Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.08.005
Felix Ehret , Charles Leland Rogers , James Fontanesi , George D. Wilson , Bhargava S. Chitti , John Starner , Baho Sidiqi , Anuj Goenka , Michael Schulder , Anna M.E. Bruynzeel , Joost J.C. Verhoeff , Alexander C. MacDonagh , Hannah I. Park , Helen A. Shih , Lawrence Kleinberg
Radiation therapy has a central role in the treatment of various malignant central nervous system tumors, including gliomas, high-grade meningiomas, and brain metastases. This also applies to a plethora of non-malignant central nervous system lesions, such as vestibular schwannomas and arteriovenous malformations, and, in specific situations, for selected functional and psychiatric disorders. In patients with these conditions, the goal of radiation therapy is generally to preserve and stabilize function. In addition, as these illnesses, with some exceptions such as arteriovenous malformations, are rarely life-threatening, the risks of radiation therapy must be interpreted in a different context than for patients with malignancy. Given the continuous and growing interest in the use of radiation therapy for non-malignant tumors and functional conditions, this review summarizes the current and future directions in central nervous system applications, addressing its use for the management of vestibular schwannomas, arteriovenous malformations, trigeminal neuralgia, tremor, Alzheimer’s disease, and other psychiatric conditions, such as obsessive-compulsive disorder, addiction, and eating disorders.
{"title":"Radiation Therapy for Non-Malignant Central Nervous System Tumors, Disorders, and Illnesses — Current Applications and Future Directions","authors":"Felix Ehret , Charles Leland Rogers , James Fontanesi , George D. Wilson , Bhargava S. Chitti , John Starner , Baho Sidiqi , Anuj Goenka , Michael Schulder , Anna M.E. Bruynzeel , Joost J.C. Verhoeff , Alexander C. MacDonagh , Hannah I. Park , Helen A. Shih , Lawrence Kleinberg","doi":"10.1016/j.semradonc.2025.08.005","DOIUrl":"10.1016/j.semradonc.2025.08.005","url":null,"abstract":"<div><div>Radiation therapy has a central role in the treatment of various malignant central nervous system tumors, including gliomas, high-grade meningiomas, and brain metastases. This also applies to a plethora of non-malignant central nervous system lesions, such as vestibular schwannomas and arteriovenous malformations, and, in specific situations, for selected functional and psychiatric disorders. In patients with these conditions, the goal of radiation therapy is generally to preserve and stabilize function. In addition, as these illnesses, with some exceptions such as arteriovenous malformations, are rarely life-threatening, the risks of radiation therapy must be interpreted in a different context than for patients with malignancy. Given the continuous and growing interest in the use of radiation therapy for non-malignant tumors and functional conditions, this review summarizes the current and future directions in central nervous system applications, addressing its use for the management of vestibular schwannomas, arteriovenous malformations, trigeminal neuralgia, tremor, Alzheimer’s disease, and other psychiatric conditions, such as obsessive-compulsive disorder, addiction, and eating disorders.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 77-94"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.08.006
Tony Y. Eng , Houda Bahig , Tiffany W. Chen , Karthik P. Meiyappan , David Roberge
Radiation therapy (RT), traditionally reserved for malignant conditions, has emerged as a valuable tool in the management of select benign tumors and proliferative disorders. In clinical scenarios where surgery is not feasible, incomplete, or associated with significant morbidity, RT offers a noninvasive and effective alternative, often yielding excellent local control and long-term symptom relief. For instance, although surgery is relatively safe and effective, radiation is the preferred treatment for many patients with acoustic neuroma. Many benign entities have demonstrated favorable responses to radiation [1]. Among these, paragangliomas (PGL)—notably glomus jugulare tumors—have emerged as prime examples where RT plays a critical role. These tumors, while histologically benign, often present with local invasiveness, cranial nerve involvement, and high recurrence rates, making complete surgical resection difficult and frequently associated with significant morbidity. Beyond PGLs, RT has shown promise in a range of other benign conditions, including many benign vascular and lymphoid disorders [2, 3, 4]. These entities, although benign, may behave in an infiltrative or recurrent manner, necessitating a multidisciplinary approach to treatment. In particular, localized lymphoid lesions may benefit from RT. This section focuses specifically on the role of RT in the management of PGL, pheochromocytoma (PCC), hemangioma, ameloblastoma, angiofibroma, Castleman disease, cutaneous pseudolymphoma, and adamantinoma. Other benign entities are discussed in a separate section of the current issue.
{"title":"Radiation Therapy for Benign Diseases and Premalignant Conditions","authors":"Tony Y. Eng , Houda Bahig , Tiffany W. Chen , Karthik P. Meiyappan , David Roberge","doi":"10.1016/j.semradonc.2025.08.006","DOIUrl":"10.1016/j.semradonc.2025.08.006","url":null,"abstract":"<div><div>Radiation therapy (RT), traditionally reserved for malignant conditions, has emerged as a valuable tool in the management of select benign tumors and proliferative disorders. In clinical scenarios where surgery is not feasible, incomplete, or associated with significant morbidity, RT offers a noninvasive and effective alternative, often yielding excellent local control and long-term symptom relief. For instance, although surgery is relatively safe and effective, radiation is the preferred treatment for many patients with acoustic neuroma. Many benign entities have demonstrated favorable responses to radiation [<span><span>1</span></span>]. Among these, paragangliomas (PGL)—notably glomus jugulare tumors—have emerged as prime examples where RT plays a critical role. These tumors, while histologically benign, often present with local invasiveness, cranial nerve involvement, and high recurrence rates, making complete surgical resection difficult and frequently associated with significant morbidity. Beyond PGLs, RT has shown promise in a range of other benign conditions, including many benign vascular and lymphoid disorders [<span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span>]. These entities, although benign, may behave in an infiltrative or recurrent manner, necessitating a multidisciplinary approach to treatment. In particular, localized lymphoid lesions may benefit from RT. This section focuses specifically on the role of RT in the management of PGL, pheochromocytoma (PCC), hemangioma, ameloblastoma, angiofibroma, Castleman disease, cutaneous pseudolymphoma, and adamantinoma. Other benign entities are discussed in a separate section of the current issue.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 95-113"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.11.001
Jean L. Nakamura MD
Radiotherapy is a valuable treatment option for a variety of nonmalignant diseases. As the indications for low-dose radiotherapy to benign conditions evolve, it is prudent to consider risks and how these might weigh against the benefits of therapy. Radiation-induced malignancies are one consideration and are more likely associated with higher doses of radiation and genetic cancer susceptibility. Radiotherapy for nonmalignant diseases typically involves doses much lower than those associated with radiation-induced malignancies. In addition, treatments are employed for conditions that are more common in the older patient population, whereas much of the historical experience with radiation-induced malignancies involves children and young adults. The low doses associated with radiotherapy for nonmalignant diseases and the patient population in whom these treatments are employed makes the estimated risk of radiation-induced carcinogenesis low. Specific factors that increase the concern for radiation-induced malignancies include repeated radiotherapy to the same site, leading to cumulative increasing dosage, radiotherapy in younger individuals, and those with known germline mutations in DNA repair genes.
{"title":"Genetic and Carcinogenic Risks of Radiotherapy for Nonmalignant Diseases","authors":"Jean L. Nakamura MD","doi":"10.1016/j.semradonc.2025.11.001","DOIUrl":"10.1016/j.semradonc.2025.11.001","url":null,"abstract":"<div><div>Radiotherapy is a valuable treatment option for a variety of nonmalignant diseases. As the indications for low-dose radiotherapy to benign conditions evolve, it is prudent to consider risks and how these might weigh against the benefits of therapy. Radiation-induced malignancies are one consideration and are more likely associated with higher doses of radiation and genetic cancer susceptibility. Radiotherapy for nonmalignant diseases typically involves doses much lower than those associated with radiation-induced malignancies. In addition, treatments are employed for conditions that are more common in the older patient population, whereas much of the historical experience with radiation-induced malignancies involves children and young adults. The low doses associated with radiotherapy for nonmalignant diseases and the patient population in whom these treatments are employed makes the estimated risk of radiation-induced carcinogenesis low. Specific factors that increase the concern for radiation-induced malignancies include repeated radiotherapy to the same site, leading to cumulative increasing dosage, radiotherapy in younger individuals, and those with known germline mutations in DNA repair genes.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 18-22"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.10.002
Bobby N. Koneru , David A. Barron , Ralph Muecke , Richard Shaffer , Tarita O. Thomas , Mathias Sonnhoff , Robert M. Blach , David R. Steike , Lisa Deloch , Pranjal Kumar Singh , Heinrich Seegenschmiedt
Periarticular soft tissue disorders, encompassing enthesopathies, tendinopathies, and bursitis, contribute substantially to musculoskeletal pain and disability, particularly in adult populations. This chapter provides a comprehensive overview of the pathophysiology, clinical manifestations, and radiotherapeutic management of major periarticular syndromes, including painful shoulder syndrome, lateral epicondylitis, greater trochanteric pain syndrome, and plantar fasciitis. We detail how these conditions often present as a continuum of overlapping pathology at the enthesis, tendon, and peri‑tendinous structures, frequently driven by repetitive microtrauma, mechanical overload, degenerative changes, and low-grade inflammation. Emphasis is placed on the clinical and imaging features distinguishing key entities such as calcific tendinitis, enthesopathies, and bursitis. Special focus is given to the role of low-dose radiotherapy (LDRT) as an effective treatment option for refractory symptoms unresponsive or contraindicated to conservative management. Contemporary practice patterns, including patient selection, target volume delineation based on imaging, and technical variations between linear accelerator and orthovoltage techniques, are discussed. Data from recent prospective and retrospective studies are summarized, demonstrating notable pain reduction rates and functional improvement with LDRT, and outlining response rates, optimal dosage regimens, timing of re-irradiation, and age-based treatment considerations. The chapter concludes with practical recommendations for integrating radiotherapy into multimodal care pathways for periarticular soft tissue disorders, underscoring its utility in symptom control and functional restoration.
{"title":"Periarticular Soft Tissue Disorders: Enthesopathies, Tendinopathies, and Bursitis—Pathophysiology and Radiotherapeutic Approaches","authors":"Bobby N. Koneru , David A. Barron , Ralph Muecke , Richard Shaffer , Tarita O. Thomas , Mathias Sonnhoff , Robert M. Blach , David R. Steike , Lisa Deloch , Pranjal Kumar Singh , Heinrich Seegenschmiedt","doi":"10.1016/j.semradonc.2025.10.002","DOIUrl":"10.1016/j.semradonc.2025.10.002","url":null,"abstract":"<div><div>Periarticular soft tissue disorders, encompassing enthesopathies, tendinopathies, and bursitis, contribute substantially to musculoskeletal pain and disability, particularly in adult populations. This chapter provides a comprehensive overview of the pathophysiology, clinical manifestations, and radiotherapeutic management of major periarticular syndromes, including painful shoulder syndrome, lateral epicondylitis, greater trochanteric pain syndrome, and plantar fasciitis. We detail how these conditions often present as a continuum of overlapping pathology at the enthesis, tendon, and peri‑tendinous structures, frequently driven by repetitive microtrauma, mechanical overload, degenerative changes, and low-grade inflammation. Emphasis is placed on the clinical and imaging features distinguishing key entities such as calcific tendinitis, enthesopathies, and bursitis. Special focus is given to the role of low-dose radiotherapy (LDRT) as an effective treatment option for refractory symptoms unresponsive or contraindicated to conservative management. Contemporary practice patterns, including patient selection, target volume delineation based on imaging, and technical variations between linear accelerator and orthovoltage techniques, are discussed. Data from recent prospective and retrospective studies are summarized, demonstrating notable pain reduction rates and functional improvement with LDRT, and outlining response rates, optimal dosage regimens, timing of re-irradiation, and age-based treatment considerations. The chapter concludes with practical recommendations for integrating radiotherapy into multimodal care pathways for periarticular soft tissue disorders, underscoring its utility in symptom control and functional restoration.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 48-60"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.07.001
Annika Schlamann , James B. Yu , Alexander Rühle
Osteoarthritis (OA) is a widespread degenerative joint disease with increasing prevalence in aging populations. While conservative management such as physiotherapy, NSAIDs, and intraarticular injections form the mainstay of treatment, a significant proportion of patients, particularly elderly individuals or those unfit for surgery, remain symptomatic. Low-dose radiotherapy (LDRT) has re-emerged as a potential noninvasive therapeutic option based on its anti-inflammatory effects and favorable safety profile. This narrative review summarizes current clinical evidence, practical recommendations, and future directions for the use of LDRT in OA. Although some randomized controlled trials have reported no additional benefit of LDRT over sham treatment, these studies have been criticized for limited sample size, short follow-up duration, suboptimal patient selection, and deviation from standard LDRT protocols. Nevertheless, other randomized trials as well as large retrospective studies suggest clinically meaningful benefits in selected patients. Standard dosing regimens typically consist of 3.0-6.0 Gy delivered in 0.5-1.0 Gy fractions over 2-3 weeks, with a second course recommended in nonresponders. Practical considerations including patient selection, joint-specific dose planning, and patient education are essential to optimize outcomes. While the absolute risk of radiation-induced malignancy is considered negligible in elderly populations, safety measures such as shielding and cumulative dose monitoring are advised. Further large-scale, placebo-controlled studies are needed to clarify optimal dose, timing, and synergistic effects with pharmacological therapies to strengthen the role of LDRT in OA management.
{"title":"Low-Dose Radiotherapy for Osteoarthritis: Current Evidence, Practical Recommendations and Future Perspectives","authors":"Annika Schlamann , James B. Yu , Alexander Rühle","doi":"10.1016/j.semradonc.2025.07.001","DOIUrl":"10.1016/j.semradonc.2025.07.001","url":null,"abstract":"<div><div>Osteoarthritis (OA) is a widespread degenerative joint disease with increasing prevalence in aging populations. While conservative management such as physiotherapy, NSAIDs, and intraarticular injections form the mainstay of treatment, a significant proportion of patients, particularly elderly individuals or those unfit for surgery, remain symptomatic. Low-dose radiotherapy (LDRT) has re-emerged as a potential noninvasive therapeutic option based on its anti-inflammatory effects and favorable safety profile. This narrative review summarizes current clinical evidence, practical recommendations, and future directions for the use of LDRT in OA. Although some randomized controlled trials have reported no additional benefit of LDRT over sham treatment, these studies have been criticized for limited sample size, short follow-up duration, suboptimal patient selection, and deviation from standard LDRT protocols. Nevertheless, other randomized trials as well as large retrospective studies suggest clinically meaningful benefits in selected patients. Standard dosing regimens typically consist of 3.0-6.0 Gy delivered in 0.5-1.0 Gy fractions over 2-3 weeks, with a second course recommended in nonresponders. Practical considerations including patient selection, joint-specific dose planning, and patient education are essential to optimize outcomes. While the absolute risk of radiation-induced malignancy is considered negligible in elderly populations, safety measures such as shielding and cumulative dose monitoring are advised. Further large-scale, placebo-controlled studies are needed to clarify optimal dose, timing, and synergistic effects with pharmacological therapies to strengthen the role of LDRT in OA management.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 39-47"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.11.003
Isabel Falke MD , Ulrich Schäfer MD, PhD , Oliver Micke MD, PhD , Ralph Mücke MD, PhD , Jan Kriz MD, PhD
Radiotherapy is increasingly used for benign diseases, especially in Germany, where over 50% of radiation treatments address nonmalignant conditions such as osteoarthritis, plantar fasciitis, and Dupuytren’s disease. Low-dose regimens have shown good efficacy in pain reduction and disease stabilization, with minimal toxicity. For rarer indications like Gorham-Stout disease, pigmented villonodular synovitis, and lymphatic fistulas, evidence is limited to case series and retrospective studies. Randomized trials remain scarce, and further research is needed to evaluate long-term outcomes and patient quality of life. Radiotherapy appears safe when used appropriately, though concerns about late effects require continued monitoring. For rare diseases, collaborative data collection and biological studies may help address current evidence gaps.
{"title":"Radiotherapy for Other Nonmalignant Diseases","authors":"Isabel Falke MD , Ulrich Schäfer MD, PhD , Oliver Micke MD, PhD , Ralph Mücke MD, PhD , Jan Kriz MD, PhD","doi":"10.1016/j.semradonc.2025.11.003","DOIUrl":"10.1016/j.semradonc.2025.11.003","url":null,"abstract":"<div><div>Radiotherapy is increasingly used for benign diseases, especially in Germany, where over 50% of radiation treatments address nonmalignant conditions such as osteoarthritis, plantar fasciitis, and Dupuytren’s disease. Low-dose regimens have shown good efficacy in pain reduction and disease stabilization, with minimal toxicity. For rarer indications like Gorham-Stout disease, pigmented villonodular synovitis, and lymphatic fistulas, evidence is limited to case series and retrospective studies. Randomized trials remain scarce, and further research is needed to evaluate long-term outcomes and patient quality of life. Radiotherapy appears safe when used appropriately, though concerns about late effects require continued monitoring. For rare diseases, collaborative data collection and biological studies may help address current evidence gaps.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 127-134"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.10.003
Raffaella De Pietro , Pamela Samson , Maiwand Ahmadsei , Phillip Cuculich , Geoffrey D. Hugo , Marcin Miszczyk , Franziska Nägler , Ardan M. Saguner , Clifford Robinson , Nicolaus Andratschke
Stereotactic arrhythmia radioablation (STAR) has emerged as a novel, noninvasive therapeutic option for patients with drug- and ablation-refractory ventricular tachycardia (VT). Derived from stereotactic body radiotherapy (SBRT), STAR enables the delivery of a single, high-dose fraction of ionizing radiation to arrhythmogenic myocardial tissue with submillimeter precision while minimizing exposure to surrounding cardiac and extracardiac structures. This review summarizes current evidence regarding mechanisms of action, patient selection, treatment planning, and clinical outcomes of STAR. Preclinical and early clinical studies suggest that STAR exerts rapid antiarrhythmic effects through modulation of cardiac conduction proteins and potential structural remodeling, though long-term efficacy remains under investigation. Clinical trials and prospective registries report substantial reductions in VT burden with acceptable short-term safety, yet recurrence rates and late toxicities require further evaluation. The European STOPSTORM consortium has been established to standardize treatment protocols, harmonize target delineation, and coordinate multicenter clinical validation. As STAR continues to evolve, multidisciplinary collaboration between radiation oncologists, cardiologists, and medical physicists will be essential to define optimal practice standards, ensure patient safety, and assess long-term outcomes. STAR represents a promising paradigm shift in the management of refractory VT, offering a noninvasive alternative when conventional therapies are ineffective or infeasible.
{"title":"Radioablation for Ventricular Tachycardia: Current Evidence and Future Perspectives","authors":"Raffaella De Pietro , Pamela Samson , Maiwand Ahmadsei , Phillip Cuculich , Geoffrey D. Hugo , Marcin Miszczyk , Franziska Nägler , Ardan M. Saguner , Clifford Robinson , Nicolaus Andratschke","doi":"10.1016/j.semradonc.2025.10.003","DOIUrl":"10.1016/j.semradonc.2025.10.003","url":null,"abstract":"<div><div>Stereotactic arrhythmia radioablation (STAR) has emerged as a novel, noninvasive therapeutic option for patients with drug- and ablation-refractory ventricular tachycardia (VT). Derived from stereotactic body radiotherapy (SBRT), STAR enables the delivery of a single, high-dose fraction of ionizing radiation to arrhythmogenic myocardial tissue with submillimeter precision while minimizing exposure to surrounding cardiac and extracardiac structures. This review summarizes current evidence regarding mechanisms of action, patient selection, treatment planning, and clinical outcomes of STAR. Preclinical and early clinical studies suggest that STAR exerts rapid antiarrhythmic effects through modulation of cardiac conduction proteins and potential structural remodeling, though long-term efficacy remains under investigation. Clinical trials and prospective registries report substantial reductions in VT burden with acceptable short-term safety, yet recurrence rates and late toxicities require further evaluation. The European STOPSTORM consortium has been established to standardize treatment protocols, harmonize target delineation, and coordinate multicenter clinical validation. As STAR continues to evolve, multidisciplinary collaboration between radiation oncologists, cardiologists, and medical physicists will be essential to define optimal practice standards, ensure patient safety, and assess long-term outcomes. STAR represents a promising paradigm shift in the management of refractory VT, offering a noninvasive alternative when conventional therapies are ineffective or infeasible.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 61-76"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.11.005
Michael Heinrich Seegenschmiedt , Hans Theodor Eich , Gabriele Reinartz
Orbital radiotherapy (RT) is an effective treatment for moderate-to-severe Graves´ ophthalmopathy (GO), especially when combined with steroids, as it reduces painful eye symptoms associated with retroorbital and eye lid soft tissue swelling, improves eye movement, and can decrease the need for prolonged steroid therapy. It is generally well-tolerated; common side effects include temporary dryness and conjunctivitis, with rare long-term risks like cataracts and a very small theoretical risk of radiation-induced cancer. RT benefits are rarely immediate and improved symptoms are typically observed several weeks to months after the treatment. GO is treated with the retrobulbar space considered as clinical target volume (CTV). Retrobulbar RT is carried out either with lateral opposing fields or with intensity modulated radiotherapy (IMRT) while protecting the radiosensitive lenses considered as organs at risk (OAR). The dose concept should be adapted to the respective phase of the disease: in the early purely inflammatory phase a single dose 0.3-2.0 Gy applied in 8 daily fractions up to a total dose of 2.4-16 Gy is sufficient and well tolerated; in the more advanced inflammatory to fibrotic phase single doses of 1.8-2.0 Gy applied in 8-10 fractions 5 times weekly up to a total dose of 16-20 Gy are required to gain improvement of symptoms. To avoid severe ophthalmologic symptoms, the efficacy of radiation could also be improved by using a reduced single dose of only 1 Gy and extending the duration of therapy with the radiation applied only once a week. In GO with manifest ocular muscle dysfunction, antiproliferative external beam RT has a Grade B recommendation, supported by Level 2 evidence.
{"title":"Radiotherapy for Nonmalignant Eye Diseases: Graves’ Ophthalmopathy – Pseudotumor Orbitae","authors":"Michael Heinrich Seegenschmiedt , Hans Theodor Eich , Gabriele Reinartz","doi":"10.1016/j.semradonc.2025.11.005","DOIUrl":"10.1016/j.semradonc.2025.11.005","url":null,"abstract":"<div><div>Orbital radiotherapy (RT) is an effective treatment for moderate-to-severe Graves´ ophthalmopathy (GO), especially when combined with steroids, as it reduces painful eye symptoms associated with retroorbital and eye lid soft tissue swelling, improves eye movement, and can decrease the need for prolonged steroid therapy. It is generally well-tolerated; common side effects include temporary dryness and conjunctivitis, with rare long-term risks like cataracts and a very small theoretical risk of radiation-induced cancer. RT benefits are rarely immediate and improved symptoms are typically observed several weeks to months after the treatment. GO is treated with the retrobulbar space considered as clinical target volume (CTV). Retrobulbar RT is carried out either with lateral opposing fields or with intensity modulated radiotherapy (IMRT) while protecting the radiosensitive lenses considered as organs at risk (OAR). The dose concept should be adapted to the respective phase of the disease: in the <em>early purely inflammatory</em> phase a single dose 0.3-2.0 Gy applied in 8 daily fractions up to a total dose of 2.4-16 Gy is sufficient and well tolerated; in the <em>more advanced</em> inflammatory to fibrotic phase single doses of 1.8-2.0 Gy applied in 8-10 fractions 5 times weekly up to a total dose of 16-20 Gy are required to gain improvement of symptoms. To avoid severe ophthalmologic symptoms, the efficacy of radiation could also be improved by using a reduced single dose of only 1 Gy and extending the duration of therapy with the radiation applied only once a week. In GO with manifest ocular muscle dysfunction, antiproliferative external beam RT has a Grade B recommendation, supported by Level 2 evidence.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 114-126"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.10.001
Anna-Jasmina Donaubauer PhD , Lia Mogge MSc , Philipp Schubert PhD , Rainer Fietkau PhD , Oliver J. Ott PhD , Benjamin Frey PhD , Udo S. Gaipl PhD
Low dose radiation therapy (LDRT) is commonly applied for its pain and symptom-relieving effects in the treatment of different benign diseases, such as chronic degenerative and inflammatory, or hyperproliferative disorders. Most clinical trials report a beneficial therapeutic effect of LDRT and further, robust preclinical evidence on the biological modes of action of LDRT is existent. In chronic degenerative and inflammatory diseases such as osteoarthritis, LDRT can ameliorate inflammatory processes and impacts positively on the bone metabolism. A key mechanism is the modulation of the endothelium and the phenotype of macrophages. In the bone, the deposition of new bone matrix is supported, while bone degradation is diminished. In hyperproliferative disorders, the main mode of action is the inhibition of the differentiation and proliferation of fibroblasts and myofibroblasts, along with a modulation of inflammatory mediators, such as cytokines. Even though comprehensive preclinical evidence supports the use of LDRT, biological mechanistic insights from randomized clinical trials is mostly missing for LDRT and indicates a significant translational gap. Apart from preclinical data, the evidence for LDRT is based largely on observational clinical trials, with only limited randomized and placebo-controlled trials available. In the future, rigorously designed randomized disease-specific studies with standardized protocols, translational research programs and objectifiable clinical and biological endpoints are needed to establish LDRT as precise and evidence-based therapy.
{"title":"Biological Effects of Low-Dose Radiation Therapy: From Mechanistic Aspects to Translational Approaches and Challenges","authors":"Anna-Jasmina Donaubauer PhD , Lia Mogge MSc , Philipp Schubert PhD , Rainer Fietkau PhD , Oliver J. Ott PhD , Benjamin Frey PhD , Udo S. Gaipl PhD","doi":"10.1016/j.semradonc.2025.10.001","DOIUrl":"10.1016/j.semradonc.2025.10.001","url":null,"abstract":"<div><div>Low dose radiation therapy (LDRT) is commonly applied for its pain and symptom-relieving effects in the treatment of different benign diseases, such as chronic degenerative and inflammatory, or hyperproliferative disorders. Most clinical trials report a beneficial therapeutic effect of LDRT and further, robust preclinical evidence on the biological modes of action of LDRT is existent. In chronic degenerative and inflammatory diseases such as osteoarthritis, LDRT can ameliorate inflammatory processes and impacts positively on the bone metabolism. A key mechanism is the modulation of the endothelium and the phenotype of macrophages. In the bone, the deposition of new bone matrix is supported, while bone degradation is diminished. In hyperproliferative disorders, the main mode of action is the inhibition of the differentiation and proliferation of fibroblasts and myofibroblasts, along with a modulation of inflammatory mediators, such as cytokines. Even though comprehensive preclinical evidence supports the use of LDRT, biological mechanistic insights from randomized clinical trials is mostly missing for LDRT and indicates a significant translational gap. Apart from preclinical data, the evidence for LDRT is based largely on observational clinical trials, with only limited randomized and placebo-controlled trials available. In the future, rigorously designed randomized disease-specific studies with standardized protocols, translational research programs and objectifiable clinical and biological endpoints are needed to establish LDRT as precise and evidence-based therapy.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 23-38"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1016/j.semradonc.2025.11.002
Alexander Rühle MD, MHBA , Thomas F. DeLaney MD
This special issue, “Functional Radiotherapy for Non-Malignant Diseases – The Potential of Ionizing Radiation Beyond Cancer Treatment”, addresses one of the oldest yet often overlooked areas of radiation medicine: the therapeutic use of ionizing radiation for non-malignant disorders. More than a century after the first medical use of X-rays, functional radiotherapy for non-malignant diseases is experiencing a renaissance, supported by growing clinical and biological evidence. The articles in this issue span the historical evolution, mechanistic underpinnings, and modern clinical applications of radiotherapy across diverse indications. They address topics such as the biological effects and potential carcinogenic risks of low-dose irradiation, radiotherapy for osteoarthritis and periarticular soft-tissue disorders, benign and premalignant tumors, Graves’ ophthalmopathy, and hyperproliferative diseases including Dupuytren’s and Ledderhose’s disease, among others. Emerging applications such as stereotactic arrhythmia radioablation and functional radiotherapy for neurological or psychiatric disorders further extend its scope. Together, these contributions illustrate how radiotherapy for non-malignant diseases has evolved from empirical practice to a scientifically grounded therapy aimed at functional restoration. In the future, the establishment of standardized protocols, international registries, and prospective clinical trials will be essential to validate efficacy and safety, thereby defining the evolving role of radiotherapy beyond cancer treatment.
{"title":"Functional Radiotherapy for Non-Malignant Diseases: The Potential of Ionizing Radiation Beyond Cancer Treatment","authors":"Alexander Rühle MD, MHBA , Thomas F. DeLaney MD","doi":"10.1016/j.semradonc.2025.11.002","DOIUrl":"10.1016/j.semradonc.2025.11.002","url":null,"abstract":"<div><div>This special issue, “<em>Functional Radiotherapy for Non-Malignant Diseases – The Potential of Ionizing Radiation Beyond Cancer Treatment”</em>, addresses one of the oldest yet often overlooked areas of radiation medicine: the therapeutic use of ionizing radiation for non-malignant disorders. More than a century after the first medical use of X-rays, functional radiotherapy for non-malignant diseases is experiencing a renaissance, supported by growing clinical and biological evidence. The articles in this issue span the historical evolution, mechanistic underpinnings, and modern clinical applications of radiotherapy across diverse indications. They address topics such as the biological effects and potential carcinogenic risks of low-dose irradiation, radiotherapy for osteoarthritis and periarticular soft-tissue disorders, benign and premalignant tumors, Graves’ ophthalmopathy, and hyperproliferative diseases including Dupuytren’s and Ledderhose’s disease, among others. Emerging applications such as stereotactic arrhythmia radioablation and functional radiotherapy for neurological or psychiatric disorders further extend its scope. Together, these contributions illustrate how radiotherapy for non-malignant diseases has evolved from empirical practice to a scientifically grounded therapy aimed at functional restoration. In the future, the establishment of standardized protocols, international registries, and prospective clinical trials will be essential to validate efficacy and safety, thereby defining the evolving role of radiotherapy beyond cancer treatment.</div></div>","PeriodicalId":49542,"journal":{"name":"Seminars in Radiation Oncology","volume":"36 ","pages":"Pages 1-2"},"PeriodicalIF":3.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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