Pub Date : 2026-02-01Epub Date: 2026-01-15DOI: 10.1016/j.radonc.2026.111378
Tetsuo Saito, Nobuki Imano, Naoki Nakamura
{"title":"When consensus falters: Holding on to a shared yardstick for the assessment of treatment efficacy.","authors":"Tetsuo Saito, Nobuki Imano, Naoki Nakamura","doi":"10.1016/j.radonc.2026.111378","DOIUrl":"10.1016/j.radonc.2026.111378","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111378"},"PeriodicalIF":5.3,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994504","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}
Pub Date : 2026-02-01DOI: 10.1016/j.radonc.2026.111415
Lena Nenoff , Annabell Eberhardt , Rebecca Bütof , Albin Fredriksson , Stefan Menkel , Virginia Gambetta , Esther GC Troost , Christian Richter , Kristin Stützer
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.
{"title":"Systematic optimization for the rapid generation of high-quality online adapted proton therapy plans in a commercial treatment planning system","authors":"Lena Nenoff , Annabell Eberhardt , Rebecca Bütof , Albin Fredriksson , Stefan Menkel , Virginia Gambetta , Esther GC Troost , Christian Richter , 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":"2026-02-01","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}
Pub Date : 2026-02-01DOI: 10.1016/j.radonc.2026.111416
Melanie Machiels , Orit Kaidar-Person , Gustavo N. Marta , Icro Meattini , Philip Poortmans
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.
Main findings.
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.
Conclusion
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.
{"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 , Orit Kaidar-Person , Gustavo N. Marta , Icro Meattini , 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":"2026-02-01","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}
Pub Date : 2026-01-31DOI: 10.1016/j.radonc.2026.111413
Mary-Ann Carmichael , Catherine Paterson , Andi Agbejule , Sue Robins , Raymond J. Chan , Nicolas H. Hart , Fiona Crawford-Williams
Background and purpose
As cancer survival rates continue to improve, optimising the provision of quality cancer survivorship care is paramount. Radiation therapists (RTTs) play a pivotal role in the delivery of cancer treatment, but their involvement in providing cancer survivorship care has yet to be explored or understood. This systematic review aimed to examine the role of the RTT within the Quality of Cancer Survivorship Framework across the cancer care continuum.
Methods
Five databases were searched from inception until August 2025. Studies were included if they described or evaluated survivorship care interventions delivered by RTTs, whether within formal roles (e.g. advanced practice) or as part of routine clinical practice. Studies were also included if they reported on RTTs knowledge, attitudes or skills related to survivorship care, defined as care and support provided from diagnosis onwards across the cancer care continuum.
Results
Thirty-eight articles met the inclusion criteria. Sixteen articles reported RTT-delivered survivorship care interventions, and twenty-two articles reported RTT knowledge, attitudes and skills related to survivorship care. Most studies fit within three domains: surveillance and management of psychosocial effects (n = 23), surveillance and management of physical effects (n = 7), and health promotion and disease prevention (n = 7). RTTs expressed willingness to be involved in survivorship care, however highlighted barriers, including limited time and lack of knowledge and training that restricted their involvement.
Conclusions
RTT survivorship specific roles are lacking, however RTTs can play a valuable role in the provision of survivorship care for patients during and after treatment. Barriers to RTTs providing this care include lack of knowledge, training, and time.
{"title":"Role of the radiation therapist in cancer survivorship care: An integrative systematic review","authors":"Mary-Ann Carmichael , Catherine Paterson , Andi Agbejule , Sue Robins , Raymond J. Chan , Nicolas H. Hart , Fiona Crawford-Williams","doi":"10.1016/j.radonc.2026.111413","DOIUrl":"10.1016/j.radonc.2026.111413","url":null,"abstract":"<div><h3>Background and purpose</h3><div>As cancer survival rates continue to improve, optimising the provision of quality cancer survivorship care is paramount. Radiation therapists (RTTs) play a pivotal role in the delivery of cancer treatment, but their involvement in providing cancer survivorship care has yet to be explored or understood. This systematic review aimed to examine the role of the RTT within the Quality of Cancer Survivorship Framework across the cancer care continuum.</div></div><div><h3>Methods</h3><div>Five databases were searched from inception until August 2025. Studies were included if they described or evaluated survivorship care interventions delivered by RTTs, whether within formal roles (e.g. advanced practice) or as part of routine clinical practice. Studies were also included if they reported on RTTs knowledge, attitudes or skills related to survivorship care, defined as care and support provided from diagnosis onwards across the cancer care continuum.</div></div><div><h3>Results</h3><div>Thirty-eight articles met the inclusion criteria. Sixteen articles reported RTT-delivered survivorship care interventions, and twenty-two articles reported RTT knowledge, attitudes and skills related to survivorship care. Most studies fit within three domains: surveillance and management of psychosocial effects (n = 23), surveillance and management of physical effects (n = 7), and health promotion and disease prevention (n = 7). RTTs expressed willingness to be involved in survivorship care, however highlighted barriers, including limited time and lack of knowledge and training that restricted their involvement.</div></div><div><h3>Conclusions</h3><div>RTT survivorship specific roles are lacking, however RTTs can play a valuable role in the provision of survivorship care for patients during and after treatment. Barriers to RTTs providing this care include lack of knowledge, training, and time.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111413"},"PeriodicalIF":5.3,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106973","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}
Pub Date : 2026-01-31DOI: 10.1016/j.radonc.2026.111414
Rémy Kinj, Luis Schiappacasse, Veljko Grilj, Zoi Tsourti, Frédéric Duclos, Marine Hebeisen, Wendy Jeanneret-Sozzi, Stéphanie Viguet-Carrin, Julie Chenal, Patrik Goncalves Jorge, Walter Reiner Geyer, Gian Guyer, Claude Bailat, François Bochud, Fernanda G Herrera, Raphaël Moeckli, Urania Dafni, Olivier Gaide, Jean Bourhis
Introduction: The observation in preclinical studies that FLASH radiotherapy (FLASH-RT) can spare normal tissues while maintaining its anti-tumoral effect provided the rational for its clinical translation. In this context, this clinical trial presents the first-in-human dose-escalation trial of FLASH-RT.
Materials and methods: This phase I clinical trial enrolled patients presenting progressive melanoma with cutaneous metastases refractory to systemic treatment. A 3 + 3 dose-escalation design was used to determine the maximum tolerated dose (MTD), starting at 22 Gy and escalating in 2 Gy increments up to 28 Gy. Dose-limiting toxicity (DLT) was defined as any Grade ≥ 3 adverse event occurring in the irradiated field within 4 weeks post-RT. FLASH-RT was delivered using a 9 MeV Mobetron (IntraOp, USA) at a dose rate exceeding 200 Gy/s, delivered in 10 pulses over 90 ms. For all patients, dosimetry was performed using alanine, thermoluminescent dosimeters (TLD), and films.
Results: Between June 2021 and September 2024, 11 patients were enrolled, with 15 lesions treated in 10 out of these patients. One patient was enrolled at two different dose levels for distinct lesions. The trial initially aimed to dose escalation up to 34 Gy but was discontinued after completing of dose level 28 Gy due to slow accrual. No DLTs were observed at any of the administered dose levels (22-28 Gy), and the MTD was not reached.
Conclusion: Dose escalation of FLASH-RT delivered in a single fraction up to 28 Gy did not induce DLTs in the irradiation field, indicating a favorable tolerance of human tissue to the acute effects of FLASH-RT.
{"title":"A phase I dose escalation of FLASH radiotherapy in patients with cutaneous metastases from melanoma: The IMPulse trial.","authors":"Rémy Kinj, Luis Schiappacasse, Veljko Grilj, Zoi Tsourti, Frédéric Duclos, Marine Hebeisen, Wendy Jeanneret-Sozzi, Stéphanie Viguet-Carrin, Julie Chenal, Patrik Goncalves Jorge, Walter Reiner Geyer, Gian Guyer, Claude Bailat, François Bochud, Fernanda G Herrera, Raphaël Moeckli, Urania Dafni, Olivier Gaide, Jean Bourhis","doi":"10.1016/j.radonc.2026.111414","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111414","url":null,"abstract":"<p><strong>Introduction: </strong>The observation in preclinical studies that FLASH radiotherapy (FLASH-RT) can spare normal tissues while maintaining its anti-tumoral effect provided the rational for its clinical translation. In this context, this clinical trial presents the first-in-human dose-escalation trial of FLASH-RT.</p><p><strong>Materials and methods: </strong>This phase I clinical trial enrolled patients presenting progressive melanoma with cutaneous metastases refractory to systemic treatment. A 3 + 3 dose-escalation design was used to determine the maximum tolerated dose (MTD), starting at 22 Gy and escalating in 2 Gy increments up to 28 Gy. Dose-limiting toxicity (DLT) was defined as any Grade ≥ 3 adverse event occurring in the irradiated field within 4 weeks post-RT. FLASH-RT was delivered using a 9 MeV Mobetron (IntraOp, USA) at a dose rate exceeding 200 Gy/s, delivered in 10 pulses over 90 ms. For all patients, dosimetry was performed using alanine, thermoluminescent dosimeters (TLD), and films.</p><p><strong>Results: </strong>Between June 2021 and September 2024, 11 patients were enrolled, with 15 lesions treated in 10 out of these patients. One patient was enrolled at two different dose levels for distinct lesions. The trial initially aimed to dose escalation up to 34 Gy but was discontinued after completing of dose level 28 Gy due to slow accrual. No DLTs were observed at any of the administered dose levels (22-28 Gy), and the MTD was not reached.</p><p><strong>Conclusion: </strong>Dose escalation of FLASH-RT delivered in a single fraction up to 28 Gy did not induce DLTs in the irradiation field, indicating a favorable tolerance of human tissue to the acute effects of FLASH-RT.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111414"},"PeriodicalIF":5.3,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107000","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}
Pub Date : 2026-01-30DOI: 10.1016/j.radonc.2026.111406
Anne Sophie V.M. van den Heerik , Nanda Horeweg , Marie A.D. Haverkort , Nienke Kuijsters , Stefan Kommoss , Friederike L.A. Koppe , Marlies E. Nowee , Henrike Westerveld , Maria A.A. de Jong , Filip Frühauf , Jeltsje S. Cnossen , Jan Willem M. Mens , Jannet C. Beukema , Cyrus Chargari , Charles Gillham , Dorine S.J. Tseng , Katrien Vandecasteele , Moritz Hamann , Mandy Kiderlen , Stephan Polterauer , Wilbert B. van den Hout
Purpose
The international PORTEC-4a trial demonstrated that individualised adjuvant treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes.
Patients and methods
Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data.
Results
All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile arm and 197 in standard arm. QALYs were comparable (p = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile arm compared to standard arm (€11,898 vs €13,047, p = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (€9,995 vs €11,926, p < 0.01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, p = 0.17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective.
Conclusion
Individualised adjuvant treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.
{"title":"Cost-utility-analysis of molecular-integrated-profile for women with (high)intermediate risk endometrial cancer − PORTEC-4a an international, randomised, phase 3 trial","authors":"Anne Sophie V.M. van den Heerik , Nanda Horeweg , Marie A.D. Haverkort , Nienke Kuijsters , Stefan Kommoss , Friederike L.A. Koppe , Marlies E. Nowee , Henrike Westerveld , Maria A.A. de Jong , Filip Frühauf , Jeltsje S. Cnossen , Jan Willem M. Mens , Jannet C. Beukema , Cyrus Chargari , Charles Gillham , Dorine S.J. Tseng , Katrien Vandecasteele , Moritz Hamann , Mandy Kiderlen , Stephan Polterauer , Wilbert B. van den Hout","doi":"10.1016/j.radonc.2026.111406","DOIUrl":"10.1016/j.radonc.2026.111406","url":null,"abstract":"<div><h3>Purpose</h3><div>The international PORTEC-4a trial demonstrated that individualised adjuvant treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes.</div></div><div><h3>Patients and methods</h3><div>Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data.</div></div><div><h3>Results</h3><div>All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile arm and 197 in standard arm. QALYs were comparable (<em>p</em> = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile arm compared to standard arm (€11,898 vs €13,047, <em>p</em> = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (€9,995 vs €11,926, <em>p</em> < 0<em>.</em>01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, <em>p</em> = 0<em>.</em>17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective.</div></div><div><h3>Conclusion</h3><div>Individualised adjuvant treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111406"},"PeriodicalIF":5.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100423","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}
Pub Date : 2026-01-30DOI: 10.1016/j.radonc.2026.111405
Sofia Spampinato , Sezen Kutluyer , Saliha Almaz , Nicoline Schuur , Jobert Sturm , Miranda E.M.C. Christianen , Jan Willem Mens , Helena C. van Doorn , Henrike Westerveld
Purpose
Treatment for locally advanced cervical cancer (LACC), and especially brachytherapy, can be physically and psychologically demanding for patients. The IMPRaCC study (Impact of primary Radiotherapy on the psychosocial well-being of patients with LACC) aimed to investigate risk factors, peak moments of distress, and unmet needs.
Material and methods
Analyses of EORTC-C30 questionnaires in a cohort of LACC patients (2019–2024) were combined with semi-structured interviews 4–16 weeks post-treatment. Questionnaires were collected at baseline, during treatment, and regularly throughout follow-up up to two years. Linear-mixed models evaluated changes in scores from baseline. Scores were also compared to a healthy reference population. Logistic regression identified factors associated with deteriorations in emotional (EF) and social functioning (SF) and fatigue during treatment and follow-ups. Interviews were evaluated using thematic analyses.
Results
Among 142 LACC patients, baseline EF and SF during treatment were impaired compared to the reference population, but improved in follow-up. Deteriorations in EF, SF and fatigue were more frequent during treatment (18.6%, 48.8%, 62.8%) than follow-up (10.4%, 25%, 34.4%). Psychiatric history was associated with worse SF during treatment, while being in a relationship and psychological support were protective factors. Brachytherapy delivered in four vs. three fractions seemed to be associated with worse EF, SF and fatigue. Interviews with 13 patients revealed emotional distress, especially before brachytherapy, and need for clear and consistent communication across multiple healthcare professionals.
Conclusion
Psychiatric history assessments, psychological support, and consistent communication support tailored care for LACC patients. Brachytherapy regimens of three fractions may further reduce psychosocial distress.
{"title":"Impact of primary radiotherapy on the psychosocial well-being of patients with locally advanced cervical cancer (IMPRaCC study)","authors":"Sofia Spampinato , Sezen Kutluyer , Saliha Almaz , Nicoline Schuur , Jobert Sturm , Miranda E.M.C. Christianen , Jan Willem Mens , Helena C. van Doorn , Henrike Westerveld","doi":"10.1016/j.radonc.2026.111405","DOIUrl":"10.1016/j.radonc.2026.111405","url":null,"abstract":"<div><h3>Purpose</h3><div>Treatment for locally advanced cervical cancer (LACC), and especially brachytherapy, can be physically and psychologically demanding for patients. The IMPRaCC study (Impact of primary Radiotherapy on the psychosocial well-being of patients with LACC) aimed to investigate risk factors, peak moments of distress, and unmet needs.</div></div><div><h3>Material and methods</h3><div>Analyses of EORTC-C30 questionnaires in a cohort of LACC patients (2019–2024) were combined with semi-structured interviews 4–16 weeks post-treatment. Questionnaires were collected at baseline, during treatment, and regularly throughout follow-up up to two years. Linear-mixed models evaluated changes in scores from baseline. Scores were also compared to a healthy reference population. Logistic regression identified factors associated with deteriorations in emotional (EF) and social functioning (SF) and fatigue during treatment and follow-ups. Interviews were evaluated using thematic analyses.</div></div><div><h3>Results</h3><div>Among 142 LACC patients, baseline EF and SF during treatment were impaired compared to the reference population, but improved in follow-up. Deteriorations in EF, SF and fatigue were more frequent during treatment (18.6%, 48.8%, 62.8%) than follow-up (10.4%, 25%, 34.4%). Psychiatric history was associated with worse SF during treatment, while being in a relationship and psychological support were protective factors. Brachytherapy delivered in four <em>vs</em>. three fractions seemed to be associated with worse EF, SF and fatigue. Interviews with 13 patients revealed emotional distress, especially before brachytherapy, and need for clear and consistent communication across multiple healthcare professionals.</div></div><div><h3>Conclusion</h3><div>Psychiatric history assessments, psychological support, and consistent communication support tailored care for LACC patients. Brachytherapy regimens of three fractions may further reduce psychosocial distress.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111405"},"PeriodicalIF":5.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100480","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}
Pub Date : 2026-01-30DOI: 10.1016/j.radonc.2026.111411
Felix Ehret, Jimm Grimm, Samuel M Vorbach, Oliver Blanck, Alexander Rühle
{"title":"Response to \"A threshold without a map: Why isodose normalization must accompany D95/D2 TCP cutpoints\".","authors":"Felix Ehret, Jimm Grimm, Samuel M Vorbach, Oliver Blanck, Alexander Rühle","doi":"10.1016/j.radonc.2026.111411","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111411","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111411"},"PeriodicalIF":5.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100470","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}
Pub Date : 2026-01-30DOI: 10.1016/j.radonc.2026.111384
Kari Tanderup , Anna M. Kirby , Jesper Grau Eriksen , Nuria Jornet , Jenny Bertholet , Chiara Gasparotto , Marianne C. Aznar , Luca Boldrini , Kerstin Borgmann , Catharine H. Clark , Elizabeth Forde , Barbara A. Jereczek-Fossa , Uulke A. van der Heide , Coen Hurkmans , Icro Meattini , Piet Ost , Esther G.C. Troost , Alessandro Cortese , Matthias Guckenberger
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.
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.
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.
{"title":"ESTRO’s principles for environmental sustainability in the radiation oncology community","authors":"Kari Tanderup , Anna M. Kirby , Jesper Grau Eriksen , Nuria Jornet , Jenny Bertholet , Chiara Gasparotto , Marianne C. Aznar , Luca Boldrini , Kerstin Borgmann , Catharine H. Clark , Elizabeth Forde , Barbara A. Jereczek-Fossa , Uulke A. van der Heide , Coen Hurkmans , Icro Meattini , Piet Ost , Esther G.C. Troost , Alessandro Cortese , 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":"2026-01-30","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}
Proton therapy offers potentially improved normal tissue sparing compared to photon-based whole-pelvic radiotherapy (WPRT) for high-risk prostate cancer, but its sensitivity to anatomical and setup variations raises concerns about robustness. The aim of this study was – within the setting of a multicentre randomised clinical trial – to explore whether the dose-volume advantages of proton therapy persisted when subject to inter-fractional variation.
Materials and methods
Five patients treated with WPRT at a national proton centre were included. Comparative photon plans were created independently by five photon therapy centres. Nominal proton and photon plans were evaluated alongside recalculated plans on two repeat computed tomography scans per patient and with robustness scenarios simulating geometric uncertainties. Dose-volume metrics for target volumes and normal tissues were compared between the two modalities using linear mixed effects models accounting for patient and centre variability.
Results
Target coverage was consistently robust for both modalities across all plan types. Proton therapy resulted in significantly reduced bowel V35Gy by 11.2 percentage points (95% CI [4.1:18.4], p = 0.01) and bowel mean dose by 13.9 Gy (95% CI [9.5:18.4], p < 0.001). Bladder mean dose was also lower with proton therapy (reduced by 18.4 Gy, p = 0.02). These advantages remained consistent across nominal, recalculated, and uncertainty scenario plans. No consistent modality-related differences were observed for high-dose normal tissue metrics.
Conclusion
Within this robustness-inclusive multicentre comparison study, proton-based WPRT maintained target coverage comparable to photon therapy and consistently reduced low- and intermediate-dose exposure to normal tissues, while demonstrating preserved robustness under the influence of inter-fractional variation.
背景和目的：与基于光子的全盆腔放疗（WPRT）相比，质子治疗对高危前列腺癌的正常组织保留有潜在的改善，但其对解剖学和设置变化的敏感性引起了对稳健性的担忧。本研究的目的是-在多中心随机临床试验的背景下-探索质子治疗的剂量-体积优势是否在受到分数间变化时持续存在。材料和方法：在国家质子中心接受WPRT治疗的5例患者。比较光子计划由五个光子治疗中心独立创建。在每位患者两次重复计算机断层扫描和模拟几何不确定性的鲁棒性情景中，评估了标称质子和光子计划以及重新计算的计划。使用考虑患者和中心可变性的线性混合效应模型，比较两种模式下靶体积和正常组织的剂量-体积指标。结果：在所有计划类型的两种模式中，目标覆盖率始终是稳健的。质子治疗导致肠道V35Gy显著降低11.2个百分点（95% CI [4.1:18.4], p = 0.01），肠道平均剂量显著降低13.9 Gy （95% CI [9.5:18.4], p ）。结论：在这项包含稳定期的多中心比较研究中，基于质子的WPRT保持了与光子治疗相当的靶点覆盖率，并持续减少了低剂量和中剂量对正常组织的暴露，同时在分数间变化的影响下保持了稳定期。
{"title":"A robustness-inclusive comparison of proton- versus photon-based whole-pelvic radiotherapy for prostate cancer within a randomised clinical trial","authors":"Sofie Tilbæk , Stine Elleberg Petersen , Liliana Stolarczyk , Kasper Lind Laursen , Steffen Bjerre Hokland , Susan BlakNyrup Biancardo , Kirsten Legaard Jakobsen , Rasmus Havelund , Terje Andersen , Bjarke Mortensen , Christine Vestergård Madsen , Anders Schwartz Vittrup , Henriette Lindberg , Dorthe Yakymenko , Jimmi Søndergaard , Ludvig Paul Muren","doi":"10.1016/j.radonc.2026.111404","DOIUrl":"10.1016/j.radonc.2026.111404","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Proton therapy offers potentially improved normal tissue sparing compared to photon-based whole-pelvic radiotherapy (WPRT) for high-risk prostate cancer, but its sensitivity to anatomical and setup variations raises concerns about robustness. The aim of this study was – within the setting of a multicentre randomised clinical trial – to explore whether the dose-volume advantages of proton therapy persisted when subject to inter-fractional variation.</div></div><div><h3>Materials and methods</h3><div>Five patients treated with WPRT at a national proton centre were included. Comparative photon plans were created independently by five photon therapy centres. Nominal proton and photon plans were evaluated alongside recalculated plans on two repeat computed tomography scans per patient and with robustness scenarios simulating geometric uncertainties. Dose-volume metrics for target volumes and normal tissues were compared between the two modalities using linear mixed effects models accounting for patient and centre variability.</div></div><div><h3>Results</h3><div>Target coverage was consistently robust for both modalities across all plan types. Proton therapy resulted in significantly reduced bowel <em>V</em><sub>35Gy</sub> by 11.2 percentage points (95% CI [4.1:18.4], p = 0.01) and bowel mean dose by 13.9 Gy (95% CI [9.5:18.4], p < 0.001). Bladder mean dose was also lower with proton therapy (reduced by 18.4 Gy, p = 0.02). These advantages remained consistent across nominal, recalculated, and uncertainty scenario plans. No consistent modality-related differences were observed for high-dose normal tissue metrics.</div></div><div><h3>Conclusion</h3><div>Within this robustness-inclusive multicentre comparison study, proton-based WPRT maintained target coverage comparable to photon therapy and consistently reduced low- and intermediate-dose exposure to normal tissues, while demonstrating preserved robustness under the influence of inter-fractional variation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"217 ","pages":"Article 111404"},"PeriodicalIF":5.3,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087010","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}
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