Pub Date : 2025-08-14DOI: 10.1016/j.canrad.2025.104707
Stéphanie Träger
Complementary therapies are used by cancer patients at every stage of treatment. Denying this reality would mean denying our patients’ quest for well-being and autonomy. It would also mean ignoring the satisfaction they derive from them. There is a need for clarification on the definitions of the terms used, as well as on regulations and practitioner training. Developing clinical studies of good methodological quality that are adapted to practice is essential to providing scientific proof of efficacy and safety (qualitative and quantitative evaluations). Integrating complementary therapies with supportive care is a fundamental interdisciplinary approach to integrative oncology. This integration must be considered at all levels – institutionally, within the framework of the service project, and in the patient's care pathway – in order to optimize quality of care and overall management.
{"title":"Complementary therapies: What are we talking about?","authors":"Stéphanie Träger","doi":"10.1016/j.canrad.2025.104707","DOIUrl":"10.1016/j.canrad.2025.104707","url":null,"abstract":"<div><div>Complementary therapies are used by cancer patients at every stage of treatment. Denying this reality would mean denying our patients’ quest for well-being and autonomy. It would also mean ignoring the satisfaction they derive from them. There is a need for clarification on the definitions of the terms used, as well as on regulations and practitioner training. Developing clinical studies of good methodological quality that are adapted to practice is essential to providing scientific proof of efficacy and safety (qualitative and quantitative evaluations). Integrating complementary therapies with supportive care is a fundamental interdisciplinary approach to integrative oncology. This integration must be considered at all levels – institutionally, within the framework of the service project, and in the patient's care pathway – in order to optimize quality of care and overall management.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104707"},"PeriodicalIF":1.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-14DOI: 10.1016/j.canrad.2025.104706
Marie-Adélaïde Ossedat , Jérôme Durand-Labrunie
This review aims to explore the radiobiological rationale and clinical evidence supporting the use of hypofractionated radiotherapy in the management of rectal tumours, particularly in neoadjuvant treatment strategies and organ preservation approaches. An overview of key randomized controlled trials on hypofractionated radiotherapy, also called short-course radiotherapy, was conducted. Clinical trials have demonstrated oncological equivalence between hypofractionated radiotherapy and standard long-course chemoradiotherapy in terms of overall survival and local recurrence, but short-course radiotherapy represents a relevant therapeutic option for frail or elderly patients. In the total neoadjuvant treatment context, short-course radiotherapy combined with consolidation chemotherapy improves distant control but may increase the risk of local recurrence. Recent studies suggest that short-course radiotherapy can lead to organ preservation when followed by transanal surgery or active surveillance in well-selected patients, and that its combination with immune checkpoint inhibitors can safely increase complete response rates. Its use in total neoadjuvant treatment, immunotherapy combinations, and organ preservation strategies requires careful patient selection and further comparative trials to refine its indications.
{"title":"Hypofractionated radiotherapy in the management of rectal tumours","authors":"Marie-Adélaïde Ossedat , Jérôme Durand-Labrunie","doi":"10.1016/j.canrad.2025.104706","DOIUrl":"10.1016/j.canrad.2025.104706","url":null,"abstract":"<div><div>This review aims to explore the radiobiological rationale and clinical evidence supporting the use of hypofractionated radiotherapy in the management of rectal tumours, particularly in neoadjuvant treatment strategies and organ preservation approaches. An overview of key randomized controlled trials on hypofractionated radiotherapy, also called short-course radiotherapy, was conducted. Clinical trials have demonstrated oncological equivalence between hypofractionated radiotherapy and standard long-course chemoradiotherapy in terms of overall survival and local recurrence, but short-course radiotherapy represents a relevant therapeutic option for frail or elderly patients. In the total neoadjuvant treatment context, short-course radiotherapy combined with consolidation chemotherapy improves distant control but may increase the risk of local recurrence. Recent studies suggest that short-course radiotherapy can lead to organ preservation when followed by transanal surgery or active surveillance in well-selected patients, and that its combination with immune checkpoint inhibitors can safely increase complete response rates. Its use in total neoadjuvant treatment, immunotherapy combinations, and organ preservation strategies requires careful patient selection and further comparative trials to refine its indications.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104706"},"PeriodicalIF":1.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.canrad.2025.104683
Claudia Pouypoudat , Sébastien Thureau , Nicolas Giraud , Yaniss Belaroussi , Étienne Martin
T1N0 non-small cell lung cancers account for about 20 % of all lung cancer cases and are defined as tumours up to 3 cm without nodal or distant metastasis. The incidence of early-stage diagnoses is increasing, largely driven by the implementation of low dose computed tomography screening programs. Surgery has long been considered the standard of care for these tumours, offering excellent oncologic outcomes and allowing essential pathological staging. However, surgery may be indicated or poorly tolerated in certain populations, particularly elderly or medically inoperable patients. Stereotactic body radiotherapy has emerged as a non-invasive alternative with high local control rates and reduced early morbidity. This raises a critical question: should all patients with early-stage non-small cell lung cancer be managed surgically, or is there a role for treatment individualization? Current evidence highlights the need of balancing curative intent with treatment-related risks. Several clinical trials are currently evaluating stereotactic body radiotherapy in operable patients, aiming to identify subsets that may derive benefit from a non-surgical approach. This review advocates for a personalized, patient-centred treatment strategy, integrating tumour characteristics, operability, comorbidities, and patient preference.
{"title":"Surgery for all patients with T1N0 non-small cell lung cancer?","authors":"Claudia Pouypoudat , Sébastien Thureau , Nicolas Giraud , Yaniss Belaroussi , Étienne Martin","doi":"10.1016/j.canrad.2025.104683","DOIUrl":"10.1016/j.canrad.2025.104683","url":null,"abstract":"<div><div>T1N0 non-small cell lung cancers account for about 20 % of all lung cancer cases and are defined as tumours up to 3<!--> <!-->cm without nodal or distant metastasis. The incidence of early-stage diagnoses is increasing, largely driven by the implementation of low dose computed tomography screening programs. Surgery has long been considered the standard of care for these tumours, offering excellent oncologic outcomes and allowing essential pathological staging. However, surgery may be indicated or poorly tolerated in certain populations, particularly elderly or medically inoperable patients. Stereotactic body radiotherapy has emerged as a non-invasive alternative with high local control rates and reduced early morbidity. This raises a critical question: should all patients with early-stage non-small cell lung cancer be managed surgically, or is there a role for treatment individualization? Current evidence highlights the need of balancing curative intent with treatment-related risks. Several clinical trials are currently evaluating stereotactic body radiotherapy in operable patients, aiming to identify subsets that may derive benefit from a non-surgical approach. This review advocates for a personalized, patient-centred treatment strategy, integrating tumour characteristics, operability, comorbidities, and patient preference.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104683"},"PeriodicalIF":1.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.canrad.2025.104689
Gianfranco Brusadin , Adrian P. Brady , Monika Hierath , David C. Howlett
<div><h3>Purpose</h3><div>The project entitled “Quality Improvement Through Clinical Audit in Diagnostic (Including Interventional) Radiology, Radiotherapy and Nuclear Medicine (Including Therapies)” (QuADRANT) was conceived to thoroughly assess the state of clinical audit implementation across Europe, regarding the medical application of ionizing radiation. The central aim was to elevate the quality and safety standards in radiological procedures. This initiative arose from the understanding that consistent and rigorous clinical audit is fundamental for enhancing patient outcomes and adhering to safety regulations in cancer treatment using radiation. The project aimed to address the observed variations in how clinical audit was being applied across Europe.</div></div><div><h3>Material and methods</h3><div>The QuADRANT project employed a comprehensive methodology to gather data. This included an extensive review of existing literature, European regulations, and international guidelines pertinent to clinical audit in radiological procedures. National surveys were conducted, reaching out to representatives from European Union member states and other selected countries to collect information on national frameworks, methodologies, existing barriers, and facilitating factors. In-depth case studies, involving site visits and interviews with various stakeholders such as healthcare professionals and policymakers, provided deeper insights. Expert consultations with specialists in medical physics, radiation oncology, and quality assurance further enriched the data. Workshops were also held to engage national stakeholders in discussions about legal requirements, benefits, and good practices of clinical audit. The collected data was systematically analysed to identify key trends, common challenges, successful strategies, and areas ripe for improvement, leading to the formulation of evidence-based recommendations.</div></div><div><h3>Results</h3><div>The project observed significant variations in the adoption and maturity of clinical audit programs across European countries, even within individual nations. While some countries demonstrated well-established practices, particularly concerning dosimetry audits in radiotherapy, a widespread and comprehensive clinical audit program covering all radiological procedures was often lacking. Data collection for audit purposes was frequently inconsistent, with common deviations from standard practice noted in patient data registration, diagnosis, treatment details, and the recording of adverse events. Many countries reported limited financial and human resources allocated to clinical audit. A general lack of awareness among healthcare professionals regarding the specific requirements and benefits of clinical audit was also identified. Organizational culture sometimes presented resistance to systematic quality improvement initiatives. Challenges were noted in data quality and the burden associated with manual data entry
{"title":"The QuADRANT project: Enhancing quality and safety in radiological procedures through clinical audit","authors":"Gianfranco Brusadin , Adrian P. Brady , Monika Hierath , David C. Howlett","doi":"10.1016/j.canrad.2025.104689","DOIUrl":"10.1016/j.canrad.2025.104689","url":null,"abstract":"<div><h3>Purpose</h3><div>The project entitled “Quality Improvement Through Clinical Audit in Diagnostic (Including Interventional) Radiology, Radiotherapy and Nuclear Medicine (Including Therapies)” (QuADRANT) was conceived to thoroughly assess the state of clinical audit implementation across Europe, regarding the medical application of ionizing radiation. The central aim was to elevate the quality and safety standards in radiological procedures. This initiative arose from the understanding that consistent and rigorous clinical audit is fundamental for enhancing patient outcomes and adhering to safety regulations in cancer treatment using radiation. The project aimed to address the observed variations in how clinical audit was being applied across Europe.</div></div><div><h3>Material and methods</h3><div>The QuADRANT project employed a comprehensive methodology to gather data. This included an extensive review of existing literature, European regulations, and international guidelines pertinent to clinical audit in radiological procedures. National surveys were conducted, reaching out to representatives from European Union member states and other selected countries to collect information on national frameworks, methodologies, existing barriers, and facilitating factors. In-depth case studies, involving site visits and interviews with various stakeholders such as healthcare professionals and policymakers, provided deeper insights. Expert consultations with specialists in medical physics, radiation oncology, and quality assurance further enriched the data. Workshops were also held to engage national stakeholders in discussions about legal requirements, benefits, and good practices of clinical audit. The collected data was systematically analysed to identify key trends, common challenges, successful strategies, and areas ripe for improvement, leading to the formulation of evidence-based recommendations.</div></div><div><h3>Results</h3><div>The project observed significant variations in the adoption and maturity of clinical audit programs across European countries, even within individual nations. While some countries demonstrated well-established practices, particularly concerning dosimetry audits in radiotherapy, a widespread and comprehensive clinical audit program covering all radiological procedures was often lacking. Data collection for audit purposes was frequently inconsistent, with common deviations from standard practice noted in patient data registration, diagnosis, treatment details, and the recording of adverse events. Many countries reported limited financial and human resources allocated to clinical audit. A general lack of awareness among healthcare professionals regarding the specific requirements and benefits of clinical audit was also identified. Organizational culture sometimes presented resistance to systematic quality improvement initiatives. Challenges were noted in data quality and the burden associated with manual data entry ","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104689"},"PeriodicalIF":1.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1016/j.canrad.2025.104687
Olivier Cravéreau , Vincent Bourbonne , Loïg Vaugier , François Lucia , Florence Le Tinier , Jacques Cadranel , Boris Duchemann , Paul Habert , Nicolas Martz , William Gehin , Marie Bruand , Anaïs Stefani , Johann Marcel , Ida Trampetti , Christelle Clément-Duchêne , Delphine Lerouge , Adrien Laville , Kim Cao , Nicolas Pourel , Audrey Zaccariotto , Jean-Christophe Faivre
Purpose
Radiation-induced lung injury is relatively uncommon but disabling, and a dose-limiting factor in thoracic radiotherapy. This complication is mainly encountered following radiotherapy for lung cancers. We provide recommendations for good clinical practice, defining the prevention and management of radiation-induced lung injury.
Methods
Members of the Association francophone pour les soins oncologiques de support (Afsos; French-speaking association for oncology care and support) and the Société française de radiothérapie oncologique (SFRO, French society for radiation oncology) set up a multidisciplinary working and review group to draft these recommendations for 2023 to 2024, based on a systematic review of the literature.
Results
Radiation-induced lung injury comprises several forms, mainly resulting from acute toxicity (radiation pneumonitis) and chronic toxicity (radiation fibrosis). Specific forms can be identified, such as organising pneumonia (formerly bronchiolitis obliterans organizing pneumonia) and radiation recall pneumonia. The risk factors are numerous and include dosimetric risk factors, patient-related factors and tumour-related factors. New challenges include the specific complications of stereotactic radiotherapy, the combination of recent specific oncological treatments including tyrosine kinase inhibitors and immunotherapy, and the association with certain pathologies such as interstitial lung disease.
Conclusion
The profile of radiation-induced lung injury is evolving with new radiotherapy techniques and innovative systemic oncology treatments. Rapid detection and management of these side-effects are essential for good patient care.
{"title":"Recommandations de l’Association francophone pour les soins oncologiques de support et de la Société française de radiothérapie oncologique relatives aux effets secondaires respiratoires radio-induits","authors":"Olivier Cravéreau , Vincent Bourbonne , Loïg Vaugier , François Lucia , Florence Le Tinier , Jacques Cadranel , Boris Duchemann , Paul Habert , Nicolas Martz , William Gehin , Marie Bruand , Anaïs Stefani , Johann Marcel , Ida Trampetti , Christelle Clément-Duchêne , Delphine Lerouge , Adrien Laville , Kim Cao , Nicolas Pourel , Audrey Zaccariotto , Jean-Christophe Faivre","doi":"10.1016/j.canrad.2025.104687","DOIUrl":"10.1016/j.canrad.2025.104687","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation-induced lung injury is relatively uncommon but disabling, and a dose-limiting factor in thoracic radiotherapy. This complication is mainly encountered following radiotherapy for lung cancers. We provide recommendations for good clinical practice, defining the prevention and management of radiation-induced lung injury.</div></div><div><h3>Methods</h3><div>Members of the Association francophone pour les soins oncologiques de support (Afsos; French-speaking association for oncology care and support) and the Société française de radiothérapie oncologique (SFRO, French society for radiation oncology) set up a multidisciplinary working and review group to draft these recommendations for 2023 to 2024, based on a systematic review of the literature.</div></div><div><h3>Results</h3><div>Radiation-induced lung injury comprises several forms, mainly resulting from acute toxicity (radiation pneumonitis) and chronic toxicity (radiation fibrosis). Specific forms can be identified, such as organising pneumonia (formerly bronchiolitis obliterans organizing pneumonia) and radiation recall pneumonia. The risk factors are numerous and include dosimetric risk factors, patient-related factors and tumour-related factors. New challenges include the specific complications of stereotactic radiotherapy, the combination of recent specific oncological treatments including tyrosine kinase inhibitors and immunotherapy, and the association with certain pathologies such as interstitial lung disease.</div></div><div><h3>Conclusion</h3><div>The profile of radiation-induced lung injury is evolving with new radiotherapy techniques and innovative systemic oncology treatments. Rapid detection and management of these side-effects are essential for good patient care.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104687"},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1016/j.canrad.2025.104686
Sophie Boisbouvier , Coralie Hulot-Geffroy , Alexandra Boucaud , Coralie Tachin-Bourgeon , Fabien Salesses , Jean-Christophe Faivre
Research is emerging within the French radiation therapists’ community. In this context, the present article aimed to provide an overview of the research process from an idea to a research project, highlight several funded French research projects led by radiation therapists, and identify the barriers and facilitators to these professionals conducting research. The research process follows those of the traditional scientific method, beginning with an idea inspired by clinical practice. This idea is then refined through a review of the literature which helps to challenge preconceived ideas and outdated practices. A clear research question is formulated using established models and is subsequently refined to ensure the project is feasible, interesting, novel, ethical and relevant. The process should be done in an interprofessional environment. To date, several projects have been funded by national or regional grants reflecting growing interest and engagement in research among radiation therapists in France. This progress has been made possible thanks to institutional support and dedicated research grants available to radiation therapists. Nonetheless, several challenges remain, including the need for training in scientific method and evidence-based practice, proficiency in English, and access to literature.
{"title":"Radiation therapist, a key player in radiotherapy research","authors":"Sophie Boisbouvier , Coralie Hulot-Geffroy , Alexandra Boucaud , Coralie Tachin-Bourgeon , Fabien Salesses , Jean-Christophe Faivre","doi":"10.1016/j.canrad.2025.104686","DOIUrl":"10.1016/j.canrad.2025.104686","url":null,"abstract":"<div><div>Research is emerging within the French radiation therapists’ community. In this context, the present article aimed to provide an overview of the research process from an idea to a research project, highlight several funded French research projects led by radiation therapists, and identify the barriers and facilitators to these professionals conducting research. The research process follows those of the traditional scientific method, beginning with an idea inspired by clinical practice. This idea is then refined through a review of the literature which helps to challenge preconceived ideas and outdated practices. A clear research question is formulated using established models and is subsequently refined to ensure the project is feasible, interesting, novel, ethical and relevant. The process should be done in an interprofessional environment. To date, several projects have been funded by national or regional grants reflecting growing interest and engagement in research among radiation therapists in France. This progress has been made possible thanks to institutional support and dedicated research grants available to radiation therapists. Nonetheless, several challenges remain, including the need for training in scientific method and evidence-based practice, proficiency in English, and access to literature.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104686"},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some radiotherapy courses are cancelled or stopped permanently, mostly in palliative situations, due to rapid decline in patient condition, complications, death, or inability to complete the sessions. These occurrences negatively affect patients (increased morbidity and mortality, useless constraints), healthcare professionals (ethical distress), and departmental operations (longer treatment start delays, under-utilization of resources). By reducing the number of non-beneficial (“non-pertinent”) irradiations, we have developed an eight-point action plan to implement in radiation department: (1) provide stronger training in palliative radiotherapy (in both initial and continuing medical education, including communication skills and learning to say “no” when appropriate); (2) perform a more rigorous assessment of patients at the initial consultation (evaluating general condition, nutritional status, supportive care needs, and prognosis); (3) create a dedicated forum for team discussions and reinforce the role of the radiotherapy technical meeting when difficulties arise during simulation or treatment planning; (4) better tailor radiotherapy technique (e.g., use of intensity modulation) as well as total dose, fractionation, to each patient's profile – especially for those most at risk or frail; (5) improve management of care timelines and define key objectives to minimize delays, adapting resources and organization to needs (e.g., a “zero delay” project group with specific indicators); (6) establish a process for medical and multidisciplinary reevaluation during the course of treatment that can lead to stopping or modifying the radiotherapy if the indication becomes questionable; (7) integrate palliative radiotherapy into the overall personalized supportive care plan, with early palliative care involvement from the time of incurable disease diagnosis; (8) evaluate professional practices (through defined indicators, satisfaction surveys, and morbidity-mortality meetings) to drive continuous improvement.
{"title":"State of the art: How to avoid unnecessary radiotherapy?","authors":"Jean-Christophe Faivre , Paul Jung , Élodie Morel , Thibaud Haaser , Amandine ruffier-Loubière","doi":"10.1016/j.canrad.2025.104685","DOIUrl":"10.1016/j.canrad.2025.104685","url":null,"abstract":"<div><div>Some radiotherapy courses are cancelled or stopped permanently, mostly in palliative situations, due to rapid decline in patient condition, complications, death, or inability to complete the sessions. These occurrences negatively affect patients (increased morbidity and mortality, useless constraints), healthcare professionals (ethical distress), and departmental operations (longer treatment start delays, under-utilization of resources). By reducing the number of non-beneficial (“non-pertinent”) irradiations, we have developed an eight-point action plan to implement in radiation department: (1) provide stronger training in palliative radiotherapy (in both initial and continuing medical education, including communication skills and learning to say “no” when appropriate); (2) perform a more rigorous assessment of patients at the initial consultation (evaluating general condition, nutritional status, supportive care needs, and prognosis); (3) create a dedicated forum for team discussions and reinforce the role of the radiotherapy technical meeting when difficulties arise during simulation or treatment planning; (4) better tailor radiotherapy technique (e.g., use of intensity modulation) as well as total dose, fractionation, to each patient's profile – especially for those most at risk or frail; (5) improve management of care timelines and define key objectives to minimize delays, adapting resources and organization to needs (e.g., a “zero delay” project group with specific indicators); (6) establish a process for medical and multidisciplinary reevaluation during the course of treatment that can lead to stopping or modifying the radiotherapy if the indication becomes questionable; (7) integrate palliative radiotherapy into the overall personalized supportive care plan, with early palliative care involvement from the time of incurable disease diagnosis; (8) evaluate professional practices (through defined indicators, satisfaction surveys, and morbidity-mortality meetings) to drive continuous improvement.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104685"},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adjuvant radiotherapy after conservative surgery is the standard treatment for invasive breast cancer, showing reduced risk of local recurrence and long-term mortality. However, advances in tumour biology and the emergence of molecular signatures have identified subgroups with a very low risk of recurrence, particularly patients with luminal A cancers, reigniting the debate on potential radiotherapy de-escalation in this population. In addition, achieving a complete pathological response in patients who have received neoadjuvant chemotherapy suggests the possibility of adapting radiotherapy indications. This article aimed to present the major currently available data on the omission of radiotherapy in the treatment of luminal A phenotype breast cancers after conservative surgery, as well as ongoing trials on irradiation de-escalation in cases of complete pathological response after neoadjuvant chemotherapy, particularly for the cN1–ypN0 and cN2–3–ypN0 subtypes. Several prospective studies and randomized trials, including LUMINA, PRIME II, and trials using genomic signatures (POLAR, Oncotype DX®, Prosigna®), suggest the feasibility of omitting radiotherapy for some very low-risk patients, without demonstrated effects on overall survival. However, the persistent benefit of local control has been observed. The National Surgical Adjuvant Breast and Bowel Project (NSABP)-B51/Radiation Therapy Oncology Group (RTOG) 1304 trial and Radiotherapy After Primary Chemotherapy (RAPCHEM) registry showed that the omission of nodal radiotherapy could be considered after a complete nodal pathological response (ypN0), with good short-term locoregional control, although definitive long-term results have not been reported. The omission of radiotherapy for breast cancers with a good prognosis, particularly in patients with luminal A tumours and those with a complete response after neoadjuvant treatment, represents a promising avenue for therapeutic de-escalation. However, it must be determined based on strict biological and clinical selection criteria and validated via long-term controlled trials.
保守性手术后辅助放疗是浸润性乳腺癌的标准治疗方法，可降低局部复发风险和远期死亡率。然而，肿瘤生物学的进步和分子特征的出现已经确定了复发风险非常低的亚群，特别是腔a癌患者，这重新引发了对这一人群中潜在的放疗降级的争论。此外，在接受新辅助化疗的患者中获得完全的病理反应表明适应放疗指征的可能性。本文旨在介绍目前可获得的主要数据，包括保守手术后腔内A型乳腺癌省略放疗的治疗，以及正在进行的新辅助化疗后完全病理反应的照射降级试验，特别是cN1-ypN0和cN2-3-ypN0亚型。一些前瞻性研究和随机试验，包括LUMINA， PRIME II和使用基因组特征（POLAR, Oncotype DX®，Prosigna®）的试验，表明对一些极低风险患者省略放疗的可行性，而对总生存期没有证明的影响。然而，局部控制的持续效益已经被观察到。国家外科辅助乳腺和肠项目(NSABP)-B51/放射治疗肿瘤组（RTOG） 1304试验和原发性化疗后放疗（RAPCHEM）注册显示，在完全淋巴结病理反应（ypN0）后，可以考虑省略淋巴结放疗，具有良好的短期局部区域控制，尽管明确的长期结果尚未报道。预后良好的乳腺癌患者，特别是腔内a肿瘤患者和新辅助治疗后完全缓解的患者，不进行放疗，代表了治疗降级的有希望的途径。然而，它必须根据严格的生物学和临床选择标准来确定，并通过长期对照试验进行验证。
{"title":"Breast cancer tumour board: Which patients are eligible for radiotherapy de-escalation or omission?","authors":"Joran Hibon , Waisse Waissi , David Pasquier , Séverine Racadot","doi":"10.1016/j.canrad.2025.104688","DOIUrl":"10.1016/j.canrad.2025.104688","url":null,"abstract":"<div><div>Adjuvant radiotherapy after conservative surgery is the standard treatment for invasive breast cancer, showing reduced risk of local recurrence and long-term mortality. However, advances in tumour biology and the emergence of molecular signatures have identified subgroups with a very low risk of recurrence, particularly patients with luminal A cancers, reigniting the debate on potential radiotherapy de-escalation in this population. In addition, achieving a complete pathological response in patients who have received neoadjuvant chemotherapy suggests the possibility of adapting radiotherapy indications. This article aimed to present the major currently available data on the omission of radiotherapy in the treatment of luminal A phenotype breast cancers after conservative surgery, as well as ongoing trials on irradiation de-escalation in cases of complete pathological response after neoadjuvant chemotherapy, particularly for the cN1–ypN0 and cN2–3–ypN0 subtypes. Several prospective studies and randomized trials, including LUMINA, PRIME II, and trials using genomic signatures (POLAR, Oncotype DX®, Prosigna®), suggest the feasibility of omitting radiotherapy for some very low-risk patients, without demonstrated effects on overall survival. However, the persistent benefit of local control has been observed. The National Surgical Adjuvant Breast and Bowel Project (NSABP)-B51/Radiation Therapy Oncology Group (RTOG) 1304 trial and Radiotherapy After Primary Chemotherapy (RAPCHEM) registry showed that the omission of nodal radiotherapy could be considered after a complete nodal pathological response (ypN0), with good short-term locoregional control, although definitive long-term results have not been reported. The omission of radiotherapy for breast cancers with a good prognosis, particularly in patients with luminal A tumours and those with a complete response after neoadjuvant treatment, represents a promising avenue for therapeutic de-escalation. However, it must be determined based on strict biological and clinical selection criteria and validated via long-term controlled trials.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104688"},"PeriodicalIF":1.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.canrad.2025.104678
David Dearnaley
Radical radiotherapy is an effective treatment and standard of care for localised prostate cancer. Most conventionally treatment has been given with 1.8 to 2.0 Gy fractions to a dose of 74 to 79.2 Gy. Radiobiology insights have encouraged the exploration of hypofractionated schedules. Over 7000 patients have contributed to eight randomised controlled trials comparing conventional fractionation with modest hypofractionation using 2.4 to 3.4 Gy fractions. These studies have used both non-inferiority statistical designs aiming to define isoeffective and isotoxic moderate hypofractionated radiotherapy schedules as well as dose-escalated hypofractionated schedules intended to show improved disease control whilst maintaining a low level of late side effects. Long-term follow-up of over 10 years is now available from four of the studies. Patients with low-high risk disease have been studied treating with or without androgen-deprivation. Meta-analysis of individual patient data from seven available trials has been performed with median follow-up of 5 to 7 years. The studies of isoeffective moderate hypofractionated radiotherapy show that a dose of 60 Gy in 3 Gy fractions delivered over 4 weeks is non-inferior to doses of 74 Gy to 78 Gy in 2 Gy fractions delivered over 7.4 to 7.8 weeks with similar levels of disease control and survival. Low levels of late side effects were maintained using intensity-modulated radiotherapy techniques. In distinction trials using dose-escalated hypofractionated schedules have not increased effectiveness and have raised levels of late side effects. This may relate to very modest hypofractionation and treatment protraction. There is now adequate evidence for radiotherapy delivering 60 Gy in 20 fractions over 4 weeks to be the standard schedule for all patients with localised prostate cancer.
{"title":"Moderate hypofractionated radiotherapy for localised prostate cancer: A new standard of care","authors":"David Dearnaley","doi":"10.1016/j.canrad.2025.104678","DOIUrl":"10.1016/j.canrad.2025.104678","url":null,"abstract":"<div><div>Radical radiotherapy is an effective treatment and standard of care for localised prostate cancer. Most conventionally treatment has been given with 1.8 to 2.0<!--> <!-->Gy fractions to a dose of 74 to 79.2<!--> <!-->Gy. Radiobiology insights have encouraged the exploration of hypofractionated schedules. Over 7000 patients have contributed to eight randomised controlled trials comparing conventional fractionation with modest hypofractionation using 2.4 to 3.4<!--> <!-->Gy fractions. These studies have used both non-inferiority statistical designs aiming to define isoeffective and isotoxic moderate hypofractionated radiotherapy schedules as well as dose-escalated hypofractionated schedules intended to show improved disease control whilst maintaining a low level of late side effects. Long-term follow-up of over 10<!--> <!-->years is now available from four of the studies. Patients with low-high risk disease have been studied treating with or without androgen-deprivation. Meta-analysis of individual patient data from seven available trials has been performed with median follow-up of 5 to 7<!--> <!-->years. The studies of isoeffective moderate hypofractionated radiotherapy show that a dose of 60<!--> <!-->Gy in 3<!--> <!-->Gy fractions delivered over 4<!--> <!-->weeks is non-inferior to doses of 74<!--> <!-->Gy to 78<!--> <!-->Gy in 2<!--> <!-->Gy fractions delivered over 7.4 to 7.8<!--> <!-->weeks with similar levels of disease control and survival. Low levels of late side effects were maintained using intensity-modulated radiotherapy techniques. In distinction trials using dose-escalated hypofractionated schedules have not increased effectiveness and have raised levels of late side effects. This may relate to very modest hypofractionation and treatment protraction. There is now adequate evidence for radiotherapy delivering 60<!--> <!-->Gy in 20 fractions over 4<!--> <!-->weeks to be the standard schedule for all patients with localised prostate cancer.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104678"},"PeriodicalIF":1.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-30DOI: 10.1016/j.canrad.2025.104684
Alice Blache , Constance Huck , Vérane Achard , Alexandre Coutte , Maxime Galienne , Jonathan Khalifa , Paul Sargos
Purpose
Trimodal therapy, combining transurethral resection of the bladder tumour, radiotherapy, and concurrent radiosensitization, is an established bladder-preserving alternative to radical cystectomy in muscle-invasive bladder cancer. Hypofractionated radiotherapy has gained interest due to radiobiological advantages and logistical convenience, yet its efficacy and safety remain under evaluation.
Methods
A review of prospective phase II and III trials published between 2000 and 2025 was conducted in Medline using the search engine PubMed. Studies were included if they assessed hypofractionated radiotherapy (excluding stereotactic body radiotherapy) for non-metastatic muscle-invasive bladder cancer within a curative-intent using a trimodal therapy approach. Key endpoints included progression-free survival, overall survival, and toxicity.
Results
Seven prospective trials (five phase II, two phase III) were identified. The largest evidence come from the BC2001 and BCON trials, which demonstrated that a dose of 55 Gy delivered in 20 fractions was non-inferior to a dose of 64 Gy delivered in 32 fractions in terms of locoregional control and overall survival, with similar genitourinary and gastrointestinal toxicity rates. Additional studies confirmed comparable efficacy between hypofractionated and conventional fractionated radiotherapy regimens. Various concurrent systemic therapies were used, including cisplatin, 5-fluorouracil with mitomycin C, gemcitabine, and carbogen with nicotinamide, though no regimen showed clear superiority. Elective pelvic nodes irradiation remains controversial; one phase III trial showed no benefit, while recent data suggest a potential survival advantage without increased toxicity, even in hypofractionated protocols.
Conclusion
Hypofractionated chemoradiotherapy is a safe and effective bladder-preserving strategy in selected patients with muscle-invasive bladder cancer. It offers comparable oncological outcomes and toxicity to conventional radiotherapy, with improved treatment efficiency. While systemic radiosensitization remains essential, further research is needed to optimize agents and clarify the role of pelvic nodes irradiation in hypofractionated settings.
{"title":"Hypofractionated radiotherapy in the management of bladder cancer","authors":"Alice Blache , Constance Huck , Vérane Achard , Alexandre Coutte , Maxime Galienne , Jonathan Khalifa , Paul Sargos","doi":"10.1016/j.canrad.2025.104684","DOIUrl":"10.1016/j.canrad.2025.104684","url":null,"abstract":"<div><h3>Purpose</h3><div>Trimodal therapy, combining transurethral resection of the bladder tumour, radiotherapy, and concurrent radiosensitization, is an established bladder-preserving alternative to radical cystectomy in muscle-invasive bladder cancer. Hypofractionated radiotherapy has gained interest due to radiobiological advantages and logistical convenience, yet its efficacy and safety remain under evaluation.</div></div><div><h3>Methods</h3><div>A review of prospective phase II and III trials published between 2000 and 2025 was conducted in Medline using the search engine PubMed. Studies were included if they assessed hypofractionated radiotherapy (excluding stereotactic body radiotherapy) for non-metastatic muscle-invasive bladder cancer within a curative-intent using a trimodal therapy approach. Key endpoints included progression-free survival, overall survival, and toxicity.</div></div><div><h3>Results</h3><div>Seven prospective trials (five phase II, two phase III) were identified. The largest evidence come from the BC2001 and BCON trials, which demonstrated that a dose of 55<!--> <!-->Gy delivered in 20 fractions was non-inferior to a dose of 64<!--> <!-->Gy delivered in 32 fractions in terms of locoregional control and overall survival, with similar genitourinary and gastrointestinal toxicity rates. Additional studies confirmed comparable efficacy between hypofractionated and conventional fractionated radiotherapy regimens. Various concurrent systemic therapies were used, including cisplatin, 5-fluorouracil with mitomycin C, gemcitabine, and carbogen with nicotinamide, though no regimen showed clear superiority. Elective pelvic nodes irradiation remains controversial; one phase III trial showed no benefit, while recent data suggest a potential survival advantage without increased toxicity, even in hypofractionated protocols.</div></div><div><h3>Conclusion</h3><div>Hypofractionated chemoradiotherapy is a safe and effective bladder-preserving strategy in selected patients with muscle-invasive bladder cancer. It offers comparable oncological outcomes and toxicity to conventional radiotherapy, with improved treatment efficiency. While systemic radiosensitization remains essential, further research is needed to optimize agents and clarify the role of pelvic nodes irradiation in hypofractionated settings.</div></div>","PeriodicalId":9504,"journal":{"name":"Cancer Radiotherapie","volume":"29 5","pages":"Article 104684"},"PeriodicalIF":1.4,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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