Radiotherapy and Oncology最新文献

{"title":"Improving mortality prediction after radiotherapy with large language model structuring of large-scale unstructured electronic health records.","authors":"Sangjoon Park, Chan Woo Wee, Seo Hee Choi, Kyung Hwan Kim, Jee Suk Chang, Hong In Yoon, Ik Jae Lee, Yong Bae Kim, Jaeho Cho, Ki Chang Keum, Chang Geol Lee, Hwa Kyung Byun, Woong Sub Koom","doi":"10.1016/j.radonc.2025.111052","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111052","url":null,"abstract":"<p><strong>Background and purpose: </strong>Avoiding unnecessary radiotherapy (RT) in patients with limited life expectancy requires accurate selection. Traditional survival models based on structured data often lack precision. Large language models (LLMs) offer a novel approach to structuring unstructured electronic health record (EHR) data, potentially improving survival predictions by integrating comprehensive clinical information.</p><p><strong>Materials and methods: </strong>We analyzed structured and unstructured data from 34,276 RT-treated patients at Yonsei Cancer Center. An open-source LLM structured unstructured EHR data using single-shot learning. External validation included 852 patients from Yongin Severance Hospital. We compared the LLM's performance against a domain-specific medical LLM and a smaller variant. Survival prediction models using statistical, machine-learning, and deep-learning approaches incorporated both structured and LLM-structured data.</p><p><strong>Results: </strong>The open-source LLM structured unstructured EHR data with 87.5 % accuracy, outperforming the domain-specific medical LLM (35.8 %). Larger LLMs were more effective in structuring clinically relevant features, such as general condition and disease extent, which correlated with survival. Incorporating LLM-structured features improved the deep learning model's C-index from 0.737 to 0.820 (internal validation) and from 0.779 to 0.842 (external validation). Risk stratification was also enhanced, with clearer differentiation among low-, intermediate-, and high-risk groups (p < 0.001). Additionally, models became more interpretable, as key LLM-structured features aligned with statistically significant predictors traditionally identified from structured data.</p><p><strong>Conclusion: </strong>General-domain LLMs, despite not being fine-tuned for medical data, can effectively structure large-scale unstructured EHRs, significantly improving survival prediction accuracy and model interpretability. The RT-Surv framework highlights the potential of LLMs to enhance clinical decision-making and optimize RT treatment.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111052"},"PeriodicalIF":4.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid and efficient simulation-free radiotherapy: MR guided adaptive prostate radiotherapy on the MR-Linac using diagnostic MRI reference planning.","authors":"Joan Chick, Francis Casey, Sian Cooper, Trina Herbert, Sophie Alexander, Norina Predescu, Szabolcs-Botond Lőrincz-Molnár, Simeon Nill, Uwe Oelfke, Alison Tree, Alex Dunlop","doi":"10.1016/j.radonc.2025.111053","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111053","url":null,"abstract":"<p><strong>Background and purpose: </strong>Simulation-free radiotherapy offers improved efficiency for adaptive treatments. This planning study presents a simulation-free pre-treatment workflow for prostate cancer online adaptive radiotherapy on a MR-Linac. Previously acquired diagnostic MR images are used to create a reference treatment plan without clinician input, and subsequent adapted plans are then compared with those from the traditional workflow with simulation.</p><p><strong>Materials and methods: </strong>All patients treated with 36.2 Gy in 5-fractions within the HERMES trial were retrospectively assessed for eligibility of simulation-free reference planning. If eligible, reference images were created from existing diagnostic MRI (T1w and T2w) to enable MR only reference treatment planning. Target and OAR reference structures were autosegmented without clinician input. Online plan adaptation was simulated using existing clinical treatment images and structure sets. Adapted plans were compared with existing clinical plans, and synthetic CT accuracy assessed.</p><p><strong>Results: </strong>87.5 % of patients had suitable diagnostic scans. Reference images and treatment plans were successfully created. Online treatment plans were simulated and were clinically acceptable for target dose and conformality, meeting all mandatory clinical goals with no detriment to OAR dose or plan deliverability. Accuracy of the synthetic CT approach was high with gamma results at 2 mm/2% all above 98.9 %.</p><p><strong>Conclusion: </strong>This study has shown that non radiotherapy-dedicated diagnostic MRI can be used for reference prostate planning on the MR-Linac, generating clinically equivalent adapted plans when compared to those originating from radiotherapy-simulation reference plans. This potentially saves multiple weeks in the pathway, improving radiotherapy efficiency and patient experience.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111053"},"PeriodicalIF":4.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probing the therapeutic window of proton minibeam radiotherapy using dose-response curves in a mouse model.","authors":"Fardous Reaz, Line Kristensen, Erik Traneus, Brita Singers Sørensen, Niels Bassler","doi":"10.1016/j.radonc.2025.111050","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111050","url":null,"abstract":"<p><strong>Purpose: </strong>Proton minibeam radiotherapy (pMBRT) has been observed in preclinical studies to spare normal tissues through its spatially fractionated dose profile. Translating pMBRT to clinical application requires quantification of its therapeutic gain, compared to conventional proton therapy. We compare pMBRT to conventional proton therapy in vivo, focusing on reducing damage to non-target tissues while ensuring the same uniform target dose to achieve equal tumor control.</p><p><strong>Methods and materials: </strong>We used a multislit collimator in an established mouse irradiation setup to deliver a uniform dose to the target while maintaining a high dose contrast in the entrance region. The right hind legs of 75 female C3H/HeNRj mice were irradiated with the highest dose contrast. Acute skin toxicity was recorded up to 25 days post-irradiation, using a seven-level scoring scheme (0.5 to 3.5) to quantify skin reaction following a well-established protocol. For tumor control comparison, we used CDF1 female mice with a C3H mouse mammary carcinoma subcutaneously implanted in the foot. Dose-response curves of the level of acute skin toxicity and tumor control were generated as a function of the planning target volume (PTV) dose for both conventional and pMBRT setups, allowing for direct comparison.</p><p><strong>Results: </strong>pMBRT demonstrated significantly improved normal tissue sparing ability compared to conventional irradiation for same doses in the target. No incidence of higher levels (Score 2.5, 3.0 and 3.5) of toxicity was observed in the pMBRT group, in contrast to the higher toxicity often seen in mice treated with conventional modality at the same PTV dose. At the maximum deliverable dose, the incidence of skin toxicity was still too low to complete the dose-response curves for pMBRT. The estimated grid factor of < 0.65 (Score 1.5) and < 0.7 (Score 2) suggests a substantial enhanced tissue sparing potential with pMBRT. Both modalities show similar tumor control, with TCD50 of 46.9 Gy for conventional therapy and 45 Gy for pMBRT.</p><p><strong>Conclusion: </strong>We present a comparison method to quantify the efficacy of pMBRT. The observed reduction in acute normal tissue toxicity for pMBRT, compared to conventional proton therapy for at the same PTV dose and maintaining similar tumor control, suggests that pMBRT may offer a substantial therapeutic gain.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111050"},"PeriodicalIF":4.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral vs bilateral neck irradiation: The importance of careful patient selection in tailoring radiation therapy for lateralized palatine-tonsil and non-palatine-tonsil oropharyngeal carcinoma","authors":"Max Gau ,&nbsp;Fatimah A. Alfaraj ,&nbsp;Shao Hui Huang ,&nbsp;Brian O’Sullivan ,&nbsp;Jie Su ,&nbsp;Wei Xu ,&nbsp;Sarah N. Hamilton ,&nbsp;Anthony Maletta ,&nbsp;Omar Salman ,&nbsp;Mary McInerney ,&nbsp;Abiha Javed ,&nbsp;Enrique Sanz-Garcia ,&nbsp;Scott Bratman ,&nbsp;Ezra Hahn ,&nbsp;Andrew Hope ,&nbsp;John J. Kim ,&nbsp;Nauman Malik ,&nbsp;Andrew McPartlin ,&nbsp;C. Jillian Tsai ,&nbsp;John Waldron ,&nbsp;Ali Hosni","doi":"10.1016/j.radonc.2025.111049","DOIUrl":"10.1016/j.radonc.2025.111049","url":null,"abstract":"<div><h3>Title</h3><div>Unilateral vs Bilateral Neck Irradiation: The Importance of Careful Patient Selection in Tailoring Radiation Therapy for Lateralized Palatine-Tonsil and Non-Palatine-Tonsil Oropharyngeal Carcinoma.</div></div><div><h3>Purpose</h3><div>To compare oncologic outcomes of well-lateralized oropharyngeal carcinoma (OPC) following unilateral vs bilateral neck radiotherapy (RT).</div></div><div><h3>Methods</h3><div>Patients with cT1-3 N0-2bM0 (TNM-7) OPC, treated with curative (chemo)RT in two institutions (2008–2019) were identified. For palatine tonsil tumor, unilateral neck RT was considered for tumor not invading beyond 1 cm of the tongue base or the soft palate without deep penetration. Unilateral neck RT was also considered for well-lateralized non-palatine tonsil tumor (i.e. base of tongue, soft palate or vallecula) within 1 cm of the lateral part of the mucosal corresponding oropharyngeal subsite without deep penetration. One-to-one propensity score-matched cohort of patients treated with unilateral vs bilateral neck RT was created according to patient, tumor, and treatment characteristics. The primary outcome was contralateral-only nodal failure (CNF, i.e., without local or ipsilateral regional failure). Secondary outcomes included local failure (LF), regional failure (RF), distant metastasis (DM), disease-free survival (DFS) and overall survival (OS).</div></div><div><h3>Results</h3><div>346 patients were selected for the matched cohort (173 in each group), including 46 non-palatine tonsil tumors. The median follow-up was 5.1 years. The 5-year CNF, LF, RF, DM, DFS and OS for unilateral vs bilateral neck RT groups were 1 % (95 % CI: 0 %-3%) vs 0 %, 5 % (95 % CI: 3 %-10 %) vs 2 % (95 % CI: 0 %-5%), 4 % (95 % CI: 2 %-8%) vs 4 % (95 % CI: 2 %-8%), 5 % (95 % CI: 3 %-10 %) vs 6 % (95 % CI: 3 %-10 %), 80 % (95 % CI: 74 %-87 %) vs 79 % (95 % CI: 73 %-86 %), and 85 % (95 % CI: 80 %-91 %) vs 83 % (95 % CI: 78 %-90 %), respectively (p &gt; 0.05 for all). One patient in the unilateral neck RT group had CNF after RT (cT2N2bM0 tonsillar cancer, successfully salvaged).</div></div><div><h3>Conclusion</h3><div>Careful selection of well-lateralized OPC to receive unilateral neck RT results in favourable oncologic outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111049"},"PeriodicalIF":4.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CNG (Collaborative Nasopharyngeal Carcinoma Group) stage: Improved prognostic stratification of nasopharyngeal carcinoma and association with Epstein-Barr virus DNA in the intensity-modulated radiation therapy era.","authors":"Shuohan Zheng, Ya Liu, Zheng He, Shuiqing He, Zilu Huang, Wei Luo, Fei Han, Yalan Tao, Chunyan Chen, Puyun Ouyang, Lei Chen, Ying Huang, Guanqun Zhou, Wenfei Li, Qing Liu, Chen Chen, Yunfei Xia","doi":"10.1016/j.radonc.2025.111051","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111051","url":null,"abstract":"<p><strong>Background: </strong>Current 8th AJCC stage is less effective in differentiating survival for nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy era. This study aims to evaluate the performance of CNG (Collaborative Nasopharyngeal Carcinoma Group) stage, a clinical downstaging of NPC based on the 7th AJCC stage, in predicting prognosis compared with the AJCC stage.</p><p><strong>Methods: </strong>In this prospective observational study (ClinicalTrials.gov Identifier: NCT03529279), 1930 patients were restaged based on the 7th stage: CNG Stage I: Stage I, II, and III-nonT3N2; CNG Stage II: III-T3N2, IVA, and IVB; CNG Stage III: IVC. Kaplan-Meier method and the log-rank test were performed.</p><p><strong>Results: </strong>The 5-year overall survival (OS) of patients with CNG Stage I, II, and III was 97.0 %, 91.4 %, and 72.1 %, and survival curves of different stage groups were well-separated (all p < 0.001). The OS curves for 7th and 8th Stage I, II, and III almost overlapped. In patients with pre-treatment plasma EBV DNA > 0 and ≥ 1000 copies/ml, overall and inter-group OS differences were observed in CNG stage, while not shown in 7th and 8th stages. Among CNG Stage I, II, and III, the proportion of patients with EBV DNA = 0 was gradually decreasing (30.9 % vs 10.8 % vs 3.4 %), while the proportion of EBV DNA ≥ 1000 was gradually increasing (33.3 % vs 60.0 % vs 84.8 %, p < 0.001).</p><p><strong>Conclusions: </strong>The CNG staging system presents a more accurate segregation of survival rates than the 7th and 8th editions, and it is well aligned with EBV DNA. Further studies of the staging system are warranted.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111051"},"PeriodicalIF":4.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating risk factors for skeletal-related events among bone metastases from solid tumors.","authors":"Justin Leu, Lakshmi Rekha Narra, Ted Gooley, Nathan Cross, Winston Vuong, Hiba Khan, John Kang, Jonathan T Yang, Clemens Grassberger, Erin F Gillespie","doi":"10.1016/j.radonc.2025.111048","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111048","url":null,"abstract":"<p><strong>Background and purpose: </strong>Skeletal-related events (SRE) are a major source of morbidity and mortality across cancer types. Identification of risk factors for SRE and association with survival would facilitate more targeted preventive treatment.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included patients with bone metastases from solid tumors undergoing systemic imaging from February-March 2022 who had not received radiation within one year. Survival was analyzed using Cox models, and multi-state models assessed factors linked to SRE with death as a competing risk. Outcomes were SRE (including radiation for pain) and all-cause death. Variables included tumor type, metastasis site, and trial eligibility.</p><p><strong>Results: </strong>Among 410 patients (median age 67 years; 48 % male), 162 (40 %) experienced SRE over a median follow-up of 26.8 months. Seventy-five (18.3 %) received radiation for pain alone. Experiencing any type of SRE (HR 1.98, 95 % CI 1.47-2.67, p < 0.001) or radiation for pain alone (HR 2.14, 95 % CI 1.57-2.92, p < 0.001) were both associated with increased mortality. Patients eligible for a trial of early radiation were more likely to develop SRE (HR 1.67, 95 % CI 1.18-2.37, p = 0.004). Prostate cancer histology (HR 1.70, p = 0.02) and metastases to the hip/acetabulum (HR 2.55, p = 0.02) were associated with SRE.</p><p><strong>Conclusion: </strong>Patients treated with radiation for pain alone demonstrated similar risk of death as those experiencing any type of SRE, supporting the inclusion of radiation in endpoint definitions. Prostate cancer type and hip/acetabulum metastasis location may help identify patients and lesions at elevated SRE risk, informing future preventive strategies.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111048"},"PeriodicalIF":4.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-cisplatin concurrent agents plus definitive radiotherapy for locally advanced head and neck cancer: A network meta-analysis of randomized studies","authors":"Fausto Petrelli ,&nbsp;Francesca Trevisan ,&nbsp;Massimiliano Nardone ,&nbsp;Daniela Carioli ,&nbsp;Angela Gasparini ,&nbsp;Chiara Bramati ,&nbsp;Lorenza Bruschieri ,&nbsp;Valentina Riboldi ,&nbsp;Vincenzo Capriotti ,&nbsp;Agostina De Stefani ,&nbsp;Luigi Lorini ,&nbsp;Daniele Spada ,&nbsp;Veronica Lonati ,&nbsp;Paolo Bossi","doi":"10.1016/j.radonc.2025.111033","DOIUrl":"10.1016/j.radonc.2025.111033","url":null,"abstract":"<div><h3>Introduction</h3><div>Head and neck squamous cell carcinoma (HNSCC) poses a significant clinical challenge, particularly in its locally advanced stages. Cisplatin-based, definitive, chemoradiotherapy (CRT) is recognized as the preferred treatment strategy, providing substantial survival benefits and currently achieving the best locoregional control (LRC). However, the toxicity profile of cisplatin, which includes nephrotoxicity, neurotoxicity, and ototoxicity, restricts its application in patients with comorbidities or those of advanced age. Emerging alternatives such as carboplatin, taxanes, cetuximab, and immune checkpoint inhibitors (ICIs) are gaining attention. This study undertakes a network <em>meta</em>-analysis (NMA) to assess the effectiveness and safety of these agents in conjunction with definitive RT.</div></div><div><h3>Methods</h3><div>The inclusion criteria targeted definitive RT in conjunction with non-cisplatin systemic therapies, compared to RT with or without cisplatin in adult HNSCC patients. The outcomes evaluated included overall survival (OS), progression-free survival (PFS), and locoregional control (LRC). Statistical methodologies, including the Surface Under the Cumulative Ranking Curve (SUCRA), were employed to rank the treatment protocols.</div></div><div><h3>Results</h3><div>The analysis incorporated 29 randomized controlled trials assessing 18 treatment modalities. Three cisplatin-based regimens combined with RT consistently demonstrated superior efficacy in OS, ranking as the 3 most effective option for OS, followed by weekly docetaxel combined with RT. Non-cisplatin alternatives such as mitomycin C-based regimens + RT, and methotrexate + RT, demonstrated promising efficacy. For PFS, they ranked first and second, with SUCRA scores of 83 % and 79 %, respectively. Regarding LRC, mitomycin C-based regimens + RT and weekly docetaxel + RT emerged as the top two options, achieving SUCRA scores of 97 % and 93 %, respectively. Cetuximab and ICIs combined with RT ranked lowest across all assessed outcomes.</div></div><div><h3>Conclusion</h3><div>While cisplatin remains the standard of care, carboplatin, mitomycin C-based, and weekly docetaxel + RT regimens present viable alternatives as concurrent agents during RT for patients with stage III-IV HNSCC who are not eligible for cisplatin. It is imperative to develop tailored treatment strategies to enhance clinical outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111033"},"PeriodicalIF":4.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reirradiation dose constraints in clinical practice: Results of an international survey","authors":"Joep Stroom ,&nbsp;Myriam Ayadi ,&nbsp;Anja Aarberg ,&nbsp;Vera Batel ,&nbsp;Cemile Ceylan ,&nbsp;Sinéad Cleary ,&nbsp;Carlo Greco ,&nbsp;Lone Hoffmann ,&nbsp;Andrew Jackson ,&nbsp;Colin Kelly ,&nbsp;Charles Mayo ,&nbsp;Chrysanthi Michailidou ,&nbsp;Donna H Murrell ,&nbsp;Sarah Muscat ,&nbsp;Christopher JH Pagett ,&nbsp;Kelly C Paradis ,&nbsp;Jaime Perez-Alija ,&nbsp;Ellen Yorke ,&nbsp;Ali Zaila ,&nbsp;Nick West","doi":"10.1016/j.radonc.2025.111030","DOIUrl":"10.1016/j.radonc.2025.111030","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the increasing frequency of reirradiation (reRT) in cancer treatment, a critical lack of reliable dose constraint data remains. This study addresses this gap by collating current reRT constraints used in clinical practice across multiple centers, facilitating the development of more consistent and safer reRT guidelines.</div></div><div><h3>Materials and methods</h3><div>A comprehensive survey collected data on reRT patient numbers, dose constraints, sources, and dose summation methods for 30 OARs. Information also included PRV margins, tissue recovery factors (TRF) with time intervals, α/β values, near-D_max definitions, and dose constraints in EQD2Gy for first and reRT courses. The relative difference (X_reRT) between cumulative reRT and first course constraints was calculated. Constraints with data from at least 7 centers were included for further analysis.</div></div><div><h3>Results</h3><div>A median of 6 % of treatments in 17 participating centers were reRT. Most centers derived reRT constraints from the literature (81 %) or first course constraints (68 %). In total 209 cumulative near-D_max values for 19 OARs fulfilled n ≥ 7, yielding a median inter-center variation of 21 % (IQR). While α/β values were relatively consistent, substantial variations were seen in near-D_max volume definition, TRF, and PRV margins. The median X_reRT was 26 %, primarily attributed to the TRF which had a median value of 23 %.</div></div><div><h3>Conclusions</h3><div>This multi-centre survey identified a concerning median inter-centre variation of 21 % in cumulative reRT dose constraints, indicating substantial heterogeneity in current clinical practices. Further prospective studies with rigorous and standardized dose reporting are essential to refine reRT guidelines, enhancing patient safety and treatment efficacy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111030"},"PeriodicalIF":4.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting away from elective nodal irradiation in HNSCC: What do we know and Where are we heading?","authors":"Julian Biau ,&nbsp;Vincent Grégoire ,&nbsp;Silke Tribius ,&nbsp;Pierre Blanchard ,&nbsp;Pierluigi Bonomo ,&nbsp;Jon Cacicedo ,&nbsp;Sue S. Yom","doi":"10.1016/j.radonc.2025.111046","DOIUrl":"10.1016/j.radonc.2025.111046","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111046"},"PeriodicalIF":4.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repositioning Radiation Oncology at the centre of integrated oncology care: A manifesto of the European Society for Radiotherapy and Oncology (ESTRO)","authors":"Icro Meattini ,&nbsp;Marianne C. Aznar ,&nbsp;Luca Boldrini ,&nbsp;Kerstin Borgmann ,&nbsp;Catharine H. Clark ,&nbsp;Corinne Faivre-Finn ,&nbsp;Elizabeth Forde ,&nbsp;Uulke A. van der Heide ,&nbsp;Barbara Alicja Jereczek-Fossa ,&nbsp;Núria Jornet ,&nbsp;Anna M. Kirby ,&nbsp;Piet Ost ,&nbsp;Ivica Ratosa ,&nbsp;Kari Tanderup ,&nbsp;Esther G.C. Troost ,&nbsp;Alessandro J. Cortese ,&nbsp;Matthias Guckenberger","doi":"10.1016/j.radonc.2025.111035","DOIUrl":"10.1016/j.radonc.2025.111035","url":null,"abstract":"<div><div>Modern oncology increasingly relies on integrated, multimodality care, yet radiation oncology remains undervalued in strategic frameworks despite its central therapeutic role. This ESTRO manifesto calls for a repositioning of radiation oncology as a core discipline in cancer care, scientifically, clinically, and politically. The field now extends beyond beam delivery to encompass systemic therapy integration, personalised strategies based on biology and imaging, and active participation in clinical decision-making and guideline development. Radiation oncology contributes to treatment sequencing, synergistic combinations, and innovation in areas such as radioligand therapy and artificial intelligence. ESTRO’s initiatives, including education, research networks, and oncopolicy engagement, underscore the discipline’s broad scope and societal value. Strategic partnerships with Pharma and MedTech, alongside a renewed emphasis on equitable access, are essential to sustaining progress. ESTRO invites all stakeholders to recognise radiation oncology as fundamental to the design, delivery, and evolution of modern cancer therapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Article 111035"},"PeriodicalIF":4.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}