with locoregionally recurrent nasopharyngeal 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