Radiotherapy and Oncology最新文献

{"title":"Dosimetric assessment of deep learning based organ-at-risk segmentation: insights from the HaN-Seg challenge","authors":"Gašper Podobnik ,&nbsp;Bulat Ibragimov ,&nbsp;Primož Peterlin ,&nbsp;Primož Strojan ,&nbsp;Tomaž Vrtovec","doi":"10.1016/j.radonc.2026.111387","DOIUrl":"10.1016/j.radonc.2026.111387","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To extend the previously reported geometric analysis of <em>HaN-Seg: The Head and Neck Organ-at-Risk CT and MR Segmentation Challenge</em> by integrating a dosimetric evaluation, thereby offering a comprehensive assessment of challenge results with practical insights into their clinical applicability.</div></div><div><h3>Materials and methods</h3><div>Participating teams of the HaN-Seg challenge were tasked to auto-segment 30 organs-at-risk (OARs) in the head and neck region using paired contrast-enhanced computed tomography and T1-weighted magnetic resonance images. The teams were ranked according to their geometric performance, measured by the Dice similarity coefficient (DSC) and 95th-percentile Hausdorff distance (HD₉₅). Here, we extend this evaluation with a forward dosimetric analysis, also known as <em>dosimetric impact approximation</em>, including the verification of OAR dosimetric restriction compliance, assessment of OAR priority ratings, evaluation of segmentation performance relative to tumor proximity, and correlation analysis between geometric and dosimetric metrics.</div></div><div><h3>Results</h3><div>All six teams from the previous geometric analysis were assessed for dosimetric performance on the original 14 test cases. Dosimetric analysis revealed minor performance differences among teams, with the best- and worst-performing teams achieving dosimetric compliance in 70.7% and 67.7% of OAR auto-segmentations, respectively. Most teams successfully met priority 1 dosimetric restrictions including the spinal cord, brainstem, optic chiasm, and optic nerves in 11 out of 14 test cases. The lowest compliance rates were observed for the oral cavity and submandibular glands. Correlation analysis revealed no clear relationship between geometric and dosimetric metrics.</div></div><div><h3>Conclusion</h3><div>The high dosimetric compliance highlights the practical utility of deep learning OAR auto-segmentation methods. Lower compliance for the oral cavity and submandibular glands most probably stems from their proximity to tumors and the corresponding steep dose gradients, where certain dosimetric constraints are inherently challenging to meet in clinical practice, or from the limitations of the forward dosimetric analysis. These findings underpin the critical need for both geometric and dosimetric evaluations of OAR auto-segmentation tools to ensure robust validation. Such a comprehensive assessment will be essential as commercial deep learning tools become increasingly integrated into the radiotherapy planning workflow.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111387"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[18F] AlF-NOTA-FAPI-04 PET/CT scans can predict pathologic complete response in patients receiving neoadjuvant chemoradiotherapy for locally advanced rectal cancer","authors":"Ziyuan Zhu ,&nbsp;Xiang Zhang ,&nbsp;Zhang Yun ,&nbsp;Chen Wang ,&nbsp;Wanhu Li ,&nbsp;Li Ma ,&nbsp;Lei Xu ,&nbsp;Yanlai Sun ,&nbsp;Jinming Yu ,&nbsp;Jinbo Yue","doi":"10.1016/j.radonc.2026.111429","DOIUrl":"10.1016/j.radonc.2026.111429","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We evaluated whether using the tracer [¹⁸F] AlF-NOTA-FAPI-04.</div><div>in positron emission tomography/computed tomography (PET/CT) could predict pathologic complete response (pCR) rates in patients receiving neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC).</div></div><div><h3>Materials and methods</h3><div>We prospectively evaluated 60 patients with histopathologically confirmed primary rectal cancer (20 referred for surgery and 40 for nCRT) who provided pretreatment [¹⁸F] AlF-NOTA-FAPI-04 PET/CT scans to detect FAP on tumor surfaces. Among those 40 patients, 26 provided a second [¹⁸F] AlF-NOTA-FAPI-04 PET/CT scan after the 10th radiotherapy fraction to assess changes in FAPI uptake variables. Correlations between baseline PET variables and markers of cancer-associated fibroblasts (CAFs) were assessed with Spearman’s rank test. Relationships between pathologic remission and potential predictors were assessed with logistic regression.</div></div><div><h3>Results</h3><div>The FAPI PET variables maximum and mean standardized uptake values (SUVmax, SUVmean) were positive correlated with FAP expression (p &lt; 0.05). Receiver operating characteristic curve analysis identified SUV_mean (area under the curve [AUC] = 0.869, p &lt; 0.001; cutoff value 6.02; sensitivity 100%; specificity 74.2%) and SUV_max (AUC = 0.810, p = 0.005; cutoff value 11.46; sensitivity 77.8%; specificity 80.6%), both for the primary tumor, as predicting pCR. Multivariate logistic regression showed that SUV_mean was an independent predictor of good response (odds ratio = 0.295, 95% confidence interval [CI] 0.113–0.772, p = 0.013). Changes in FAPI uptake variables were not correlated with radiotherapy response.</div></div><div><h3>Conclusions</h3><div>[¹⁸F] AlF-NOTA-FAPI-04 PET/CT uptake variables reflected the expression of CAF-related biomarkers. Higher baseline SUV_mean on [¹⁸F] AlF-NOTA-FAPI-04 PET/CT scans was associated with poor response to nCRT for LARC.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111429"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing prostate cancer stereotactic body radiotherapy: margins, dose, or target volume-de-intensification?","authors":"Jennifer Le Guevelou ,&nbsp;Paul Sargos ,&nbsp;Thomas Zilli","doi":"10.1016/j.radonc.2026.111412","DOIUrl":"10.1016/j.radonc.2026.111412","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111412"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations and future directions in identifying risk factors for radiotherapy related pelvic insufficiency fractures in gynecological cancers: A scoping review","authors":"Artemis Bouzaki ,&nbsp;Peter Hoskin ,&nbsp;Claire E. Higham ,&nbsp;Alan McWilliam ,&nbsp;Azadeh Abravan","doi":"10.1016/j.radonc.2026.111440","DOIUrl":"10.1016/j.radonc.2026.111440","url":null,"abstract":"<div><div>A systematic search of PubMed and EMBASE was conducted using terms such as “pelvic insufficiency fractures”, “radiotherapy” and “gynecological cancers”. Citations of relevant studies were also screened. Eligible studies included gynecolgical patients treated with pelvic RT, and reporting risk factors for RRIFs. Key data, including study characteristics, incidence rates, fracture definitions, imaging and dosimetry methods and statistical approaches were extracted. The Transparent Reporting of a multivariable prediction model<!--> <!-->for Individual Prognosis Or Diagnosis (TRIPOD) checklist was used to assess the methodological quality of the included studies.</div><div>28 studies met the inclusion criteria. RRIF incidence ranged from 1.7% to 37.4%. Commonly reported risk factors included advanced age, postmenopausal status, higher RT doses, low body weight, pre-existing osteoporosis, and concurrent chemotherapy. Imaging protocols, fracture definitions, and timing of detection varied widely. Statistical limitations, including reliance on univariable analyses, small sample sizes, and inconsistent baseline assessments, were common and limit reliable interpretation of risk factors. Anatomical targets for dose evaluation varied, with few studies correcting for biologically effective dose. Only one study developed a predictive model for RRIFs, which demonstrated moderate performance but lacked validation. Bone health assessments were inconsistently performed.</div><div>Interdisciplinary approaches to improve fracture risk prediction, reduce treatment-related toxicity, and guide clinical decision-making.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111440"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic optimization for the rapid generation of high-quality online adapted proton therapy plans in a commercial treatment planning system","authors":"Lena Nenoff ,&nbsp;Annabell Eberhardt ,&nbsp;Rebecca Bütof ,&nbsp;Albin Fredriksson ,&nbsp;Stefan Menkel ,&nbsp;Virginia Gambetta ,&nbsp;Esther GC Troost ,&nbsp;Christian Richter ,&nbsp;Kristin Stützer","doi":"10.1016/j.radonc.2026.111415","DOIUrl":"10.1016/j.radonc.2026.111415","url":null,"abstract":"<div><div>Online adaptive proton therapy (OAPT) requires a fast plan optimization. Different optimization parameters of a commercial treatment planning system were investigated for OAPT of locally advanced non-small cell lung-cancer patients. With the selected parameters, clinical-quality plans were optimized within a median time of 4<!--> <!--> min, currently deemed acceptable for OAPT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111415"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental determinants of cancer outcomes: a scoping review","authors":"Azadeh Abravan ,&nbsp;Isabella Fornacon-Wood ,&nbsp;Richard Kingston ,&nbsp;David Topping ,&nbsp;Gareth Price","doi":"10.1016/j.radonc.2026.111408","DOIUrl":"10.1016/j.radonc.2026.111408","url":null,"abstract":"<div><div>As cancer care evolves toward more individualized, survivorship-focused models, there is growing interest in the role of non-biological factors that shape outcomes after diagnosis. Environmental exposures, ranging from air pollution to urban infrastructure, are increasingly recognized as modifiable contributors not only to cancer incidence but also to outcomes after diagnosis. Yet, evidence on cancer outcomes remains fragmented.</div><div>We conducted a scoping review to map existing literature on the relationship between environmental factors and cancer outcomes, including mortality, treatment-related toxicity, and health-related quality of life. Air pollution was extensively studied, with consistent associations with poorer lung cancer outcomes and emerging evidence for other cancers. Radon was another common exposure investigated, largely in relation to lung cancer. Other factors such as proximity to industrial sites, chemical pollutants, green space access, noise, and meteorological conditions were less frequently examined. Most studies focused on mortality, with limited attention to quality of life or treatment-related complications. Moreover, because many studies were ecological and/or did not model exposure timing relative to diagnosis and treatment, the literature often cannot separate increased cancer mortality driven by higher incidence from worse prognosis after diagnosis. Evidence directly addressing <em>peri</em>-treatment exposures, treatment tolerance/toxicity, and survivorship-specific outcomes remains sparse. Research was concentrated in high-income countries, while evidence from low- and middle-income regions was limited.</div><div>This review highlights emerging mechanisms, data challenges, and opportunities for translational research and policy intervention, while underscoring the need for interdisciplinary, equity-focused approaches to strengthen causal inference and guide public health strategies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111408"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering the role of PMRT in low to intermediate risk breast cancer: Applying results from previous standards of treatment in the current multimodal practice","authors":"Melanie Machiels ,&nbsp;Orit Kaidar-Person ,&nbsp;Gustavo N. Marta ,&nbsp;Icro Meattini ,&nbsp;Philip Poortmans","doi":"10.1016/j.radonc.2026.111416","DOIUrl":"10.1016/j.radonc.2026.111416","url":null,"abstract":"<div><div>The recently published 10-year results of the SUPREMO trial offer valuable insights into the role of postmastectomy radiotherapy (PMRT) to the chest wall alone in low- to intermediate-risk breast cancer patients. However, the trial s design and evolving standards in surgery, radiation therapy (RT), and systemic therapy necessitate careful interpretation.</div><div>Main findings.</div><div>SUPREMO enrolled 1,600 patients, primarily with pT1-2N1M0 and pT3N0M0 disease, and reported no significant overall survival (OS) benefit at 10 years. Major protocol modifications—including reduced sample size, extended accrual, and broadened eligibility criteria—were required to ensure trial completion but compromised statistical power and generalizability. The trial s limited use of regional nodal irradiation (RNI), including internal mammary node (IMN) coverage, further limits its applicability in the context of modern evidence demonstrating clear survival benefits from comprehensive RNI. Moreover, pathology quality assurance discrepancies, evolving surgical practices (from modified radical mastectomy to more conservative approaches), and advances in systemic therapy have fundamentally altered risk profiles and treatment paradigms.</div></div><div><h3>Conclusion</h3><div>While SUPREMO contributes to understanding PMRT‘s historical role, its relevance to contemporary multimodal breast cancer management is limited. The restriction to chest wall irradiation, omission of RNI, and the predominance of<!--> <!-->lower-end intermediate-risk disease<!--> <!-->(including many patients with<!--> <!-->node-negative or limited nodal involvement) diminish its clinical impact. Future trials must integrate biology-driven risk stratification, contemporary surgical and systemic standards, and precise RT definitions, requiring pragmatic designs, robust QA, and accelerated accrual to remain relevant and avoid undertreatment in selected patients who may still benefit from PMRT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111416"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy with twice weekly Gemcitabine and Cisplatin compared to Cisplatin alone for organ preservation in muscle-invasive bladder cancer: results of the GETUG V04 randomized phase II trial","authors":"Morgan Michalet ,&nbsp;Philippe Ronchin ,&nbsp;Thomas Reynaud ,&nbsp;Nicolas Demogeot ,&nbsp;Sophie Gourgou ,&nbsp;Simon Thézenas ,&nbsp;Jean-Michel Hannoun-Lévi ,&nbsp;Naji Salem ,&nbsp;Magali Quivrin ,&nbsp;Olivier Riou ,&nbsp;Marie Charissoux ,&nbsp;Carmen Llacer-Moscardo ,&nbsp;Diego Tosi ,&nbsp;Catherine Durdux ,&nbsp;Nazim Khalladi ,&nbsp;Stéphane Culine ,&nbsp;David Azria","doi":"10.1016/j.radonc.2026.111443","DOIUrl":"10.1016/j.radonc.2026.111443","url":null,"abstract":"<div><h3>Introduction</h3><div>Trimodal therapy (TMT) is a viable option for muscle-invasive bladder cancer (MIBC), but the optimal chemotherapy regimen remains unclear. This phase II randomized trial (NCT01495676) compared cisplatin (CDDP) with twice-weekly gemcitabine (GEM) and radiation therapy (RT) with CDDP plus RT.</div></div><div><h3>Methods</h3><div>Patients with pT2-pT3N0M0 MIBC, after macroscopically complete transurethral resection (TURBT), received RT (63 Gy to the bladder, 45 Gy to the pelvis, 1,8 Gy/ fraction) with chemotherapy (CDDP 20 mg/m²/day for 4 days every 21 days alone or plus GEM 25 mg/m² twice weekly). The primary endpoint was 2-year disease-free survival (DFS); secondary endpoints included overall survival (OS) and toxicities. A 1:2 randomization was planned to include 36 patients in the control arm and 73 patients in the experimental arm.</div></div><div><h3>Results</h3><div>Sixty-nine patients were included: 24 in the RT/CDDP arm and 45 in the RT/CDDP/GEM arm. The median follow-up was 63 months. Two-year DFS was similar between groups (58.3% CI95% [36.6–77.9] vs. 60.0% CI95% [44.3–74.3]), with median DFS of 29.8 (RT/CDDP) vs. 37.4 (RT/CDDP/GEM) months. OS at 24 and 60 months was 91.3% [IC 95% 69.5–97.8] and 66.8% [IC 95% 39.6–83.9] (RT/CDDP) vs. 66.7% % [IC 95% 50.2 – 78.8] and 53.7% [IC 95% 37.2 – 67.6] (RT/CDDP/GEM). Toxicity profiles were comparable except for increased cytopenias in the GEM arm.</div></div><div><h3>Conclusions</h3><div>Adding GEM to CDDP did not improve 2-year DFS in MIBC patients treated with TMT. Results should be interpreted cautiously due to early study termination and insufficient accrual.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111443"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146171255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESTRO’s principles for environmental sustainability in the radiation oncology community","authors":"Kari Tanderup ,&nbsp;Anna M. Kirby ,&nbsp;Jesper Grau Eriksen ,&nbsp;Nuria Jornet ,&nbsp;Jenny Bertholet ,&nbsp;Chiara Gasparotto ,&nbsp;Marianne C. Aznar ,&nbsp;Luca Boldrini ,&nbsp;Kerstin Borgmann ,&nbsp;Catharine H. Clark ,&nbsp;Elizabeth Forde ,&nbsp;Barbara A. Jereczek-Fossa ,&nbsp;Uulke A. van der Heide ,&nbsp;Coen Hurkmans ,&nbsp;Icro Meattini ,&nbsp;Piet Ost ,&nbsp;Esther G.C. Troost ,&nbsp;Alessandro Cortese ,&nbsp;Matthias Guckenberger","doi":"10.1016/j.radonc.2026.111384","DOIUrl":"10.1016/j.radonc.2026.111384","url":null,"abstract":"<div><div>Climate change, pollution, and resource depletion pose significant challenges to modern society, including the healthcare sector. While the delivery of health services inherently entails energy and resource utilization, the health care sector has a relevant role to play for sustainable development, since it is estimated to account for approximately 4.7% of total greenhouse gas emissions in the EU whilst also contributing to natural resource depletion, toxic chemical release, and the generation of non-compostable waste. In response, the European Society for Radiotherapy and Oncology (ESTRO) established the Green Task Force in 2022 to support the development of a strategic framework, which integrates environmental sustainability into ESTRO’s activities.</div><div>This position paper presents ESTRO’s principles for environmental sustainability, which focus on four key areas: (1) raising awareness and sharing best practices, (2) monitoring the environmental impact of ESTRO’s activities, (3) evaluating interventions to reduce carbon emissions and improve the environmental sustainability of ESTRO activities, and (4) embedding sustainability into governance and professional activities. Examples of strategies which can reduce climate impact of ESTRO activities include advocating for environmentally conscious radiotherapy practices, considering venues that facilitate shorter travelling for participants in ESTRO conferences and educational activities, promoting digital participation, facilitating sustainable travel options and promoting healthy lifestyle.</div><div>By emphasizing sustainability, ESTRO aims to lead the radiation oncology community toward a more environmentally responsible future, balancing scientific progress with climate-conscious practices. This initiative aligns with global sustainability goals and underscores the role of oncology professionals in addressing the climate crisis.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111384"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of stereotactic MRI-guided adaptive radiotherapy for renal tumors in patients with a solitary kidney","authors":"Claire van Vliet ,&nbsp;Joyce Caro ,&nbsp;Omar Bohoudi ,&nbsp;Axel Bex ,&nbsp;Daphne Damhoff ,&nbsp;Fons J.M. van den Eertwegh ,&nbsp;Niels M. Graafland ,&nbsp;Brunolf W. Lagerveld ,&nbsp;Jeroen R.A. van Moorselaar ,&nbsp;Miguel A. Palacios ,&nbsp;Shyama U. Tetar ,&nbsp;Sonja Verheijen ,&nbsp;Nienke W. Weitkamp ,&nbsp;Antoinet van der Wel ,&nbsp;Patricia J. Zondervan ,&nbsp;Ben J. Slotman ,&nbsp;Anna M.E. Bruynzeel","doi":"10.1016/j.radonc.2026.111389","DOIUrl":"10.1016/j.radonc.2026.111389","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Patients with renal cell carcinoma (RCC) in a solitary kidney have limited treatment options. Stereotactic MRI-guided adaptive radiotherapy (SMART) offers a non-invasive alternative that preserves healthy kidney tissue. This study evaluated the clinical outcomes of SMART in patients with renal tumors in a solitary kidney. Oncological outcomes, renal function preservation, and treatment-related toxicity were assessed.</div></div><div><h3>Materials and methods</h3><div>All consecutive patients with RCC in a solitary kidney treated with SMART between 2018 and 2024 in a single center were analyzed. Local control was defined as any response or stable disease using RECIST criteria. Kaplan-Meier analysis was used for survival outcomes and paired t-tests assessed renal function changes.</div></div><div><h3>Results</h3><div>Thirty-two patients with a median age of 70 years were included. Most patients had WHO status 0–1 (93.8%) and had prior nephrectomy for RCC (78.1%). Median tumor size was 4.2 cm, and median pre-treatment eGFR was 45.8 ml/min. Seven patients were treated for multiple lesions, in simultaneous or separate sessions. Most patients were treated in a single (22.8%) or five (74.3%) fractions. After a median follow-up of 21.3 months, the local control rates at 1 and 2 years were 96.2% and 90.1%, respectively. Mean eGFR change was −6.6 ml/min, none required dialysis. No grade ≥ 3 toxicity was observed. The overall survival rate at 2 years was 80.9%.</div></div><div><h3>Conclusion</h3><div>SMART provides high local control with minimal impact on renal function, offering a non-invasive, kidney-sparing treatment option that also enables repeated treatments within the solitary kidney.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111389"},"PeriodicalIF":5.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}