Radiotherapy and Oncology最新文献

{"title":"Associations between patient-reported neurocognition, mood, and fatigue and radiation dose in oropharyngeal cancer survivors","authors":"Marcus Tyyger ,&nbsp;Zsuzsanna Iyizoba-Ebozue ,&nbsp;Emma Nicklin ,&nbsp;Florien Boele ,&nbsp;John Lilley ,&nbsp;Louise Murray ,&nbsp;Eliana Vasquez Osorio","doi":"10.1016/j.radonc.2025.111309","DOIUrl":"10.1016/j.radonc.2025.111309","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy is standard of care for oropharyngeal cancer (OPC) but it has been associated with neurocognitive issues, fatigue, and mood disturbances. Voxel-based analysis (VBA) was used to correlate dose and late radiotherapy effects on a fine-grained, voxel-level, without pre-defined regions.</div></div><div><h3>Method</h3><div>A multicentre cross-sectional study, including patients from two tertiary radiotherapy centres: Leeds Cancer Centre (Centre A) and The Christie NHS Foundation Trust, Manchester (Centre B). Patient-reported outcomes for cognitive complaints (Medical Outcomes Study Cognitive Functioning Scale), fatigue (Multidimensional Fatigue Inventory), and mood (Profile of Mood States short form) were administered at least 2 years after treatment. VBA using cross-centre validated software, and three publically available reference CTs, was performed on: single centre only subgroups, and one combined cohort. Regions of significance were clinically reviewed and investigated using dose-volume histogram (DVH) analysis.</div></div><div><h3>Results</h3><div>273 patients treated for OPC (Centre A: 118, Centre B: 155) were included, with significant inter-centre differences observed in age, T-stage, N-stage, and dose/fractionation. Dose to the identified cerebellar region differed between centres, with median equivalent dose in 2 Gy fractions (α/β = 3 Gy) of 6.8 Gy for Centre A and 10.2 Gy for Centre B. Correlations of dose with mood disturbance and fatigue within regions of the right-posterior cerebellum were identified for centre B only.</div></div><div><h3>Conclusion</h3><div>There are potential positive associations between right-posterior cerebellum dose with late mood disturbance and fatigue, including potential dose–effect thresholds and cerebella sensitivity to dose per fraction. Further research is needed to clarify these findings, and to establish causality.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111309"},"PeriodicalIF":5.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638172","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":"Evaluation of compartmentalized automatic segmentation for definition of the GTV in glioblastoma radiotherapy","authors":"Robert Poel ,&nbsp;Lucas Mose ,&nbsp;Philipp Reinhardt ,&nbsp;Michael Müller ,&nbsp;Silvan Meuller ,&nbsp;Mauricio Reyes ,&nbsp;Sarah Brueningk ,&nbsp;Peter Manser ,&nbsp;Daniel M. Aebersold ,&nbsp;Ekin Ermiş","doi":"10.1016/j.radonc.2025.111308","DOIUrl":"10.1016/j.radonc.2025.111308","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Manual delineation of target volumes in glioblastoma (GBM) radiotherapy (RT) is time-consuming and variable. This study evaluates the clinical applicability of a preliminary deep learning model (Neosoma Glioma) for automating gross tumor volume (GTV) segmentation in postoperative GBM per ESTRO-EANO guidelines.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed 100 GBM cases treated at Inselspital University Hospital, Bern (2016–2020) with standardized multi-modal MRI. Auto-segmented GTVs were compared to expert-defined contours using geometric metrics. Radiation oncologists reviewed and adjusted the best-performing configuration. Time savings, geometric similarity, and dosimetric impact were assessed.</div></div><div><h3>Results</h3><div>Optimal auto-segmentation (resection cavity plus enhancing tumor with 1 mm margin) achieved a mean Dice similarity coefficient of 0.79 (SD = 0.14) vs. ground truth. Manual adjustment took 5.9 (SD = 4.6) minutes vs. 12.3 (SD = 6.8) minutes for manual contouring (&gt;50 % time reduction). The mean Dice between auto-segmented and adjusted GTVs was 0.84 (SD = 0.18). Dosimetric evaluation showed plans from adjusted auto-segmentations were equivalent to those based on consensus contours, with no clinically relevant differences in target coverage or organ-at-risk sparing.</div></div><div><h3>Conclusion</h3><div>The Neosoma Glioma model generates clinically useful postoperative GTV segmentations, with geometric performance comparable to expert variability and dosimetric equivalence to consensus contours. It reduces contouring time by over 50%, enabling faster RT workflows. Its consistency across diverse GBM presentations supports its practical value. AI-based segmentation can help standardize GBM target definition when integrated into RT planning with proper quality assurance.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111308"},"PeriodicalIF":5.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621158","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":"Diffusion weighted imaging for gross tumor volume delineation in primary radiochemotherapy and image guided adaptive brachytherapy for cervical cancer","authors":"Lukas Zimmermann,&nbsp;Barbara Knäusl,&nbsp;Johannes Knoth,&nbsp;Alina Sturdza,&nbsp;Vincent Dick,&nbsp;Tatevik Mrva-Ghukasyan,&nbsp;Inga-Malin Simek,&nbsp;Nicole Eder-Nesvacil,&nbsp;Dietmar Georg,&nbsp;Maximilian Schmid","doi":"10.1016/j.radonc.2025.111306","DOIUrl":"10.1016/j.radonc.2025.111306","url":null,"abstract":"<div><h3>Background and purpose:</h3><div>Accurate gross tumor volume (GTV) delineation is critical for successful radiochemotherapy and image-guided adaptive brachytherapy (BT) in cervical cancer. This study investigated whether diffusion-weighted imaging (DWI) improves GTV delineation accuracy compared to T2-weighted (T2w) MRI alone, across different physician experience levels.</div></div><div><h3>Materials and Methods:</h3><div>Twenty-seven patients with locally advanced cervical carcinoma undergoing primary radiochemotherapy were analyzed. Six physicians (three experts, three residents) delineated GTVs at three time points: diagnosis (<em>init</em>), pre-brachytherapy (<em>preBT</em>), and pre-brachytherapy with applicator in situ (<em>BT</em>). Segmentations were performed using T2w images alone and T2w plus DWI (b=800<!--> <!-->s<!--> <!-->mm^-2) guidance. Expert consensus served as reference standard using STAPLE algorithm. Inter-observer agreement was assessed using conformity index, Dice-Sørensen coefficient, and Hausdorff distance.</div></div><div><h3>Results:</h3><div>DWI guidance significantly improved inter-observer agreement among experts at <em>init</em> (conformity index: 0.62<span><math><mo>→</mo></math></span> 0.70, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>) and <em>BT</em> (0.33<span><math><mo>→</mo></math></span> 0.39, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>) time points. For residents, DWI guidance enhanced agreement with expert consensus, particularly during <em>BT</em>, with significant improvements in Dice coefficient (median increase 9%, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>) and reduced Hausdorff distance (median decrease 1.3 mm, <span><math><mrow><mi>p</mi><mo>&lt;</mo><mn>0</mn><mo>.</mo><mn>05</mn></mrow></math></span>). Tumor volume correlation between <em>preBT</em> and <em>BT</em> time points improved with DWI guidance for both groups.</div></div><div><h3>Conclusion:</h3><div>Incorporating DWI into the segmentation workflow reduces inter-observer variability for both expert and resident radiation oncologists. DWI guidance particularly benefits less experienced physicians, enabling them to achieve contours closer to expert consensus standards through additional functional information.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111306"},"PeriodicalIF":5.3,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621254","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 framework for radiation oncology departments to mitigate against cyberattacks","authors":"Samuel Peters ,&nbsp;Anita O’Donovan ,&nbsp;Marcello Bellini ,&nbsp;Amanda Caissie ,&nbsp;Mary Coffey ,&nbsp;Ali Dabach ,&nbsp;Geoff P. Delaney ,&nbsp;Peter E. Fischer ,&nbsp;Gert Frenken ,&nbsp;Brian Liszewski ,&nbsp;Philippe Maingon ,&nbsp;Eric Messens ,&nbsp;Sophie Perryck ,&nbsp;Baoshe Zhang ,&nbsp;Petra Reijnders-Thijssen","doi":"10.1016/j.radonc.2025.111305","DOIUrl":"10.1016/j.radonc.2025.111305","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;The healthcare sector, particularly radiation oncology departments, is facing an increasing threat of cyberattacks that compromise patient data, disrupt clinical workflows and endanger patient safety. These attacks highlight a critical lack of preparedness and the need for a structured approach to cybersecurity resilience. While other industries have comprehensive mitigation measures in place, specific guidance for radiotherapy is lacking. This paper aims to present practical and comprehensive recommendations for mitigating cyberattacks and minimising their direct impact on patient care in radiation therapy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methodology&lt;/h3&gt;&lt;div&gt;Preparing this report involved three phases. First, the authors adapted existing international frameworks, such as the NIST CSF, to the specific needs of radiation oncology, resulting in a six-step framework: Preparation, Prevention, Detection, Response, Recovery and Debriefing and Continuous Improvement. Secondly, a systematic literature review was conducted using keywords related to cyberattacks in healthcare and radiotherapy. Third, the information extracted from the literature was aggregated and summarised into specific action measures, with final consensus being reached by the entire group based on their collective expertise.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The literature review resulted in 133 relevant articles, which were then aggregated and formulated into 190 specific action measures in total. These were assigned to the 6 steps (43 for preparation, 28 for prevention, 14 for detection, 50 for response, 22 for recovery, 24 for debriefing and continuous improvement, and nine additional steps), enabling departments to be guided through the entire lifecycle of a cyberattack. Step 1: Preparation: This proactive phase of planning for potential cyberattacks involves thorough risk assessment and identification of all systems, tools and processes. A key component is the development of a detailed business continuity plan (BCP), which must include procedures for the offline treatment or referral of patients, communication and patient prioritisation. The plan should also define the roles and responsibilities of an interdisciplinary incident response team. Step 2 – Prevention: This step focuses on implementing proactive security measures to prevent attacks. This includes user training to raise awareness, regular system updates, and general protective measures. Step 3 – Detection: This step involves identifying suspicious activities within systems and networks. It emphasises the use of security tools for real-time monitoring and the establishment of clear communication processes to enable the prompt reporting and response to potential threats. Step 4: Respond: This is the central phase of a cyberattack, focusing on executing the BCP to ensure continuity of patient treatment as quickly as possible. This includes isolating affected systems and implementing continuity of trea","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111305"},"PeriodicalIF":5.3,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145638101","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":"Patterns of care in primary brain tumour Reirradiation: A survey by the ESTRO CNS focus Group","authors":"Andrada Turcas ,&nbsp;Raphael Bodensohn ,&nbsp;Elena Clerici ,&nbsp;Isacco Desideri ,&nbsp;Felix Ehret ,&nbsp;Nils Gleim ,&nbsp;Harat Maciej ,&nbsp;Pierina Navarria ,&nbsp;Aoife Williamson ,&nbsp;Jonas Willmann ,&nbsp;Nicolaus Andratschke ,&nbsp;Giuseppe Minniti ,&nbsp;Maximilian Niyazi","doi":"10.1016/j.radonc.2025.111299","DOIUrl":"10.1016/j.radonc.2025.111299","url":null,"abstract":"<div><h3>Background</h3><div>Reirradiation is increasingly considered for patients with recurrent primary brain tumours, yet clinical practices vary significantly due to limited evidence and a lack of standardized guidelines. This survey aimed to map European practice patterns in brain tumour reirradiation.</div></div><div><h3>Methods</h3><div>A 23-item web-based survey was developed by the ESTRO CNS Focus Group to assess institutional characteristics, clinical decision-making, and technical aspects of reirradiation. Distributed via email and social media, the survey collected responses between June–July 2025. Descriptive statistics were applied.</div></div><div><h3>Results</h3><div>Eighty responses from 28 European countries were analysed. High-grade gliomas were the most frequently reirradiated tumours (&gt;80 %), followed by meningioma (56 %, low-grade glioma (49 %), and ependymoma (44 %). Conventional photon radiotherapy (RT) was the predominant technique across all tumour types, with varying use of hypofractionation, stereotactic RT, and proton therapy. Target volume definition and margin size varied by histology, with larger margins and inclusion of edema/cavities more frequent in gliomas. MRI-CT fusion was standard for planning. Concurrent systemic treatment was used mainly in high-grade gliomas. Organ at risk dose recovery and cumulative constraints were commonly considered, but threshold values and recovery models differed. Main barriers included fear of toxicities, including radiation necrosis and limited evidence.</div></div><div><h3>Conclusion</h3><div>This survey reveals high heterogeneity in brain tumour reirradiation practices across Europe, especially regarding dose, technique, and target definition. Despite shared principles, consensus is lacking for rarer tumour types. These findings underscore the need for harmonized guidelines and prospective data to optimize patient care.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111299"},"PeriodicalIF":5.3,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605568","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":"International consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases: A second update","authors":"Eva Oldenburger ,&nbsp;Jane Jomy ,&nbsp;Inmaculada Navarro-Domenech ,&nbsp;Shing Fung Lee ,&nbsp;Joanne M. Van der Velden ,&nbsp;Henry C.Y. Wong ,&nbsp;Mateusz Spalek ,&nbsp;Gustavo N. Marta ,&nbsp;Peter Hoskin ,&nbsp;Yvette M. Van der Linden ,&nbsp;Johan Menten ,&nbsp;Charles B. Simone II ,&nbsp;Daniel Roos ,&nbsp;Francesca De Felice ,&nbsp;Dirk Rades ,&nbsp;Edward Chow ,&nbsp;Philip Wong ,&nbsp;Srinivas Raman ,&nbsp;On behalf of the International Bone Metastases Consensus Working Party","doi":"10.1016/j.radonc.2025.111300","DOIUrl":"10.1016/j.radonc.2025.111300","url":null,"abstract":"<div><h3>Background and purpose</h3><div>External beam radiotherapy (EBRT) is a well-established and effective intervention for pain palliation in patients with bone metastases. Variability in trial endpoints, however, has limited comparability and synthesis of available evidence. To address this, the International Bone Metastases Consensus Working Party published endpoint guidelines in 2002 and updated them in 2012. This study aims to review, re-evaluate, and update the existing consensus to reflect contemporary clinical practice and technological advances.</div></div><div><h3>Materials and methods</h3><div>A modified Delphi process was undertaken, informed by a systematic literature review and post-2012 guideline publications. An electronic survey was distributed to previous contributors and internationally recognized bone EBRT experts. In Phase I, statements achieving ≥ 75 % agreement were accepted. Items not reaching consensus were refined by the Working Party, discussed by a core panel of eight experts, and recirculated in Phase II. Descriptive statistics summarized response rates and agreement levels.</div></div><div><h3>Results</h3><div>Of 125 experts invited, 58 participated in Phase I, and 44 in Phase II. Consensus was achieved for 38 out of 49 statements (78%), including 18 new or revised items. Key recommendations addressed eligibility criteria for trial enrolment, standardized pain and analgesic assessments, specification of radiation techniques and dose schedules, follow-up intervals, assessment timing and modalities, and incorporation of cost-effectiveness analyses.</div></div><div><h3>Conclusion</h3><div>This updated consensus provides a contemporary, standardized framework for EBRT trial design and reporting in bone metastases. Adoption will improve cross-study comparability and guide future research priorities. Regular updates are planned to ensure alignment with evolving clinical practice and technology.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111300"},"PeriodicalIF":5.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597275","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":"Stage-adjusted forecasting of radiotherapy demand and outcome benefits across income groups: Estimating survival and local control gains by 2050","authors":"Mengqi Zhou ,&nbsp;Dania Abu Awwad ,&nbsp;Geoffrey Paul Delaney ,&nbsp;Vikneswary Batumalai ,&nbsp;Aba Scott ,&nbsp;Eduardo Zubizarreta ,&nbsp;Yavuz Anacak ,&nbsp;Soehartati Gondhowiardjo ,&nbsp;Tiara B. Mayang Permata ,&nbsp;Mei Ling Yap","doi":"10.1016/j.radonc.2025.111303","DOIUrl":"10.1016/j.radonc.2025.111303","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy is a vital component of cancer care, yet access is limited. Global estimates often overlook cancer stage variability across countries with different income levels. This study assesses the supply–demand gap for megavoltage radiotherapy machines (MVMs) from 2012 to 2022 and projects the survival and local control benefits achievable by meeting optimal radiotherapy needs by 2050.</div></div><div><h3>Methods</h3><div>Global cancer data were from GLOBOCAN 2022. A validated, stage-adjusted radiotherapy utilisation model was adapted using available cancer stage data from LMICs for each geographical region. Population-based models estimating local control and survival benefit from radiotherapy were also stage-adjusted. The overall shortfall was calculated as patients not receiving treatment due to limited MVM availability. Corresponding outcome gaps were estimated by multiplying shortfall cases by their respective benefit percentages.</div></div><div><h3>Results</h3><div>Radiotherapy demand increased by 2.4 million cases from 2012 to 2022. Optimising access would yield survival benefits for &gt;860,000 people annually and improved local control for 3.5 million cases annually. Lower-middle-income countries are estimated to derive the highest population-based benefits in local control (10.65 %) and survival (4.94 %). The number of patients missing radiotherapy is projected to reach 7.9 million by 2050, creating a global local control gap of 1.2 million and a survival gap of 500,000 cases per year.</div></div><div><h3>Conclusion</h3><div>This study highlights the urgent need for enhanced policies and expanded infrastructure to address radiotherapy disparities, particularly in LMICs, to improve local control and survival outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"216 ","pages":"Article 111303"},"PeriodicalIF":5.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597250","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":"Online dose-adaptive radiotherapy considerably reduces irradiated volume in rectal cancer radiotherapy","authors":"Lukas Schröder ,&nbsp;Erik van der Bijl ,&nbsp;Lisa Wiersema ,&nbsp;Anja Betgen ,&nbsp;Baukelien van Triest ,&nbsp;Femke Peters ,&nbsp;Alice Couwenberg ,&nbsp;Uulke A. van der Heide ,&nbsp;Jan-Jakob Sonke ,&nbsp;Tomas Janssen","doi":"10.1016/j.radonc.2025.111302","DOIUrl":"10.1016/j.radonc.2025.111302","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Online adaptive radiotherapy (OART) allows for a reduction of geometric uncertainties and therefore smaller PTV margins. In this work we take the next step and introduce online dose-adaptive radiotherapy (DART), where the treatment plan is adapted not only to the geometry of the day but also to the accumulated dose delivered in previous fractions.</div></div><div><h3>Materials and methods</h3><div>14 rectal cancer patients that were treated with OART with 5x5Gy on a 1.5 T MR-Linac were retrospectively included. For fractions 1–4, a daily treatment plan using 1 mm PTV margin was generated. Actual delivered dose was estimated by recalculation of this plan on the post-treatment scan. By means of deformable image registration, the delivered doses were accumulated on the adaptation scan of fraction 5. For fraction 5, a plan was optimized to the prescribed dose, using the accumulated dose of fractions 1–4 as background. Target coverage and irradiated volume of the final accumulated delivered dose was compared with the accumulated delivered dose from conventional OART using clinical PTV margins.</div></div><div><h3>Results</h3><div>After dose accumulation, DART led to a mean decrease in CTV D_99% of 0.5 Gy compared to conventional OART, however, conform protocol, target coverage was sufficient in &gt;90 % of patients. The median dose in the 1 cm ring around the clinical PTV was reduced by 3.6 Gy and the patient volume that received 95 % of the prescribed dose decreased by 32 % (221 cm³) on average.</div></div><div><h3>Conclusion</h3><div>Online DART is technically feasible, achieving adequate delivered accumulated CTV dose, while substantially sparing the healthy tissue.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111302"},"PeriodicalIF":5.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597213","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":"First online real-time motion-including prostate and bladder dose reconstruction during prostate radiotherapy","authors":"Karolina Klucznik ,&nbsp;Thomas Ravkilde ,&nbsp;Simon Skouboe ,&nbsp;Paul Keall ,&nbsp;Laura Happersett ,&nbsp;Hai Pham ,&nbsp;Brian Leong ,&nbsp;Pengpeng Zhang ,&nbsp;Grace Tang ,&nbsp;Per R. Poulsen","doi":"10.1016/j.radonc.2025.111298","DOIUrl":"10.1016/j.radonc.2025.111298","url":null,"abstract":"<div><h3>Background and motivation</h3><div>Organ motion can distort prostate radiotherapy doses. This study presents the first real-time calculation of the motion-induced dose distortions performed online during prostate radiotherapy.</div></div><div><h3>Methods</h3><div>Twenty patients were treated with stereotactic prostate radiotherapy of 35 Gy or 40 Gy in 5 fractions using intrafractional image guidance for real-time prostate localization and patient repositioning upon prostate misalignments exceeding 1.5  mm. In-house developed software performed motion-including prostate and bladder dose reconstruction during treatment. The reconstructed doses were retrospectively validated against a clinical treatment planning system (TPS) where motion was encoded in treatment plans as multiple 3D isocenter shifts. Hypothetical doses delivered without intra-treatment repositioning were reconstructed post-treatment for comparison to illustrate how the dose reconstruction allows easy assessment of the effectiveness of the used motion mitigation method.</div></div><div><h3>Results</h3><div>Dose reconstruction was performed for 91 fractions either online during treatment (n = 41) or retrospectively using recorded motion (n = 50). The real-time calculated doses (calculated by the in-house software using a simplified algorithm) agreed with TPS calculations with mean (±std) differences of 0.1 % (±0.9 %) for clinical target volume (CTV) D_95% and 0.2 % (±0.2 %) for bladder V_36Gy. The mean time per online dose-reconstruction (±std) was 336 ± 86 ms, proving the real-time applicability of the proposed method. The average (±std) motion-induced dose distortions for individual fractions with intrafractional image guidance were –0.5 % (±1.0 %) for CTV D_95% and +0.1 % (±0.5 %) for bladder V_36Gy for individual fractions. Accumulated across all fractions of each patient, these deviations decreased to 0.0 % (±0.7 %) for the CTV and +0.1 % (±0.2 %) for the bladder. In contrast, without intratreatment repositioning, deviations would have been –1.3 % (±5.0 %) for CTV D_95% and +0.5 % (±1.5 %) for bladder V_36Gy, with individual fractions exhibiting clinically unacceptable CTV D_95% decreases of up to 42.5 %.</div></div><div><h3>Conclusion</h3><div>This study marks the first clinical realization of real-time motion-including dose reconstruction for both target and organ-at-risk structures paving the way for real-time dose-guided radiotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111298"},"PeriodicalIF":5.3,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597206","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":"Refining surveillance in Myxoid liposarcoma: long-term recurrence patterns and functional outcomes after surgery ± radiotherapy in 186 patients","authors":"Siyer Roohani ,&nbsp;Peter W.M. Chung ,&nbsp;Brendan C. Dickson ,&nbsp;Peter C. Ferguson ,&nbsp;Anthony M. Griffin ,&nbsp;David G. Kirsch ,&nbsp;Reinhardt Krcek ,&nbsp;Brian O’Sullivan ,&nbsp;David B. Shultz ,&nbsp;Kim M. Tsoi ,&nbsp;Philip Wong ,&nbsp;Jay S. Wunder ,&nbsp;Charles N. Catton","doi":"10.1016/j.radonc.2025.111275","DOIUrl":"10.1016/j.radonc.2025.111275","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess oncologic, functional outcomes, and recurrence patterns in a large cohort of prospectively collected patients with localized extremity/trunk myxoid liposarcoma with long-term follow-up.</div></div><div><h3>Methods</h3><div>Analysis of 186 patients (1992–2025) treated with surgery ± perioperative radiotherapy. Data were drawn from prospective institutional registries with central pathology/radiology review. Outcomes: wound complications, late toxicity, functional scores, overall survival (OS), cancer-specific survival (CSS), and local (LR) and distant metastatic recurrence (DM).</div></div><div><h3>Results</h3><div>Median age was 44.5 years; median follow-up 77 months. All had surgery; 86.6 % received radiotherapy (73.7 % preoperatively). Wound complications occurred in 33.3 %. Late ≥ Grade 2 toxicities: skin (7.5 %), subcutaneous fibrosis (14.5 %), joint stiffness (2.2 %), edema (9.1 %). Functional scores at last follow-up: median TESS: 97 (mean 91.3), MSTS-87: 35 (mean 33.1), MSTS-93: 100 (mean 94.7). LR: 3 cases (1.6 %, 5-year cumulative incidence: 1.4 %). DM: 31 patients (16.7 %), involving 40 sites (42.5 % soft tissue, 22.5 % lung, 17.5 % bone, 7.5 % liver, 5 % lymph nodes). Cumulative incidence of DM: 1-year 0.6 %, 5-year 10.8 %, 10-year 23.4 %. CSS was 100 %, 96.4 %, and 80 % at 1, 5, and 10 years, respectively. OS was 98.8 %, 92 %, and 74.2 % at the same time points.</div></div><div><h3>Conclusions</h3><div>Local control was high, and long-term function were favorable. Distant recurrences were more frequent, occurred at a constant rate beyond 5 years, without plateau, often involved extra-pulmonary sites, and drove late cancer-related mortality. These findings support the consideration of continued annual follow-up through at least 10 years, with imaging of pulmonary and extra-pulmonary sites to adequately capture the full spectrum of metastatic risk.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"214 ","pages":"Article 111275"},"PeriodicalIF":5.3,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588394","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}