Deutsches Arzteblatt international最新文献

{"title":"Clinical Practice Guideline: Comprehensive Geriatric Assessmentin the Hospital.","authors":"Barbara Kumlehn, Simone Brefka, Thomas Kocar, Filippo Maria Verri, Rainer Wirth, Michael Denkinger","doi":"10.3238/arztebl.m2024.0262","DOIUrl":"10.3238/arztebl.m2024.0262","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of older people are being treated in German hospitals. In 2022, more than 35.7 million hospitalized patients in Germany were of age 65 or older. Comprehensive geriatric assessment (CGA) can help to structure and improve the diagnosis and treatment of these patients, many of whom suffer from multimorbidity.</p><p><strong>Methods: </strong>The guideline group developed this guideline in accordance with the AWMF recommendations. Answers to questions were either evidence-based or consensus-based; the latter were established with a Delphi procedure followed by a consensus conference. The guideline was issued in May 2024.</p><p><strong>Results: </strong>The guideline contains twelve evidence-based and eight consensus-based recommendations and statements. The strongest evidence for the effectiveness of CGA was found in the wards for acute geriatric medicine, oncology, and orthopedics/trauma surgery, with weaker evidence from emergency departments and general surgery wards. Core elements of the guideline are the specification of a minimum duration of CGA (15 minutes), the definition of minimum requirements (six core dimensions: self-help ability, mobility, cognitive function/delirium, affect, nutrition, social situation), and setting-specific process recommendations. Specific screening instruments to identify patients who stand to benefit from CGA are recommended mainly in the oncological setting (G8 questionnaire).</p><p><strong>Conclusion: </strong>The German clinical practice guideline on CGA can serve as a guide to personalized geriatric medicine in the hospital. Further complex interventional studies are needed to evaluate the efficacy of CGA in other settings.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"156-162"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pharmacologic Inhibition of KRAS Mutants as a Treatment for Cancer: Therapeutic Principles and Clinical Results.","authors":"Stefan Kasper, Martin Sebastian","doi":"10.3238/arztebl.m2025.0002","DOIUrl":"10.3238/arztebl.m2025.0002","url":null,"abstract":"<p><strong>Background: </strong>Mutations of the KRAS oncogene are found in up to 20% of all cancers, and particularly in non-small-cell lung cancer (NSCLC) (20-40%) and colorectal cancer (CRC) (30-50%). Inhibitors of specific KRAS mutants have recently become available and are now a part of routine care.</p><p><strong>Methods: </strong>This review is based on articles published in the past 5 years that were retrieved by a selective search in PubMed for clinical trials of the pharmacological inhibition of KRAS.</p><p><strong>Results: </strong>Sotorasib and adagrasib have already been approved, on the basis of two randomized phase III trials, as specific inhibitors of the KRASG12C mutant for palliative second-line treatment. Compared to standard chemotherapy with docetaxel, both drugs significantly prolonged progression-free survival (PFS): 5.6 months (95% confidence interval [4.3; 7.8]) for sotorasib versus 4.5 [3.0; 5.7] for docetaxel, and 5.5 months [4.5; 6.7] for adagrasib versus 3.8 [2.7; 4.7] for docetaxel. Sotorasib was also found to cause fewer severe adverse drug events (33%, versus 40% with docetaxel). The most common ones were diarrhea and elevated liver enzymes. For already treated CRC, sotorasib combined with the anti-epidermal growth factor receptor (anti-EGFR) antibody panitumumab was found, in a randomized phase III trial, to prolong progression-free survival significantly compared to standard therapy with triflurdin/tipiracil or regorafenib (5.6 months [4.2; 6.3] versus 2.2 months [1.9; 3.9]), while also improving patients' quality of life. Approval by the European Medicines Agency is pending. Further KRAS and pan-RAS inhibitors are now in early clinical development.</p><p><strong>Conclusion: </strong>Pharmacological KRAS inhibition is a promising new approach to the treatment of many kinds of cancer.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"163-167"},"PeriodicalIF":6.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Genetics of Female and Male Infertility.","authors":"Frank Tüttelmann, Margot Julia Wyrwoll, Johanna Steingröver, Peter Wieacker","doi":"10.3238/arztebl.m2024.0259","DOIUrl":"10.3238/arztebl.m2024.0259","url":null,"abstract":"<p><strong>Background: </strong>An estimated 17% of all couples worldwide are involuntarily childless (infertile). The clinically identifiable causes of infertility can be found in the male or female partner or in both. The molecular pathophysiology of infertility still remains unclear in many cases but is increasingly being revealed by genetic analyses.</p><p><strong>Methods: </strong>This review article is based on pertinent publications retrieved by a selective literature search.</p><p><strong>Results: </strong>The clinical diagnostic evaluation of an infertile couple may yield an indication for genetic analysis. Women with premature ovarian insufficiency should undergo chromosomal analysis and study of the FMR1 gene. If congenital adrenal hyperplasia is suspected, the CYP21A2 gene should be investigated. In men, genetic diagnosis is based primarily on the findings of semen analysis. Klinefelter syndrome and deletions of the Y-chromosomal azoospermia factors may severely limit sperm production. In both male and female partners, the analysis of a gene panel selected on the basis of the individual indication may identify the cause of infertility, e.g., hypogonadotropic hypogonadism, premature ovarian insufficiency, or severe disturbances of spermatogenesis. In some cases, genetic analysis can help determine the likelihood of success of sperm retrieval via testicular biopsy in men, and the potential indication for oocyte cryopreservation in women.</p><p><strong>Conclusion: </strong>Genetic causes, disease patterns, and the related investigations are becoming increasingly important in the diagnostic evaluation of infertile couples and have implications for further treatment, for the children of the affected couple, and for other family members.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"115-120"},"PeriodicalIF":6.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diagnosis and Treatment of Sarcopenia and Sarcopenic Obesity.","authors":"Basel Habboub, Robert Speer, Markus Gosch, Katrin Singler","doi":"10.3238/arztebl.m2025.0004","DOIUrl":"10.3238/arztebl.m2025.0004","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia is a progressive, generalized disease of skeletal muscle characterized by a loss of muscle strength and muscle mass. The combination of obesity and sarcopenia is called sarcopenic obesity. Because of the aging of the population in many countries around the world, sarcopenia and sarcopenic obesity are a challenge for global health policy.</p><p><strong>Methods: </strong>This review is based on pertinent publications retrieved by a selective literature search.</p><p><strong>Results: </strong>The effects of sarcopenia on health and quality of life are far-reaching and include difficulty coping with everyday life, an increased risk of falling, frequent hospitalization, and increased mortality. A population-based study in Germany revealed a 7% prevalence of sarcopenia in adults aged 65 and above. The prevalence of sarcopenic obesity was 4.5%. Persons aged 65 and above who are at increased risk for sarcopenia should be screened, e.g., with the SARC-F questionnaire. If screening yields a suggestive finding (SARC-F ≥ 4 points), the diagnosis of sarcopenia should be confirmed or ruled out by measurements of muscle strength (e.g. hand-grip strength, reference values: women <16 kg, men <27 kg) and appendicular muscle mass (women <5.5 kg/m2, men <7.0 kg/m2). The demonstration of reduced muscle strength is sufficient to initiate treatment. For the diagnosis of sarcopenic obesity, increased fat mass is additionally required. The goal of treatment is to improve mobility and reduce negative health outcomes. The treatment consists of resistance training and nutritional interventions.</p><p><strong>Conclusion: </strong>A targeted and structured approach to the detection and treatment of sarcopenia and sarcopenic obesity can make a major contribution to the maintenance or improvement of these patients' functionality and quality of life.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"121-126"},"PeriodicalIF":6.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative and Stepped Care for Mental Disorders: Results of a Cluster-Randomized Controlled Trial in Outpatient Care (The COMET Study).","authors":"Daniela Heddaeus, Tharanya Seeralan, Kerstin Maehder, Sarah Porzelt, Anne Daubmann, Judith Dams, Thomas Grochtdreis, Hans-Helmut König, Olaf von dem Knesebeck, Bernd Löwe, Amra Pepić, Moritz Rosenkranz, Ingo Schäfer, Thomas Zimmermann, Bernd Schulte, Angelika Weigel, Karl Wegscheider, Silke Werner, Antonia Zapf, Martin Scherer, Jörg Dirmaier, Martin Härter","doi":"10.3238/arztebl.m2025.0011","DOIUrl":"10.3238/arztebl.m2025.0011","url":null,"abstract":"<p><strong>Background: </strong>Collaborative and stepped care (CSC) models are recommended in guidelines because of their effectiveness in treating depression and anxiety disorders. The evidence for other mental disorders is, however, limited. The aim of this study was to evaluate the effectiveness of a collaborative and stepped care model (COMET) for patients with depressive, anxiety, somatoform, and/or alcohol-related disorders and related comorbidities in the routine care setting in Germany.</p><p><strong>Methods: </strong>A prospective, cluster-randomized, controlled, parallelgroup superiority trial was conducted; the subjects were patients in primary care practices. The primary endpoint was the change in mental health-related quality of life, assessed with the SF-36 Mental Health Component Summary Score (MCS) at 6 months in the intention-to-treat population. The secondary endpoints were symptom severity, remission, and response.</p><p><strong>Results: </strong>Forty-one primary care offices were randomized either to COMET (n = 20) or treatment as usual (TAU, n = 21), and 615 patients were recruited (CSC: n = 307; TAU: n = 308). Data were available for 62% (COMET) and 55% (TAU) of the participants at 6 months. No significant group difference was found with respect to the primary endpoint (-1.96 ,95% confidence interval [-4.39; 0.48], p = 0.113) or any of the secondary endpoints.</p><p><strong>Conclusion: </strong>We found no superiority of the COMET model for the mental disorders addressed. Methodological issues, including differences at baseline and high dropout rates, make these findings challenging to interpret. Future studies should ensure comparability of groups, allocate resources for quality management, and investigate more suitable outcome measures, paying attention to factors of implementation.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"127-134"},"PeriodicalIF":6.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Acute Abdomen: Structured Diagnosis and Treatment.","authors":"Nikolaus Börner, Alina-Sophie Kappenberger, Sabine Weber, Florian Scholz, Philipp Kazmierczak, Jens Werner","doi":"10.3238/arztebl.m2025.0019","DOIUrl":"10.3238/arztebl.m2025.0019","url":null,"abstract":"<p><strong>Background: </strong>The acute abdomen is a life-threatening clinical entity that requires immediate diagnostic evaluation and appropriate treatment. 15-20% of emergency room patients with acute abdominal pain need interventional or surgical treatment.</p><p><strong>Methods: </strong>This narrative review is based on publications retrieved by a PubMed search, current textbooks and guidelines, and the authors' personal experience.</p><p><strong>Results: </strong>The acute abdomen presents with the sudden onset of maximally intense abdominal pain, sometimes with guarding, and often with impaired general well-being, ranging to manifestations of shock. Its more common causes, aside from nonspecific abdominal pain (30-41%), are acute appendicitis (8-30%), cholecystitis (9-11%), and ileus (4-5%). The diagnosis is established by the history and physical examination, laboratory tests, imaging studies, and, in some cases, exploratory laparoscopy. The acute abdomen is generally a surgical condition, but it often requires interdisciplinary, multimodal treatment and follow-up. It carries a 2% to 12% mortality, with the figure rising for every elapsed hour until specific treatment is provided.</p><p><strong>Conclusion: </strong>Structured, quality-controlled, rapid, and targeted diagnosis and treatment markedly lower the morbidity and mortality of patients presenting with an acute abdomen.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"137-144"},"PeriodicalIF":6.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Anterior Shoulder Dislocation: Epidemiology, Diagnosis, and Treatment.","authors":"Anna Patricia Goth, Alexander Klug, Georg Gosheger, Mirkka Lynn Hiort, Doruk Akgün, Kristian Nikolaus Schneider","doi":"10.3238/arztebl.m2024.0254","DOIUrl":"10.3238/arztebl.m2024.0254","url":null,"abstract":"<p><strong>Background: </strong>Traumatic anterior shoulder dislocation is the most common type of joint dislocation, with an incidence of 11 to 29 per 100 000 persons per year. Controversy still surrounds the recommendations for treatment and the available procedures for surgical stabilization.</p><p><strong>Methods: </strong>This review is based on pertinent publications (2014-2024) that were retrieved by a selective search in the PubMed and Google Scholar databases. Meta-analyses and ran - domized controlled trials (RCTs) with evidence levels I and II were included.</p><p><strong>Results: </strong>The typical injury mechanism is forcible external rotation and abduction of the arm. The diagnosis is established by x-ray, which may be supplemented by magnetic resonance imaging (MRI) for the assessment of soft-tissue structures. The indication and type of surgical treatment depends on the patient's age, sex, activity level, and concomitant injuries. For purely soft-tissue injuries, arthroscopic Bankart repair is an established treatment, with reported significant reduction in the rate of recurrent instability after follow-up periods of up to 12 years. An accompanying bony injury of the dorsal humeral head (Hill-Sachs lesion), depending on its extent, may be an indication for the arthroscopic Remplissage procedure: this can lower the rate of recurrence, but it can also cause a postoperative restriction of external rotation. In cases of chronic instability, an arthroscopic or open Latarjet procedure and bone grafting can be per formed to augment the ventral glenoid articular surface. These procedures have likewise been reported to yield low rates of recurrent instability, but also higher complication rates.</p><p><strong>Conclusion: </strong>The treatment of shoulder dislocation should be individually tailored. Although the reported results are promising, the evidence base remains weak. Prospective studies with larger case numbers are needed so that clear treatment algorithms can be established.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"89-95"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute-on-Chronic Liver Failure.","authors":"Jonel Trebicka, Michael Praktiknjo, Kai-Henrik Peiffer, Andreas Pascher, Martin Sebastian Schulz, Frank Erhard Uschner","doi":"10.3238/arztebl.m2024.0255","DOIUrl":"10.3238/arztebl.m2024.0255","url":null,"abstract":"<p><strong>Background: </strong>Cirrhosis is the end stage of chronic liver disease. Cirrhosis causes portal hypertension, which, in turn, can lead to acute on chronic liver failure (ACLF), which is defined as acute decompensation combined with failure of the liver, coagulation system, kidneys, lungs, and/or circulatory system, or hepatic encephalopathy.</p><p><strong>Methods: </strong>This review is based on a selective literature search for international publications in the NCBI database using the keywords \"liver cirrhosis\" and \"ACLF.\" Valid guidelines (up to June 2024) were also included.</p><p><strong>Results: </strong>Cirrhosis is present in approximately 1% of all hospital admissions in Germany, and complications of cirrhosis cause an estimated 1 million deaths worldwide each year. ACLF, the most severe form of decompensated liver cirrhosis, bears a 28-day mortality of 45% and affects 35% of all patients hospitalized for decompensated cirrhosis. Its precipitating factors are infection, alcohol overuse, bleeding, and drug-induced enceph alopathy (benzodiazepines or opioids). No drugs or other treatments for ACLF have been approved; only its etiology and precipitating factors are amenable to treatment.</p><p><strong>Conclusion: </strong>Liver transplantation is currently the only curative option for ACLF but is not suitable for all patients because of the narrow therapeutic window and the common presence of contraindications. Prospective data are lacking that would aid in the selection of patients for liver transplantation so that post-transplantation survival rates can be improved.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"96-102"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial Revascularization in Heart Failure With Reduced Ejection Fraction.","authors":"Bernhard Haring, Johann Bauersachs, Norbert Frey, Uta C Hoppe, Torsten Doenst, Michael Böhm","doi":"10.3238/arztebl.m2024.0249","DOIUrl":"10.3238/arztebl.m2024.0249","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) patients with reduced ejection fraction (HFrEF) now more commonly die of non-cardiovascular causes than they did in the past. In patients with both HFrEF and ischemic cardiomyopathy (as the cause of HFrEF or as an accompanying condition), the effect of myocardial revascularization-i.e. percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)-on long-term outcome is unclear.</p><p><strong>Methods: </strong>This review is based on publications that were retrieved by a selective search of the literature for pertinent clinical studies and current guidelines.</p><p><strong>Results: </strong>Drug treatment for HFrEF has markedly prolonged these patients' survival. In a comparative study, HF pharmacotherapy was found to add an average of 8.3 years to the lifespan of a 55-yearold patient with HFrEF. Three of the four randomized controlled trials on revascularization procedures were conducted prior to the major pharmacotherapy improvements leading to better outcomes in HF patients over the past decade. These trial data indicate a long-term benefit from CABG compared to medical treatment alone in patients with HFrEF and severe coronary heart disease. For example, in the STICH trial, the hazard ratio for death from any cause after a follow-up time of nearly 10 years was 0.84 (95% confidence interval, [0.73; 0.97]). The role of pre-procedural myocardial viability and ischemia testing remains to be fully determined. The choice of method for myocardial revascularization should be discussed within an interdisciplinary cardiac team in consideration of the patient's symptoms and ischemic burden, the complexity of the coronary findings, as well as the patient's perioperative risk and current medical HF therapy. No RCTs comparing CABG to PCI are yet available.</p><p><strong>Conclusion: </strong>Optimal guideline-directed medical therapy is a key determinant of long-term survival in patients with HFrEF.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"103-108"},"PeriodicalIF":6.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Radiotherapy: The Paradigm Shift to Real-Time Adaptive Radiotherapy.","authors":"Goda Kalinauskaite, Konstantin Nikolaou, Andrea Wittig, Daniel Zips, Klaus Zöphel, Carolin Senger","doi":"10.3238/arztebl.m2024.0242","DOIUrl":"10.3238/arztebl.m2024.0242","url":null,"abstract":"<p><strong>Background: </strong>Adaptive radiotherapy (ART) involves the continuous adaptation of the radiation plan according to patient- and tumorspecific feedback. In online ART, the plan is optimized in real time during the treatment; in offline ART, the plan is recalculated between treatment sessions. Hybrid linear accelerators with integrated CT, MRI, or PET are required to perform online ART.</p><p><strong>Methods: </strong>This review is based on clinically relevant studies on online ART (January 2019 - May 2024) that were retrieved by a selective search in PubMed.</p><p><strong>Results: </strong>Online ART is a new technique for which no phase 3 trials have been published; in contrast, multiple randomized trials are already available for offline ART. The initial findings of a random - ized phase 2 trial of online ART for head and neck cancer showed lower rates of G2 or higher radiation-induced dermatitis (8% vs. 31%, p = 0.05) and a lower dose to the parotid gland (mean dose: 11.5 Gy vs. 16.0 Gy, p = 0.02) with online ART compared to standard radiochemotherapy. Moreover, observational studies show that online ART is feasible and spares organs at risk in patients with esophageal, pancreatic, rectal, and prostatic cancer. Additionally, online ART can enable simulation-free treatment planning and faster initiation of radiotherapy. It is, however, more demanding of time and resources and more costly than standard radiotherapy, and no studies with long-term clinical endpoints are available to date.</p><p><strong>Conclusion: </strong>Initial studies confirm the feasibility of online ART and arouse the hope that it will enable more precise radiotherapy with less damage to surrounding structures. Phase 3 trials are needed so that the patient groups who stand to benefit most from online ART can be identified.</p>","PeriodicalId":11258,"journal":{"name":"Deutsches Arzteblatt international","volume":" Forthcoming","pages":"59-64"},"PeriodicalIF":6.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}